Does Competitiveness Influence Performance in a Surgical Skills Competition?

Daniel A Hashimoto, BA, Pritam Singh, MBBS, MA, MRCS, Paul Ziprin, MD, FRCS, Ara Darzi, KBE, PC, MD, FMedSci, Rajesh Aggarwal, MD, MA, PhD, FRCS

Imperial College London, Perelman School of Medicine University of Pennsylvania

This study investigated whether self-reported competitiveness or contentiousness affected performance in laparoscopic intracorporeal knot tying. Training in elite athletes often incorporates competition to simulate conditions that require peak performance for victory. Given the high-pressure nature of surgery, competition may be a modality to simulate high-pressure situations in which to perform surgical skills. However, few studies have investigated the competitive nature of surgeons and the effect of competitiveness on surgical performance.

Twenty-four (n=24) participants were recruited to participate in a surgical skills competition at the London Surgical Symposium. Participants were asked to complete a secure laparoscopic intracorporeal knot with three throws using the standard FLS penrose drain in a box-trainer. Participants were ranked according to time. A real-time, online leader board was projected above the box-trainer so participants could see what times had already been posted. Participants were asked to complete the modified Competitiveness Index, a validated questionnaire that assesses individual competitiveness and contentiousness on 5-point Likert scales. Correlation between suturing time, training level, competitiveness, and contentiousness was then analysed using Spearman’s rank correlation. Median regression analysis was conducted to investigate the potential effect of training year, competitiveness, and contentiousness on time. Alpha was set at 0.05.

Participants ranged in training level from third year medical students to PGY-11 surgical trainees. Median suturing time in the competition was 95.8 seconds (range: 34.5 to 271.4 sec). Median competitiveness was 30/45 (range: 8/45 to 39/45). Median contentiousness was 17/25 (range: 13/25 to 25/25). There was no significant correlation between suturing time and competitiveness (rho=-0.15, p=0.47) nor time and contentiousness (rho=-0.07, p=0.74). There was no significant correlation between suturing time and training year (rho=-0.37, p=0.07). Median regression analysis revealed that neither training year (beta=-8.71, p=0.18), competitiveness (beta=-2.68, p=0.31), nor contentiousness (beta=-0.85, p=0.89) had significant effect on intracorporeal suturing time.

Neither the level of competitiveness nor contentiousness can predict suturing performance in competition. While a trend for intracorporeal suturing time and training year can be seen it is not an independent predictor of suturing time. Future work remains to be seen if more competitive people would perform better in head-to-head competition.

Session: Poster Presentation

Program Number: P174

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