1413. One Thing At A Time! The Effect of Repetitive Interruption on a Surgeon's Dexterity, Cognitive Functioning, and Wellbeing

Authors: Gary Robert Simonds, MD, FAANS; Gary Simonds; Cara Rogers; Brian Saway; Evin Guilliams; Lisa Apfel (Black Mountain, NC)

Introduction: Surgeons are often subjected to a barrage of clinical and administrative questions, simple and complex, while operating. There is very little literature about the impact of such activity on a surgeon’s professional function and wellbeing. Methods: We evaluated the dexterity, cognition, and mood of 20 subjects, using standardized testing. We then repeated the testing while subjecting the participants to two separate batteries of questions in an attempt to simulate the effects of a busy day of fielding calls and questions by a surgeon engaged in an operative procedure. The first battery involved simple questions that could be answered reflexively. The second involved questions that required higher processing. Results: Fine motor testing demonstrated that distraction resulted in substantial decrements in multiple measures of dexterity. Reflexive questioning negatively impacted performance during tests for steadiness (p=0.014), precision (p=0.02), and information processing (p=0.029). Complex questioning caused a significant decline in steadiness (p=0.0007), precision (p=0.03), coordination (p=0.023), and information processing (p=0.0003). Neuropsychological testing showed that distraction results in considerable decline in verbal and visual memory, complex attention, mental flexibility, and psychomotor speed. The Profile of Mood States showed a decrease in feelings of vigor with both reflexive (p=0.001) and complex questioning (p=0.0004). Conclusion: This study demonstrates that a surgeon's performance and mood may be significantly affected by repetitive interruption. Even simple questions requiring reflexive answering (such as inquiries about sutures to be employed, or laxatives for floor patients) may decrement a surgeon's dexterity and cognition. Complex questions requiring higher processing (e.g. ICU patient care questions, or new patient consultations) may be particularly disruptive. This study suggests that interruptions should be held to a minimum while a surgeon is engaged in an operative procedure. Results might be generalized to all physicians involved in complex cognitive and technical functions.