Effect of distraction on the performance of endourological tasks: a randomized controlled trial

• To establish the effect of distraction on the performance of cystoscopy and basic endourological tasks by using a virtual reality (VR) simulator.

• A total of 86 third-year medical students from Maastricht University, who had no previous experience in performing the tasks on a VR simulator, were randomly assigned to an intervention or control group. • All participants performed three endourological tasks on the VR simulator. Participants in the intervention group were distracted 1 min into the third task. The distraction consisted of being asked to answer questions about a medical case that had been presented to all the participants before the hands-on session. After two adequate verbal responses the conversation was terminated. • Number of traumata, number of missed lesions in the bladder and time to completion were measured by the VR simulator.

• Number of traumata and missed lesions, as well as time to completion were significantly higher in the intervention than in the control group with effect sizes (using Cohen's categorization) of 0.48, 0.41 and 0.50 respectively. • Nevertheless, only 9.5% of the participants in the intervention group reported feeling burdened by the distraction.

• Distraction during the performance of endourological skills results in significantly poorer performance by medical students on all the variables measured in a controlled learning environment. • Most students do not realize they are affected by distraction. • Further research is needed to determine the impact of distraction on more experienced participants and on patient safety.