2023 General Surgery Presentations

Anthony J Laporta, MD, COL, RET, USA, FACS, FACODSH1; Taylor Norris, MS1; PhD Rebecca Ryznar, PhD1; Sagar Patel, MS1; Dean Paz, MS1; K.Dean Rvu Gubler, DO, FACS, Captain, RET, USN1; Peter Kufahl, PhD2; Greg Schwimmer, BS2; Richard Besserman, MD2; 1Rocky Vista U Military Medicine; 2Zxerex-Arizona State U

Our prior research validated the benefits of immersion surgical skills training through evidence of hormone habituation, improvement in hardiness and emotional intelligence scores. In this study, we investigate how sleep and fatigue metrics changeduring training.

Methods: Forty-two (42) military medical students participated in immersion mass casualty trauma training for five consecutive days. Participants roleplay as patients, nurses, surgeons, or ER physicians as they performed medical treatment for simulated patients injured in mass casualty scenarios within the training for Border Patrol and ATF. All participants were tested twice daily with ZXEREX Oculomotor technology used in earlier drug intoxication and fatigue studies. 24 students wore a Fitbit Versa 2 continuously throughout the event.

Results: Fitbit data shows improvements from day one to the end in minutes in REM (61 – 78), deep sleep (57-77), in bed (392-416) and less time in light sleep (225-217). Previously peak velocity/displacement measured in both eyes was reported. Here we report significant intersaccadic drift velocity in both eyes of increase in drift "velocity" over time (p < 0.001). The peak velocity/displacement ratio has been shown in previous research to decrease over time during intense visual tasks, signaling fatigue. Here, we examined binocular peak drift in a 2-way ANOVA of Condition (0500hr "A" versus a1700hr "B" and Day (1 through 4), we found direct improvement greater in the A session on Day 1 (t = 1.9, p = 0.05) but greater in the B session on Day 4 (t=-2.4, p < 0.02). In addition, self-reported Sleep and Tiredness were consistent with the data.

Discussion: This quantitative data strongly shows an easy, repeatable, cost effective, 2 minute test to measure work related fatigue. As educators, this provides an improvement tool for real-world training for residents, the military, and first responders. This will enhance our understanding of the relationship of training to sleep, fatigue and habituation. There is measurement of distinct improvement from the start of the training to the end and capability to perform duties and alertness. Afternoon fatigue showed considerablyless degradation as sleep improved showing habituation.

Conclusion: Quantative oculomotor measurement of saccadic and mucrosaccadic eye movements showed significant improvement in fatigue associated with sleep improvement later in the week. This type of evaluation could significantly improve training for residents, soldiers and first responders.