Stress, coping, and surgical error

Emotional stress can be empowering, and can facilitate improved performance as concentration, focus, and efficiency of action are enhanced. This phenomenon is most evident in the classic “fight or flight” response to perceived threats. However, there comes a breaking point, which excessive stress can result in compromised performance. The field of surgery beckons individuals who thrive in stressful environments, who can experience states of heightened awareness and enjoy the challenging nature of the job. However, long term success in the field requires consistent use of positive coping mechanisms for stress.

A study was conducted to assess the effect of different coping mechanisms on laparoscopic surgical performance. Twenty postgraduate year $2$‍ residents were selected and offered a questionnaire assessing coping mechanism employed throughout medical school and the internship year. Results were categorized into positive and negative coping mechanism categories. The extent to which these mechanisms were utilized was also evaluated on a scale of $5$‍ to $15$‍. Positive coping categories included: minimization, distraction, situation control, substitute gratification, reaction control, and positive self-instructions. Negative coping mechanisms included: escape, rumination, resignation, self-blame, and avoidance. Following completion of the survey, the residents were observed using a simulated laparoscopic surgical training device. After being oriented to the training environment, the residents completed a “difficult” setting, including difficult manipulation and unexpected bleeding of a major vessel.

Measured performance outcomes including time to completion, errors, and economy of maneuvers were recorded and correlated to the associated individuals coping mechanism evaluation. The results for negative coping strategies and associated errors are documented in Figure $1$‍, while the results for positive coping strategies and associated errors can be found in Figure $2$‍.

Figure $1$‍

Figure $2$‍

Based on the information in the passage and the associated figures, high utilization of rumination as a coping strategy would correlate with an estimated how many laparoscopic errors?