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Updated: Feb 18, 2026
Assessment of Stress Effects on Cognitive Flexibility using an Operant Strategy Shifting Paradigm
Published on: May 4, 2020
Mental skills training effectively minimizes operative performance deterioration under stressful conditions: Results
N E Anton1, J Beane2, A M Yurco3
1Carolinas Medical Center, Carolinas Simulation Center, Charlotte, NC, United States; Indiana University, Department of Surgery, Indianapolis, IN, United States.
Background:
Stress can negatively impact surgical performance, but mental skills may help. We hypothesized that a comprehensive mental skills curriculum (MSC) would minimize resident performance deterioration under stress.
Methods:
Twenty-four residents were stratified then randomized to receive mental skills and FLS training (MSC group), or only FLS training (control group). Laparoscopic suturing skill was assessed on a live porcine model with and without external stressors. Outcomes were compared with t-tests.
Results:
Twenty-three residents completed the study. The groups were similar at baseline. There were no differences in suturing at posttest or transfer test under normal conditions. Both groups experienced significantly decreased performance when stress was applied, but the MSC group significantly outperformed controls under stress.
Conclusions:
This MSC enabled residents to perform significantly better than controls in the simulated OR under unexpected stressful conditions. These findings support the use of psychological skills as an integral part of a surgical resident training.
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