Surgical Endoscopy

, Volume 26, Issue 9, pp 2423-2429

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Conscious monitoring and control (reinvestment) in surgical performance under pressure

  • Neha MalhotraAffiliated withInstitute of Human Performance, University of Hong KongInstitute of Performance, The Hong Kong Jockey Club Building for Interdisciplinary Research Email author 
  • , Jamie M. PooltonAffiliated withInstitute of Human Performance, University of Hong KongDepartment of Surgery, University of Hong Kong
  • , Mark R. WilsonAffiliated withSchool of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter
  • , Karen NgoAffiliated withInstitute of Human Performance, University of Hong Kong
  • , Rich S. W. MastersAffiliated withInstitute of Human Performance, University of Hong Kong



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.


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).


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.


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.


Reinvestment Laparoscopic training Motor skills Time pressure Surgical stressors Motor learning and control