Abstract
BackgroundManual dexterity and visual-spatial ability are considered key to the development of superior laparoscopic skills. Nevertheless, these abilities do not reliably explain all the variance found in the technical performance of surgical trainees. Consequently, we must look beyond these abilities to improve our understanding of laparoscopic skills and to better identify/develop surgical potential earlier on.PurposeTo assess the individual and collective impact of physical, cognitive, visual, and psychological variables on performance during and after basic simulation-based laparoscopic skills training.MethodThirty-four medical students (laparoscopic novices) completed a proficiency-based laparoscopic skills training program (using either a 2D or 3D viewing mode). This was followed by one testing session, a follow-up testing session with new (yet similar) tasks, and a series of physical, cognitive, visual, and psychological measures.ResultsThe statistical models that best predicted variance in training performance metrics included four variables: viewingmode (2D vs 3D), psychologicalflexibility, perceivedtaskdemands, and manualdexterity (bimanual). In subsequent testing, a model that included viewingmode and manualdexterity (assembly) best predicted performance on the pre-practiced tasks. However, for a highly novel, spatially complex laparoscopic task, performance was best predicted by a model that comprised viewingmode, visual-spatialability, and perceivedtaskdemands. At follow-up, manualdexterity (assembly) alone was the best predictor of performance on new (yet similar) tasks.ConclusionBy focussing exclusively on physical/cognitive abilities, we may overlook other important predictors of surgical performance (e.g. psychological variables). The present findings suggest that laparoscopic performance may be more accurately explained through the combined effects of physical, cognitive, visual, and psychological variables. Further, the results suggest that the predictors may change with both task demands and the development of the trainee. This study highlights the key role of psychological skills in overcoming initial training challenges, with far-reaching implications for practice.
Highlights
Manual dexterity and visual-spatial ability are considered key to the development of superior laparoscopic skills
While research shows that academic achievements are limited in their ability to predict surgical performance [6,7,8], many surgeons believe that certain innate abilities are the key to superior laparoscopic skill [7]
When controlling for the effects of other predictors, the results showed that as psychological flexibility increased, the number of training repetitions required to reach proficiency significantly decreased
Summary
Manual dexterity and visual-spatial ability are considered key to the development of superior laparoscopic skills These abilities do not reliably explain all the variance found in the technical performance of surgical trainees. Method Thirty-four medical students (laparoscopic novices) completed a proficiency-based laparoscopic skills training program (using either a 2D or 3D viewing mode) This was followed by one testing session, a follow-up testing session with new (yet similar) tasks, and a series of physical, cognitive, visual, and psychological measures. Results The statistical models that best predicted variance in training performance metrics included four variables: viewing mode (2D vs 3D), psychological flexibility, perceived task demands, and manual dexterity (bimanual). A model that included viewing mode and manual dexterity (assembly) best predicted performance on the pre-practiced tasks. While research shows that academic achievements (e.g. grades, test knowledge) are limited in their ability to predict surgical performance [6,7,8], many surgeons believe that certain innate abilities are the key to superior laparoscopic skill [7]
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