Subjective and HRV-based Data Assessing Supervising Surgeon Intraoperative Stress with Perceived Trainee Breast Surgery Skill Proficiency.

OBJECTIVE

To examine the association between perceived trainee technical skill proficiency and supervising surgeons' intraoperative stress using both subjective assessments and heart rate variability (HRV)-based physiological indicators and to explore whether this association differs according to the supervisor's operative role.

DESIGN

Prospective observational study. After each procedure, supervisors completed structured questionnaires assessing subjective intraoperative stress and mood states. Trainee technical proficiency was evaluated by supervisors using a 10-item scale developed for breast surgery training. HRV was continuously recorded, and 2 indices were calculated: LF/HF↑% (percentage of operative time with LF/HF ratios exceeding the intraoperative mean) and RR↓% (percentage of RR intervals shorter than the preoperative baseline). Correlations were analyzed separately for each group.

SETTING

Single academic institution.

PARTICIPANTS

Supervising surgeons served either as primary surgeon (Group 1) or 1st assistant (Group 2) during breast surgeries involving trainees.

RESULTS

A total of 123 procedures were analyzed (Group 1: n = 52, Group 2: n = 71). Trainee technical skill scores showed significant negative correlations with supervising surgeons' subjective stress scores in both groups (Group 1: ρ = -0.592, p < 0.001; Group 2: ρ = -0.706, p < 0.001). In contrast, no significant associations in either group were observed between trainee skill scores and HRV-derived indices.

CONCLUSIONS

Supervising surgeons' perceptions of trainee technical proficiency were associated with self-perceived intraoperative stress in both primary and assistant roles, while HRV-based physiological markers showed no such associations. Subjective stress ratings may capture supervisory cognitive load and educational burden more sensitively than HRV metrics alone.