Stress, coping, and surgical error
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Stress, coping, and surgical error
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[ID] => 559132
[post_author] => 12815
[post_date] => 2024-12-26 11:14:30
[post_date_gmt] => 2024-12-26 16:14:30
[post_content] => Practice Passage (Question 1-5)
*This passage is the property of Khan Academy and has been reformatted into an AAMC-style interface in their entirety by MedLife Mastery. MedLife Mastery does not endorse and is not an affiliate of Khan Academy.
Emotional stress can be empowering, and can facilitate improved performance as concentration, focus, and efficiency of action are enhanced. This phenomenon is most evident in the classic “fight or flight” response to perceived threats. However, there comes a breaking point, which excessive stress can result in compromised performance. The field of surgery beckons individuals who thrive in stressful environments, who can experience states of heightened awareness and enjoy the challenging nature of the job. However, long term success in the field requires consistent use of positive coping mechanisms for stress.
A study was conducted to assess the effect of different coping mechanisms on laparoscopic surgical performance. Twenty postgraduate year 2 residents were selected and offered a questionnaire assessing coping mechanisms employed throughout medical school and the internship year. Results were categorized into positive and negative coping mechanism categories. The extent to which these mechanisms were utilized was also evaluated on a scale of 5 to 15. Positive coping categories included: minimization, distraction, situation control, substitute gratification, reaction control, and positive self-instructions. Negative coping mechanisms included: escape, rumination, resignation, self-blame, and avoidance. Following completion of the survey, the residents were observed using a simulated laparoscopic surgical training device. After being oriented to the training environment, the residents completed a “difficult” setting, including difficult manipulation and unexpected bleeding of a major vessel.
Measured performance outcomes including time to completion, errors, and economy of maneuvers were recorded and correlated to the associated individuals coping mechanism evaluation. The results for negative coping strategies and associated errors are documented in Figure 1, while the results for positive coping strategies and associated errors can be found in Figure 2.
Figure 1
Figure 2
[post_title] => Stress, coping, and surgical error
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[question] => Based on the information in the passage and the associated figures, high utilization of rumination as a coping strategy would correlate with an estimated how many laparoscopic errors?
[value] => Array
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[answer] => 1
[description] => Reason for the Correct Answer:
Rumination is a negative coping strategy.
The question asks you to evaluate the effect of a highly utilized negative coping mechanism on laparoscopic procedure errors.
The figure offers evidence that strong implementation of negative coping mechanisms correlates with a high number of errors.
)
[answers] => Array
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[0] => Array
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[each_answer] => A. 226-300
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[1] => Array
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[each_answer] => B. 151-225
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[2] => Array
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[each_answer] => C. 76-150
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[3] => Array
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[each_answer] => D. 1-75
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[1] => Array
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[quiz_unique_key] => 3873426850
[question] => Determination that an unexpected outcome during a laparoscopic is stressful occurs during which stage of appraisal?
[value] => Array
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[answer] => 3
[description] => Reason for the Correct Answer:
Which stage of stress appraisal includes evaluation of a potential threat?
The evaluation of a potential threat as stressful or not occurs in the first stage of appraisal.
The evaluation of a potential threat as stressful occurs during primary appraisal.
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[answers] => Array
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[0] => Array
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[each_answer] => A. Secondary appraisal
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[1] => Array
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[each_answer] => B. Post appraisal
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[each_answer] => C. Primary appraisal
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[each_answer] => D. Ante appraisal
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[quiz_unique_key] => 2261298308
[question] => What category of stressors best describes the unexpected bleeding of a major vessel for the surgeon practicing a laparoscopic appendectomy?
[value] => Array
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[answer] => 3
[description] => Reason for the Correct Answer:
The surgeon is likely to encounter this type of stress regularly in his/her job.
Even though unexpected events occur regularly for the surgeon, he or she is conscious of their occurrence.
Because these unexpected outcomes are not ambient, and because they happen regularly for the surgeon, these would best be considered a daily hassle. It is noteworthy that this error occurs during a simulation. If a major unexpected outcome were to affect a patient, it could be considered a significant life change.
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[0] => Array
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[each_answer] => A. Ambient
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[each_answer] => B. Significant life change
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[each_answer] => C. Daily hassle
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[each_answer] => D. Catastrophic
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[quiz_unique_key] => 2377279144
[question] => The heightened awareness associated with the challenging field of surgery is stimulated by which component of the nervous system?
[value] => Array
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[answer] => 1
[description] => Reason for the Correct Answer:
“Heightened awareness”
“Heightened awareness” is associated with the fight-or-flight response.
The fight-or-flight response is governed by the sympathetic nervous system.
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[answers] => Array
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[0] => Array
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[each_answer] => A. Sympathetic
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[each_answer] => B. Metabolic
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[each_answer] => C. Somatic
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[each_answer] => D. Parasympathetic
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[quiz_unique_key] => 83407773
[question] => Which of the following could be a confounding variable in this study?
[value] => Array
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[answer] => 4
[description] => Reason for the Correct Answer:
Lack of informed consent is an ethical issue, not a design issue.
Variation in coping strategies is desired in this study.
Variation in levels of surgical skills could explain the number of errors. While all of the students are in the same surgical year, they may have had different surgical skills and experiences.
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[answers] => Array
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[each_answer] => A. Lack of informed consent
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[each_answer] => B. Lack of generalizability of results
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[each_answer] => C. Variation in coping strategies scores
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[each_answer] => D. Variation in levels of surgical skill
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