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

What's known on the subject? and What does the study add? Although research in other fields of society demonstrate a negative effect of distraction on performance, little research is done within the surgical specialties. We aimed to establish what the effect of distraction is, on the performance of basic endourological tasks by medical students. OBJECTIVE center dot To establish the effect of distraction on the performance of cystoscopy and basic endourological tasks by using a virtual reality (VR) simulator. SUBJECTS AND METHODS center dot 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. center dot 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. center dot Number of traumata, number of missed lesions in the bladder and time to completion were measured by the VR simulator. RESULTS center dot 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. center dot Nevertheless, only 9.5% of the participants in the intervention group reported feeling burdened by the distraction. CONCLUSIONS center dot 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. center dot Most students do not realize they are affected by distraction. center dot Further research is needed to determine the impact of distraction on more experienced participants and on patient safety.