QUIET PLEASE! Effect of distraction on simulated posterior segment
Received: 27 September 2017 /Revised: 21 December 2017 /Accepted: 27 December 2017 /Published online: 4 February 2018
The Author(s) 2018. This article is an open access publication
Purpose To determine the effect of distraction on posterior segment surgical performance using a virtual reality simulator in
expert and novice ophthalmic surgeons.
Methods Twenty subjects were given 6 min to read an unpublished research paper and then were randomized into two groups.
Group 1 subjects were allowed 3 min to complete a standardized vitreoretinal simulated task undistracted. Group 2 subjects were
asked six questions on the research paper whilst completing the same task. Each subject then performed the alternate scenario.
Finally, all participants were asked six questions on the research paper whilst not operating.
Results There was no evidence of a difference in the odometer values (p = 0.127), cognitive task score (p =0.390)oroverall
surgical task scores (p = 0.113) between the two groups. The time taken by the distracted group was significantly greater (95% CI
−26.03 to −1.67, t-test p =0.028).
Conclusion Distraction significantly increases the time taken to perform a simulated vitreoretinal surgical task for all grades of
surgeon. More studies are required to understand the impact on different types of distraction on surgical performance.
The effect of distraction on performance has been the subject of
extensive research in fields such as driving and aviation, as it
affects public safety. Cognitive distraction can adversely affect
driving behavior – e.g. drivers spend less time looking to the
periphery, checking instruments, mirrors or traffic lights, and
also apply hard braking more frequently when distracted .
In the presence of two simultaneous stimuli, ‘dual task’
interference occurs, resulting in a delayed response to the sec-
ond stimulus. One cannot process central operations for two
tasks simultaneously and therefore cannot perform both tasks
simultaneously to an equally high standard .
The effect of distraction on surgical performance and out-
come has also attracted interest. Up to 1 in 10 patients admit-
ted to hospital experience an adverse event, almost half of
which are preventable and many of which are associated with
surgical care . Operating conditions can involve frequent
disruptions and interruptions. These can be varied, such as
unwanted background noise or music, bleeps or phone calls,
the surgeon’s emotional state, doors opening, or being directly
asked a relatively complex question about a subject unrelated
to the operation being done. In one observational study, up to
39 events (distractions or interruptions, such as doors opening,
phones/bleeps going off, irrelevant communication, etc.) were
observed in a single case .
The objective of this study was to determine whether dis-
traction has an effect on the performance of cognitive and
simulated posterior segment surgical tasks, in surgeons of dif-
ferent levels of experience. We hypothesized that both cogni-
tive and simulated surgical performance would be adversely
affected in the distracted group.
* Gerard McGowan
Tennent Institute of Ophthalmology, 1053 Great Western Road,
Glasgow G12 0YN, UK
University of Strathclyde, 16 Richmond Street, Glasgow G1 1QX,
Graefe's Archive for Clinical and Experimental Ophthalmology (2018) 256:519–523