• Maya Enser, Jérôme Moriceau, Julien Abily, Cédric Damm, Emilie Occhiali, Emmanuel Besnier, Thomas Clavier, Antoine Lefevre-Scelles, Bertrand Dureuil, and Vincent Compère.
• From the Department of Anaesthesia and Intensive Care, Rouen University Hospital, (ME, JM, JA, CD, EO, EB, TC, ALS, BD, VC); and Normandie Univ, UNIROUEN, inserm U982 (VC), Mont-Saint-Aignan, France.
• Eur J Anaesthesiol. 2017 Jul 1; 34 (7): 464-470.

BackgroundNoise, which is omnipresent in operating rooms and ICUs, may have a negative impact not only patients but also on the concentration of and communication between clinical staff.ObjectiveThe present study attempted to evaluate the impact of noise on the performance of anaesthesiology residents' clinical reasoning. Changes in clinical reasoning were measured by script concordance tests (SCTs).DesignThis was a randomised and crossover study.SettingSingle centre at Rouen University Hospital in April 2014.PopulationAll year 1 to 4 residents enrolled in the anaesthesiology training programme were included.InterventionPerformance was assessed using a 56-item SCT. Two resident groups were formed, and each was exposed to both quiet and noisy atmospheres during SCT assessment. Group A did the first part of the assessment (28 SCT) in a quiet atmosphere and the second part (28 SCT) in a noisy atmosphere. Group B did the same in reverse order.Main Outcome MeasuresThe primary outcome of this study was residents' performance as measured by SCT, with and without noise (mean of 100 points 95% confidence interval).ResultsForty-two residents were included. Residents' performance, measured by SCT, was weaker in a noisy environment than in a quiet environment [59.0 (56.0 to 62.0) vs 62.8 (60.8 to 64.9), P = 0.04]. This difference lessened as medical training advanced, as this difference in performance in noisy vs quiet environments was not observed in year 3 and 4 residents [62.9 (59.2 to 66.5) vs 64.0 (61.9 to 66.1), P = 0.60], whereas it was higher for year 1 and 2 residents [54.8 (50.6 to 59.1) vs 61.5 (57.9 to 65.1), P = 0.02].ConclusionOur study suggests that noise affects clinical reasoning of anaesthesiology residents especially junior residents when measured by SCT. This observation supports the hypothesis that noise should be prevented in operating rooms especially when junior residents are providing care.

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