Stress Exposure Training in Surgery – A systematic review and introduction of novel surgical training paradigm.

Objective The operating theatre is an environment of intense cognitive stimulus requiring coordinated application of technical and non-technical skills to optimise patient outcomes. Surgeons may undergo a significant “stress response”, activated when perceived demands of a situation exceed perceived resources, which can impair performance, most acutely demonstrated in trainee surgeons. This systematic review aims to understand existing literature on stress exposure training (SET) and explore its applicability to surgical training. Methods A systematic review of articles published in PubMed, Ovid and Scopus was conducted in accordance with PRISMA guidelines, with “stress response, exposure and inoculation in healthcare, medicine, or surgery” as the search terms, and without time limit. Articles meeting the inclusion criteria underwent dual author abstract review, and full text review if meeting pre-defined criteria. Results 1335 eligible papers were identified, refined to 103 on abstract, with 36 undergoing full text review. These were categorised into i) simulation training and stress response in healthcare workers; ii) stress response in surgeons; and iii) stress exposure training in healthcare. SET has developed from a clinical intervention to treat stress-induced psychopathology to an effective, generalisable training approach implemented by high-stress high-performance industries, including the military and aeronautics. Conclusion The impact of the stress response on performance is pertinent in modern surgical training. We have identified an applicable, evidence-based training model and propose the development of a Stress Exposure Training in Surgery programme incorporating well established Human Factors training to address this deficit in current surgical training and improve patient outcomes.