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The research catalogue is an archive of ESRC-funded grants and outputs. Links, files and other content will no longer be maintained or updated after April 2014.

'Bilateral (Hong Kong):' Gaze strategies of laparoscopy surgeons: Observational learning, implicit knowledge and performance in demanding conditions

Grant reference: RES-000-22-3016

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Journal article details

Conscious monitoring and control (reinvestment) in surgical performance under pressure
Background: Research on intraoperative stressors has focused on external factors without considering individual differences in the ability to cope with stress. One individual difference that is implicated in adverse effects of stress on performance is “reinvestment,” the propensity for conscious monitoring and control of movements. The aim of this study was to examine the impact of reinvestment on laparoscopic performance under time pressure. Methods: Thirty-one medical students (surgery rotation) were divided into high- and low-reinvestment groups. Participants were first trained to proficiency on a peg transfer task and then tested on the same task in a control and time pressure condition. Outcome measures included generic performance and process measures. Stress levels were assessed using heart rate and the State Trait Anxiety Inventory (STAI). Results: High and low reinvestors demonstrated increased anxiety levels from control to time pressure conditions as indicated by their STAI scores, although no differences in heart rate were found. Low reinvestors performed significantly faster when under time pressure, whereas high reinvestors showed no change in performance times. Low reinvestors tended to display greater performance efficiency (shorter path lengths, fewer hand movements) than high reinvestors. Conclusion: Trained medical students with a high individual propensity to consciously monitor and control their movements (high reinvestors) displayed less capability (than low reinvestors) to meet the demands imposed by time pressure during a laparoscopic task. The finding implies that the propensity for reinvestment may have a moderating effect on laparoscopic performance under time pressure.

Primary contributor

Author Neha Malhotra

Additional contributors

Co-author Jamie M. Poolton
Co-author Mark R. Wilson
Co-author Karen Ngo
Co-author Rich S.W. Masters

Additional details

01 September 2012
New York, NY
Surgical endoscopy


Cite this outcome


Malhotra, Neha et al (2012) Conscious monitoring and control (reinvestment) in surgical performance under pressure. Surgical endoscopy. 26 (9), pp. 2423-2429 New York, NY: Springer.


Malhotra Neha et al. Conscious monitoring and control (reinvestment) in surgical performance under pressure. Surgical endoscopy 2012; 26 (9): 2423-2429.