The impact of visual scanning in the laparoscopic environment after engaging in strain coping

Objective: We aimed to determine whether visual scanning has a detrimental impact on the monitoring of critical signals and the performance of a concurrent laparoscopic training task after participants engaged in Hockey's strain coping. Strain coping refers to straining cognitive (attentional) resources joined with latent decrements (i.e., stress). Background: DeLucia and Betts (2008) reported that monitoring critical signals degraded performance of a laparoscopic peg-reversal task compared with no monitoring. However, performance did not differ between displays in which critical signals were shown on split screens (less visual scanning) and separated displays (more visual scanning). We hypothesized that effects of scanning may occur after prolonged strain coping. Method: Using a between-subjects design, we had undergraduates perform a laparoscopic training task that induced strain coping. Then they performed a laparoscopic peg-reversal task while monitoring critical signals with a split-screen or separated display. We administered the NASA'Task Load Index (TLX) and Dundee Stress State Questionnaire (DSSQ) to assess strain coping. Results: The TLX and DSSQ profiles indicated that participants engaged in strain coping. Monitoring critical signals resulted in slowed peg-reversal performance compared with no monitoring. Separated displays degraded critical-signal monitoring compared with split-screen displays. Conclusion: After novice observers experience strain coping, visual scanning can impair the detection of critical signals. Application: Results suggest that the design and arrangement of displays in the operating room must incorporate the attentional limitations of the surgeon. Designs that induce visual scanning may impair monitoring of critical information at least in novices. Presenting displays closely in space may be beneficial.