The Effect of Time Pressure on Motion Economy and Smoothness of Interventional Radiology Trainee Performance in Simulated Central Venous Line Placement

Purpose: To evaluate the effect of being under time pressure on procedural performance using hand motion analysis.

Materials And Methods: Eight radiology trainees performed central venous access on a phantom while recording video and hand motion data using an electromagnetic motion tracker. Each trainee performed the procedure six times: the first three trials without any prompts (control), while for the next three, they were asked to perform the task as fast as possible (time pressure). Validated hand motion metrics were analyzed, and two blinded and independent evaluators rated procedural performance using a previously validated task-specific global rating scale (GRS). Motion/time ratios and linear mixed-effect methods were used to control for time, and constants for both strategies were compared.

Results: Hand motion analysis showed that trainees completed the simulated procedure faster under time pressure (46 ± 18 s vs. 56 ± 27 s, p = 0.008) than during the control strategy. However, when controlling for time, trainees moved their hands 79 more centimeters (p = 0.04), made 15 more translational movements (p = 0.003) and 18 more rotational movements (p = 0.01) when under time pressure compared to at their own pace.

Conclusion: Although trainees could perform the procedure faster under time pressure, there was a deterioration in hand motion economy and smoothness. This suggests that hand motion metrics offer a more comprehensive assessment of technical performance than time alone.