High-Stress Shifts Among Orthopaedic Trainees Alter Cognitive Abilities and Surgical Performance

Abstract

Category: Other; Trauma Introduction/Purpose: The effect of sleep deprivation and environmental stresses for orthopaedic trainees can manifest as physical and mental impairment in addition to worsening psychomotor performances. Lack of sleep and rest may compromise both decision making and clinical judgement, though this area of study largely has been unstudied. The purpose of this study is to quantify the volume of clinical workload that precipitates a decline in psychomotor and cognitive performance among orthopaedic trainees. Methods: The study cohort was comprised of Orthopedic Surgery residents (PGYII-V) from an Level I Academic Medical System/Tertiary Care Center taking primary fracture/trauma call over 1 24 month span. Resident participants were evaluated prior to, and immediately after, 12 and 24-hour call shifts. Participants’ technical and spatial processing abilities were evaluated via targeted drilling exercises on sawbones. Cognitive performance and neuropsychology assessments were captured with a validated, cognitive testing platform. These performances were analyzed against matched-clinical workload stress-level assignments following each call shift. Results: Following exposure to call-shifts, residents that experienced a high-stress call shift displayed statistically significant impairments to their cognitive performances with declines in their mental flexibilities (P = 0.0079) and information processing (P = 0.0003) capabilities. High-stress call shift exposure was also associated with significantly worse performance on psychomotor testing, a proxy for surgical performances, as demonstrated by higher aiming errors (P = 0.028) and miss distances (P = 0.046) on drilling exercises. Linear regression demonstrated a protective effect of increased baseline attention on psychomotor performance following call shift exposure (P=0.0004). Conclusion: Following high-stress call shifts among orthopaedic trainees, one can expect declines in neurocognition and technical performance independent of length of call shift and sleep deprivation. This study demonstrates a statistically significant and potentially clinically important relationship between increased clinical workload and decline in psychomotor performance and cognitive function. Higher baseline attention may be protective against this decline.