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Physiological Parameters Associated With Non-technical Skills During Surgical Crises Simulation.

Joel Norton1, Alistair Geraghty2, Emma Howie3

  • 1Surgical Sabermetrics Laboratory, Usher Institute, University of Edinburgh, Edinburgh, UK; Clinical Surgery, University of Edinburgh, Edinburgh, UK; Department of Vascular Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.

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|April 25, 2026
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Summary
This summary is machine-generated.

Physiological measures of cognitive load, including electrodermal activity and heart rate, correlate with non-technical skills (NTS) during surgical crisis simulations. This research aids in developing objective assessments for surgical performance.

Keywords:
cognitive loadnon-technical skillssabermetricssensorssimulationtraining

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Area of Science:

  • Medical Simulation
  • Surgical Education
  • Physiological Monitoring

Background:

  • Non-technical skills (NTS) are crucial for surgical patient safety.
  • Assessing NTS objectively during high-stakes events like surgical crises remains challenging.
  • Cognitive load, a measure of mental effort, may influence NTS performance.

Purpose of the Study:

  • To explore linear and non-linear relationships between physiological indicators of cognitive load and expert-rated NTS in simulated surgical crises.
  • To identify objective physiological markers that correlate with surgical trainees' NTS performance.
  • To advance the development of automated NTS assessment tools.

Main Methods:

  • A multicenter, prospective observational study involving 32 surgical trainees during simulated crises (bleeding, perforated viscus, unexpected finding).
  • Cognitive load was measured subjectively (SURG-TLX) and objectively using heart-rate variability (HRV) and electrodermal activity (EDA).
  • Non-technical skills were assessed using the Non-technical Skills for Surgeon's Taxonomy (NOTSS) by expert raters.

Main Results:

  • Increased electrodermal activity (EDA) was associated with reduced NOTSS scores, while increased heart rate (HR) correlated with higher NOTSS scores.
  • A significant inverted-U relationship was found between heart-rate variability (SDNN) and NOTSS scores, indicating an optimal cognitive load range for performance.
  • Bleeding simulations elicited the highest subjective cognitive load, while perforated viscus scenarios resulted in the highest NOTSS scores.

Conclusions:

  • Physiological measures of cognitive load demonstrate meaningful associations with expert-rated NTS during surgical crisis simulations.
  • These findings support the potential for using objective physiological data to assess surgical NTS.
  • This research contributes to the development of automated systems for evaluating surgical skills in training and practice.