Emily Boyle

Video Gaming Enhances Psychomotor Skills But Not Visuospatial and Perceptual Abilities in Surgical Trainees

INTRODUCTION There is considerable interest in the identification and assessment of underlying aptitudes or innate abilities that could potentially predict excellence in the technical aspects of operating. However, before the assessment of innate abilities is introduced for high-stakes assessment (such as competitive selection into surgical training programs), it is essential to determine that these abilities are stable and unchanging and are not influenced by other factors, such as the use of video games. The aim of this study was to investigate whether experience playing video games will predict psychomotor performance on a laparoscopic simulator or scores on tests of visuospatial and perceptual abilities, and to examine the correlation, if any, between these innate abilities. METHODS Institutional ethical approval was obtained. Thirty-eight undergraduate medical students with no previous surgical experience were recruited. All participants completed a self-reported questionnaire that asked them to detail their video game experience. They then underwent assessment of their psychomotor, visuospatial, and perceptual abilities using previously validated tests. The results were analyzed using independent samples t tests to compare means and linear regression curves for subsequent analysis. RESULTS Students who played video games for at least 7 hours per week demonstrated significantly better psychomotor skills than students who did not play video games regularly. However, there was no difference on measures of visuospatial and perceptual abilities. There was no correlation between psychomotor tests and visuospatial or perceptual tests. CONCLUSIONS Regular video gaming correlates positively with psychomotor ability, but it does not seem to influence visuospatial or perceptual ability. This study suggests that video game experience might be beneficial to a future career in surgery. It also suggests that relevant surgical skills may be gained usefully outside the operating room in activities that are not related to surgery.

Training Surgical Skills Using Nonsurgical Tasks—Can Nintendo Wii™ Improve Surgical Performance?

BACKGROUND It has been suggested that abilities in nonsurgical tasks may translate to the surgical setting, with video gaming attracting particular attention because of the obvious similarities in the skills required. The aim of this study was to assign laparoscopic novices prospectively to receive a period of structured practice on the Nintendo Wii™ (Nintendo of America, Inc, Redmond, Washington) and compare their performance of basic laparoscopic tasks before and after this session to control subjects. METHODS In all, 22 medical students with no prior laparoscopic or video game experience were recruited to the study. They were randomized into 2 groups: group 1 served as the control and group 2 was the Wii™ group. All subjects performed 2 physical (bead transfer and glove cutting) and 1 virtual laparoscopic simulated tasks on the ProMIS surgical simulator (Haptica, Boston, Massachusetts). Performance metrics were measured. The same tasks were repeated an average of 7 days later, and between the 2 sessions, the subjects in the Wii™ group had structured practice sessions on the Wii™ video game. RESULTS Taken together, all subjects improved their performance significantly from session 1 to session 2. For the physical tasks, the Wii™ group performed better on session 2 for all metrics but not significantly. The Wii™ group showed a significant performance improvement for one metric in the bead transfer task compared with controls. For the virtual task, there was no significant improvement between sessions 1 and 2. CONCLUSIONS The novice subjects demonstrated a steep learning curve between their first and second attempts at the laparoscopic tasks. Practicing on the Wii™ was associated with a trend toward a better performance on session 2, although the difference was not significant. This finding suggests that a more intensive practice schedule may be associated with a better performance, and we propose that training on non-surgical tasks may be a cheap, convenient, and effective addition to current training curricula.

The importance of expert feedback during endovascular simulator training

OBJECTIVES Complex endovascular skills are difficult to obtain in the clinical environment. Virtual reality (VR) simulator training is a valuable addition to current training curricula, but is there a benefit in the absence of expert trainers? METHODS Eighteen endovascular novices performed a renal artery angioplasty/stenting (RAS) on the Vascular Interventional Surgical Trainer simulator. They were randomized into three groups: Group A (n = 6, control), no performance feedback; Group B (n = 6, nonexpert feedback), feedback after every procedure from a nonexpert facilitator; and Group C (n = 6, expert feedback), feedback after every procedure from a consultant vascular surgeon. Each trainee completed RAS six times. Simulator-measured performance metrics included procedural and fluoroscopy time, contrast volume, accuracy of balloon placement, and handling errors. Clinical errors were also measured by blinded video assessment. Data were analyzed using SPSS version 15. RESULTS A clear learning curve was observed across the six trials. There were no significant differences between the three groups for the general performance metrics, but Group C made fewer errors than Groups A (P = .009) or B (P = .004). Video-based error assessment showed that Groups B and C performed better than Group A (P = .002 and P = .000, respectively). CONCLUSION VR simulator training for novices can significantly improve general performance in the absence of expert trainers. Procedure-specific qualitative metrics are improved with expert feedback, but nonexpert facilitators can also enhance the quality of training and may represent a valuable alternative to expert clinical faculty.

Optimising surgical training: use of feedback to reduce errors during a simulated surgical procedure

Objective To assess the effect of proximate or immediate feedback during an intensive training session. The authors hypothesised that provision of feedback during a training session would improve performance and learning curves. Methods Twenty-eight trainee surgeons participated in the study between September and December 2008. They were consecutively assigned to group 1 (n=16, no feedback) or group 2 (n=12, feedback) All the participants performed five hand-assisted laparoscopic colectomy procedures on the ProMIS surgical simulator. Efficiency of instrument use (instrument path length and smoothness) and predefined intraoperative error scores were assessed. Facilitators assisted their performance and answered questions when asked. Group 1 participants were given no extra assistance, but group 2 participants received standardised feedback and the chance to review errors after every procedure. Data were analysed using SPSS V.15. Mann–Whitney U tests were used to compare mean performance results, and analysis of variance was used to calculate within-subject improvement. Results Group 1 achieved better results for instrument path length (23 874 mm vs 39 086 mm, p=0.001) and instrument smoothness (2015 vs 2567, p=0.045) However, group 2 (feedback) performed significantly better with regard to error scores (14 vs 4.42, p=0.000). In addition, they demonstrated a smoother learning curve. Inter-rater reliability for the error scores was 0.97. Conclusion The provision of standardised proximate feedback was associated with significantly fewer errors and an improved learning curve. Reducing errors in the skills lab environment should lead to safer clinical performance. This may help to make training more efficient and improve patient safety.

Assessment of the role of aptitude in the acquisition of advanced laparoscopic surgical skill sets: results from a virtual reality-based laparoscopic colectomy training programme.

PurposeThe surgeons of the future will need to have advanced laparoscopic skills. The current challenge in surgical education is to teach these skills and to identify factors that may have a positive influence on training curriculums. The primary aim of this study was to determine if fundamental aptitude impacts on ability to perform a laparoscopic colectomy.MethodsA practical laparoscopic colectomy course was held by the National Surgical Training Centre at the Royal College of Surgeons in Ireland. The course consisted of didactics, warm-up and the performance of a laparoscopic sigmoid colectomy on thesimulator. Objective metrics such as time and motion analysis were recorded. Each candidate had their psychomotor and visual spatial aptitude assessed. The colectomy trays were assessed by blinded experts post procedure for errors.ResultsTen trainee surgeons that were novices with respect to advanced laparoscopic procedures attended the course. A significant correlation was found between psychomotor and visual spatial aptitude and performance on both the warm-up session and laparoscopic colectomy (r > 0.7, p < 0.05). Performance on the warm-up session correlated with performance of the laparoscopic colectomy (r = 0.8, p = 0.04). There was also a significant correlation between the number of tray errors and time taken to perform the laparoscopic colectomy (r = 0.83, p = 0.001).ConclusionThe results have demonstrated that there is a relationship between aptitude and ability to perform both basic laparoscopic tasks and laparoscopic colectomy on a simulator. The findings suggest that there may be a role for the consideration of an individual’s inherent baseline ability when trying to design and optimise technical teaching curricula for advanced laparoscopic procedures.

Towards continuous improvement of endoscopy standards: validation of a colonoscopy assessment form.

Aim  The assessment of procedural colonoscopy skills is important and topical. The aim of this study was to develop and validate a competency‐based colonoscopy assessment form that would be easy to use, suitable for the assessment of junior and senior endoscopists and potentially a useful instrument to detect differences in performance standards following different training interventions.

Coping with stress in surgery: the difficulty of measuring non-technical skills

BackgroundNon-technical skills are relevant to surgical performance but are difficult to quantify. The aim of this study was to investigate the relationship between self-efficacy, which is a measure of stress-coping ability, and surgical performance.MethodsTwo hundred and sixteen basic surgical trainees were assessed on their performance of three bench model-type open and laparoscopic surgical tasks. They also completed a 10-item General Self-Efficacy (GSE) questionnaire to assess their stress-coping abilities. Their assessment scores were correlated with the GSE scores.ResultsThe mean GSE score of 31.39 was higher than the recorded population norms. There was no significant correlation between GSE and surgical performance for open or laparoscopic tasks.ConclusionJunior surgical trainees have high self-belief scores, but these abilities are difficult to measure and quantify. More refined methods may be necessary to measure non-technical skills relevant to surgery.