The impact of trainer behaviour on trainee cognitive load and performance during vascular surgery simulation
| ISRCTN | ISRCTN58991380 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN58991380 |
| Integrated Research Application System (IRAS) | 337352 |
| Sponsor | Academic and Clinical Central Office for Research and Development (ACCORD) |
| Funders | Royal College of Surgeons of Edinburgh, Vascular Society, Association for the Study of Medical Education, Circulation Foundation, Faculty of Surgical Trainers (FST) |
- Submission date
- 05/01/2026
- Registration date
- 07/01/2026
- Last edited
- 06/01/2026
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Surgery
Plain English summary of protocol
Background and study aims
It is well established that incivility remains a significant issue in surgery around the world, resulting in staff burnout and risk to patient safety. The aim of this study was to see if different surgical trainer behaviour impacts the cognitive load (mental resource required to meet the demands of a task) and performance of surgical trainees in a simulated operating theatre.
Who can participate?
Vascular surgery trainees aged 20 to 50 years with a National Training Number
What does the study involve?
We wanted to assess whether a rude and uncivil trainer caused higher cognitive load and poorer performance compared to a pleasant and supportive trainer. To do this we allocated vascular surgery trainees to one of two groups: half the trainees completed a simulated task with a rude trainer, and half did so with a supportive trainer. We assessed cognitive load using digital sensors, which measure things like brain wave activity and changes in heart rate, and the participants also completed surveys to give insight into how they were feeling during the simulation. Expert surgeons and academics watched videos of the simulations to see how well the participants performed in their ability to suture and tie knots (technical skills), as well as their communication and teamwork (non-technical skills).
What are the possible benefits and risks of participating?
We anticipate that the results of this research can provide an evidence base to eliminate destructive training dynamics, improve staff wellbeing and enhance patient safety.
Where is the study run from?
This study was run organised by the Surgical Sabermetrics Laboratory at the Usher Institute within the University of Edinburgh and took place in Newcastle, Cambridge, and Edinburgh in simulated operating theatres.
When is the study starting and how long is it expected to run for?
Data collection spanned from September 2024 to September 2025
Who is funding the study?
The study is part of a PhD funded by the Royal College of Surgeons of Edinburgh (RCSEd), the Vascular Society of Great Britain and Ireland (VSGBI) and the Circulation Foundation. Grants from the Faculty of Surgical Trainers (FST) and the Association for the Study of Medical Education (ASME) also partially funded this research.
Who is the main contact?
Joel Norton, j.norton-3@sms.ed.ac.uk
Contact information
Principal investigator
Usher Building, The University of Edinburgh
5-7 Little France Road
Edinburgh BioQuarter - Gate 3
Edinburgh
EH16 4UX
United Kingdom
| Phone | +44 (0)131 651 7869 |
|---|---|
| Steven.yule@ed.ac.uk |
Scientific, Public
Vascular Surgery Office, Royal Infirmary of Edinburgh
51 Little France Crescent
Old Dalkeith Road
Edinburgh
EH164SA
United Kingdom
| Phone | +44 (0)7891496193 |
|---|---|
| j.norton-3@sms.ed.ac.uk |
Study information
| Primary study design | Interventional | |
|---|---|---|
| Allocation | Randomized controlled trial | |
| Masking | Open (masking not used) | |
| Control | Placebo | |
| Assignment | Parallel | |
| Purpose | Prevention | |
| Scientific title | Utilizing a surgical sabermetrics framework to assess the impact of trainer behaviour on trainee cognitive load and performance during vascular surgery simulation | |
| Study objectives | To assess the impact of different trainer behaviours on surgical trainee intraoperative cognitive load, technical skills and non-technical skills in the simulated operating room. | |
| Ethics approval(s) |
Approved 08/01/2024, Health Research Authority (2nd Floor, 2 Redman Place, Stratford, London, E20 1JQ, United Kingdom; +44 (0)207 104 8000; contact@hra.nhs.uk), ref: 337352 | |
| Health condition(s) or problem(s) studied | Surgical trainee intraoperative cognitive load, technical skills and non-technical skills | |
| Intervention | This study used a parallel-group, two-arm randomized controlled trial (RCT) to assess the impact of trainer behaviour on surgical trainee cognitive load and performance during high-fidelity vascular surgery simulation using a Surgical Sabermetrics Framework (Yule et al., 2021). Vascular surgery residents who met inclusion criteria were assigned in a 1:1 ratio to either a friendly and supportive trainer or a rude and uncivil trainer whilst completing a routine standardised vascular anastomosis in a simulated operating room. Randomization was performed using a computer-generated random sequence. Participant blinding was not feasible given the intervention. Participants were briefed that they needed to complete a femoral anastomosis, and watched a video demonstrating how to do this, but they did not receive any instructions regarding trainer behaviour. Following the initial simulation, senior trainees (ST6 and above) were called back to the operating room to find that the trainer had left a junior surgeon to close and a major bleed had occured in the same simulation patient. Residents would then have to manage the bleeding until the trainer returned, 5 minutes later. Technical and non-technical skills were retrospectively assessed by expert raters from audiovisual recordings, using validated scoring systems. Cognitive load was assessed by a self-assessment survey and by utilising physiological sensors (heart-rate variability, electrodermal activity, electroencephalography), data from which act as valid and reliable proxies of cognitive load (Dias et al., 2018). Physiological metrics were measured during a 5-minute presimulation rest phase, and during the simulation itself. Following the simulation, participants completed the SURG-TLX survey to self assess cognitive load (Wilson et al., 2011). Full ethical approval was obtained and the the trial was conducted in compliance with CONSORT guidelines for randomized controlled trials (Hopewell et al., 2025). | |
| Intervention type | Behavioural | |
| Primary outcome measure(s) |
| |
| Key secondary outcome measure(s) |
| |
| Completion date | 30/09/2025 |
Eligibility
| Participant type(s) | |
|---|---|
| Age group | Adult |
| Lower age limit | 20 Years |
| Upper age limit | 50 Years |
| Sex | All |
| Target sample size at registration | 32 |
| Total final enrolment | 58 |
| Key inclusion criteria | Vascular surgery residents based in the United Kingdom or Ireland with a National Training Number |
| Key exclusion criteria | 1. Residents with pre-exisiting personal relationships with any of the actors in the simulation 2. Vascular trainees without a National Training Number |
| Date of first enrolment | 23/09/2024 |
| Date of final enrolment | 30/09/2025 |
Locations
Countries of recruitment
- United Kingdom
- England
- Northern Ireland
- Scotland
- Wales
- Ireland
Study participating centres
Cambridge
CB5 8RE
England
Newcastle upon Tyne
NE7 7DN
England
Old Dalkeith Road
Edinburgh
Lothian
EH16 4SA
Scotland
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|---|
| IPD sharing plan summary | Data sharing statement to be made available at a later date |
| IPD sharing plan |
Editorial Notes
06/01/2026: Study's existence confirmed by the HRA.
