Performing surgery under time pressure

Reinvestment refers to the process of rehearsing task-relevant information in the mind as a means to consciously control movements. For instance, if you’re standing over a golf putt on the 18th green, and you’re telling yourself “hold the putter lightly, keep the putter face straight, don’t take it too far back” – then you are reinvesting task-relevant knowledge in an attempt to control performance.

Unfortunately, however, this process often leads to poorer performance during high pressure situations.

The Movement Specific Reinvestment Questionnaire (MSQR) was designed to assess people who are more prone to reinvesting. People who score higher on this questionnaire have been shown to perform more poorly under pressure in skills such as golf putting and hockey dribbling.

Recently this was extended to the performance of surgical skills.

The Experimental Design

Trained medical students completed the MSRQ and were subsequently divided into high and low reinvestors. Participants were then asked to perform a laproscopic task until a level of proficiency was attained. Performance was then assessed under conditions of low pressure and high pressure. Pressure was created by including a time constraint in the task.

The Key Finding

Both high and low reinvestors reported increased anxiety when there was time pressure. Significantly, however, the low reinvestors displayed improved performance under time pressure whereas performance for the high reinvestors remained the same.

This supports the theory that people with a reduced tendency to reinvest perform better under pressure.


Malhotra, N., Poolton, J. M., Wilson, M. R., Ngo, K., & Masters, R. S. (2012). Conscious monitoring and control (reinvestment) in surgical performance under pressure. Surgical endoscopy, 26(9), 2423-2429.

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