Carolinas HealthCare System

Stress Study

The study’s focus will vary by year:

  • Year One: Curriculum development and testing via a pilot that will render preliminary data and feedback.
  • Year Two: Curriculum testing on students without surgical experience.
  • Year Three: Curriculum testing on general surgery and gynecology residents where stressful conditions, such as noise, interruptions, and verbal demands from physicians, will be simulated in the operating room.

Stress in the OR: New Curriculum Aimed at Enhancing Surgical Performance and Patient Safety

According to numerous studies, the operating room is a highly stressful work environment. For surgeons, high levels of stress can impact their performance and patient safety. To help reduce negative effects from such stressors, Carolinas HealthCare System researchers are leading a three-year study focused on enhancing physician concentration during surgery.

The project launched September 2013 with the support of a $785,000 grant awarded to Carolinas HealthCare System by the Agency for Healthcare Research & Quality (AHRQ). With the funding, Dimitrios Stefanidis, MD, PhD; Lisa Howley, MEd, PhD; and Charlie Brown, PhD, will develop a mental skills curriculum based on simulation training meant to help surgeons remain focused in the operating room.

"Strategies meant to enhance performance and cope with stress are not part of surgical training today, even though they are effective at maximizing performance under stress and are practiced routinely among top performing athletes and in other disciplines like the military," said the study’s primary investigator Dr. Stefanidis, a surgeon with the department of surgery at Carolinas HealthCare System and medical director of the Carolinas Simulation Center.

To develop a robust mental skills curriculum, Dr. Stefanidis has partnered with Dr. Howley, an expert in curriculum development. He also is teaming up with Dr. Brown, director of Get Your Head in the Game, a private consulting organization that works with Olympic and professional athletes, performing artists and business executives who are taught skills to successfully perform in high-pressure situations. Dr. Brown will work closely with the surgeons as they apply the stress-coping techniques they practice in the simulation laboratory and, eventually, in the operating room.

"The higher the stress on a surgeon’s mind, the less likely he or she will perform a safe surgery," Dr. Stefanidis said. "While higher stress is more common among less experienced surgeons, we are hopeful our curriculum will help all physicians achieve better outcomes and will serve as a model that can be implemented widely, across levels of learner experience and disciplines."

To document the effectiveness of the curriculum, researchers will track differences in performance between the group that receives mental skills training and the group that does not.

Participants’ performance will be measured by how quickly, accurately and safely they can perform their assigned tasks in the simulation and operating rooms. To determine their stress levels, researchers will monitor their heart rates and will have them complete a questionnaire to assess workload.

"The study’s findings can have a major impact on the way we train surgeons and other healthcare providers using simulation," said Dr. Howley, assistant vice president of graduate medical education at Carolinas HealthCare System. "The curriculum will help us gain a better understanding of the effect of surgeons’ mental skills on patient care. While this mental skills curriculum is focused on the training of surgeons, the approach could be expanded to other areas of healthcare delivery."

The curriculum will be made available as a resource within AHRQ’s Patient Safety Network and will be submitted as a resource within the Association of American Medical Colleges MedEdPORTAL for wide implementation.