Innate Dexterity Research Articles

Visuospatial skills are better predictors than dexterity for basic ultrasonographic and fluoroscopic skills in veterinary students.

Radiological skills including ultrasonography and fluoroscopy, require a combination of manual dexterity and visuospatial skill to develop competency. The ability to detect veterinary students with an interest in radiology but who are deficient in these skills, may permit more individual adaptations to training programs, allowing for students training in radiology to achieve maximal potential. The objective of this cohort study was to investigate whether innate dexterity and visuospatial skill could be used to predict performance of basic ultrasound and fluoroscopic skills in veterinary students. Fifty veterinary students from the Ontario Veterinary College completed three tests of visuospatial ability, two tests of manual dexterity, a three-dimensional mouse task, an ultrasound skill-testing task, and a fluoroscopic skill-testing task. Students who reported chopstick use completed the non-dominant hand ultrasound task significantly faster than students who did not (P=0.001). There was a significant positive association between scores on the Mental Rotations Test and time to complete the non-dominant hand ultrasound task (P=0.011) and fluoroscopy task (P=0.029). No variables were associated with time to complete the dominant hand ultrasound task. The results of this study suggest that visuospatial skill, as assessed by the Mental Rotations Test, is a better predictor of baseline ultrasound and endovascular fluoroscopy skill than dexterity, with the exception of reported chopstick use, in veterinary students. Visuospatial skills can be developed and may be useful to include in the veterinary curriculum for students that are deficient, or students entering a field such as diagnostic imaging.

Investigating the impact of innate dexterity skills and visuospatial aptitude on the performance of baseline laparoscopic skills in veterinary students.

To determine if manual dexterity and visuospatial skills can be used to predict baseline laparoscopic surgery skills in veterinary students. Pilot study. Veterinary students (n = 45) from years 1-4 volunteered for this study. An hour-long electronic questionnaire was completed by participants. The first section was used to collect demographics and information about prior nonsurgical experiences. The second section included 3 tests of visuospatial skills, including the Purdue Visualization of Rotations Test, Mental Rotations Test, and Raven's Advanced Progressive Matrices Test. Multiple tests were administered to assess innate dexterity, including the grooved pegboard test, indirect and direct zigzag tracking tests, and the 3Dconnexion proficiency test. Each dexterity test was performed once with the left hand and once with the right hand. The order of task performance was randomized. Basic laparoscopic skills were assessed using the validated fundamentals of laparoscopic surgery (FLS) peg transfer task. There was an association between left-handed grooved pegboard scores (95% CI -10046.36 to -1636.53, P-value = .008) and left-handed indirect zigzag tracking task (95% CI -35.78 to -8.20, P-value = .003) with FLS peg transfer scores. Individuals who reported playing videogames achieved higher scores on the FLS peg transfer task than those without videogame experience (95% CI 583.59 to 3509.97, P-value = .007). The results of this study suggest that dexterity was a better predictor of baseline laparoscopic skills than visuospatial skills in veterinary students.

Clinical psychomotor skills among left and right handed medical students: are the left-handed medical students left out?

BackgroundThere is a growing perception that the left handed (LH) medical students are facing difficulties while performing the clinical tasks that involve psychomotor skill, although the evidence is very limited and diverse. The present study aimed to evaluate the clinical psychomotor skills among Right-handed (RH) and left-handed (LH) medical students.MethodsFor this study, 54 (27 left handed and 27 right handed) first year medical students were selected. They were trained for different clinical psychomotor skills including suturing, laparoscopy, intravenous cannulation and urinary catheterization under the supervision of certified instructors. All students were evaluated for psychomotor skills by different instructors. The comparative performance of the students was measured by using a global rating scale, each selected criteria was allotted 5-points score with the total score of 25.ResultsThere were no significant differences in the performance of psychomotor skills among LH and RH medical students. The global rating score obtained by medical students in suturing techniques was: LH 15.89 ± 2.88, RH 16.15 ± 2.75 (p = 0.737), cannulation techniques LH 20.44 ± 2.81, RH 20.70 ± 2.56 (p = 0.725), urinary catheterization LH 4.33 ± 0.96 RH 4.11 ± 1.05 (p = 0.421). For laparoscopic skills total peg transfer time was shorter among LH medical students compared to RH medical students (LH 129.85 ± 80.87 s vs RH 135.52 ± 104.81 s) (p = 0.825). However, both RH and LH students completed their procedure within the stipulated time.ConclusionsAmong LH and RH medical students no significant difference was observed in performing the common surgical psychomotor skills. Surgical skills for LH or RH might not be a result of innate dexterity but rather the academic environment in which they are trained and assessed. Early laterality-related mentoring in medical schools as well as during the clinical residency might reduce the inconveniences faced by the left-handed medical personnel.

Is It Time to Adopt Vision Screening for Ophthalmology Residency Program Applicants?

Although standards of vision have been set to drive a car, a minimum standard has not been set to perform intraocular surgery. This dichotomy exists despite a general feeling among many educators of the importance of good vision in predicting the technical ability of the beginning microsurgeon. There have been barriers to implementing vision screening for ophthalmology residency applicants. Title I of the Americans With Disabilities Act of 1990 (ADA) covers employers with 15 or more employees and prohibits discrimination of qualified individuals with disabilities in recruitment, hiring, promotions, training, pay, social activities, and other privileges of employment.1 ADA Title I restricts the questions that can be asked about an applicant’s disability before a job offer is made and requires reasonable accommodation be made, unless it results in undue hardship. Because of fears of running afoul of the ADA, many ophthalmology programs do not perform visual screening of residency applicants. It is time for the profession to set a minimum standard of vision to practice ophthalmology. A 2001 workshop of surgeons from the United States and Europe were queried as to the attributes felt important in the selection of surgery resident candidates.2 In addition to cognitive factors and personality traits, innate dexterity, defined as the “strongest determining factor in the level of technical (operative) skills that the individual attains with training and experience,”was identified as a critical attribute. Felt important to innate dexterity were spatial perception, hand–eye coordination, aiming, multilimb coordination, and hand–arm steadiness. At the Royal College of Surgeons in Ireland, all shortlisted candidates for higher surgical training undergo formal testing of both technical skills and fundamental abilities (including psychomotor skills, visuospatial ability, and depth perception).3 Testing would not be necessary if applicants self-selected themselves for surgical careers on basis of their dexterity. A study using laparoscopic virtual reality simulation found applicants significantly performed lower than their self-assessment of dexterity.4 Self-assessed dexterity tasks like video gaming, sports, artistic activities, and musical instruments were not predictive of performance on the simulator. Internal medicine interns scored higher than applicants to a general surgery program on three of four tasks. If there is no apparent self-selection for a surgical career based on actual surgical skills, one needs a way to assess technical proficiency of applicants. So what visual factors are important in determining the technical ability of amicrosurgeon? Stereopsis would seem to be an obvious place to start.Weknowhigh-grade stereopsis is essential in skilled precision grasping.5 Amblyopes with deficient stereopsis have normal initial reaching and grip shaping, but deficient terminal reach and final grip closure and application.6 With the development of virtual simulators for intraocular surgery, we now have the capability to assess the effects of deficient stereopsis in a safe environment. The Eyesi eye surgery simulator (VRmagic, Mannheim, Germany) provides a virtual reality environment that can teach basic skills, measure tremor, and allow practice of some of the steps of intraocular surgery. Construct validity for the Eyesi antitremor, forceps training, and capsulorhexis modules has been established.7–9 Waqar et al studied 30 junior doctors with no previous ophthalmic surgical experience.10 Subjects undertook four attempts of the level 4 forceps module binocularly and another four monocularly to simulate an acute loss of stereopsis. Significant findings (p < 0.05) included a decrease in average total score and increases in average corneal area injured, average lens area injured, and average time taken when the simulation was performed monocularly compared with binocularly. The authors did note that 3 of the 30 subjects had a statistically significant increase in the total score when performed monocularly. This may be a function of study design, however. The increase in scores when performed monocularly was mainly due to quicker time or decreased odometer scores, perhaps due to themonocular trials being

Influence of medical students' past experiences and innate dexterity on suturing performance

BackgroundMedical students often site their ability to excel at technical tasks as justification for choosing surgery as a career path. We sought to investigate how medical students' dexterity skills and past experiences correlated with suturing performance. MethodsSixty-four 3rd-year medical students were surveyed about previous experiences that involved manual dexterity. Technical skills were then measured using a validated test of manual dexterity and subcuticular closure of a pig's foot incision. Spearman's rank correlation coefficients determined correlation between variables. ResultsPrevious experiences, self-assessment of dexterity, prior suturing, and current interest in surgery did not significantly correlate with manual dexterity or suturing skill scores. Innate manual dexterity score was the only significant correlating factor to suture skill score (Spearman's rank correlation coefficient = .336; P = .007). ConclusionsInnate manual dexterity skills are predictive of initial surgical suturing performance regardless of past student experiences. Interventions aimed at improving early surgical technique should be optimally focused on dexterity training.

The da Vinci® Surgical System Overcomes Innate Hand Dominance

The robotic surgical platform has allowed for improved ergonomics, tremor filtration, and more precise surgical movements during minimally invasive surgery. We examined the impact of the da Vinci(®) Surgical System on the lateralization of manual dexterity, or handedness, innate to most surgeons. Manual dexterity assessments were conducted among 19 robotic novices using two different skills tests: The Purdue Pegboard Test and a needle targeting test. After an initial robotic basic skills training seminar, subjects underwent testing using both open and robotic approaches. Test performance using both approaches was then compared among all subjects. The majority of subjects (84%) were right handed, and all subjects described their dominant hand as significantly or moderately more dexterous than their nondominant hand. The participants had significant differences between the dominant and nondominant hand in open skills tasks using the Purdue Pegboard test (15.4 vs 14.6 pegs, P=0.023) and needle targeting test (4.5 vs 3.7 targets, P=0.015). When the same tasks were performed using the robot, the differences in handedness were no longer observed (P=0.203, P=0.764). The da Vinci robot is capable of eliminating innate dexterity or handedness among novice surgical trainees. This provides evidence of another beneficial aspect of robot-assisted surgery over traditional laparoscopic surgery and may facilitate operative performance of complex tasks.

Extent of innate dexterity and ambidexterity across handedness and gender: Implications for training in laparoscopic surgery

As innate dexterity is considered one of the important predictors of eventual operative competence, an experimental human factors study was conducted to determine innate dexterity and ambidexterity across handedness and gender. 50 medical students (right-handed males, left-handed males, and right-handed females) were recruited as participants in a study designed to assess innate dexterity and degree of ambidexterity for endoscopic manipulations in a validated virtual-reality simulator. All participants performed unilateral and bilateral tasks with both dominant and nondominant hands in random sequence. The outcome measures were execution time, extent of ambidexterity (ambidexterity index), aiming errors, and maximum tissue damage. Right-handed males exhibited a greater level of ambidexterity than left-handed males (p = 0.02 for path length, p = 0.001 for angular path) and right-handed females (p = 0.01 for path length, p = 0.02 for angular path), and more-efficient task performance as measured by execution time (p = 0.001 for males and p = 0.03 across gender). The task quality when executed by the dominant hand was best in right-handed males (p = 0.001 vs. left-dominant males and p = 0.03 across gender). No significant difference was observed in terms of precision control and fine movements (aiming errors and maximum tissue damage) between the three groups. These findings indicate that training surgical curricula in laparoscopic surgery should be more flexible to accommodate the innate differences across handedness and gender.

What do master surgeons think of surgical competence and revalidation?

Background: There has been on-going debate and public interest in surgical competence in recent years. Methods: A Delphi reiterative opinion survey was conducted among master surgeons on selection of surgical trainees, methods of assessment of progress of surgical trainees, and revalidation of established consultant surgeons. Results: Selection—the current methods of trainee selection were considered inadequate and in need of revision. The important attributes recognized by group are cognitive factors, innate dexterity, and personality. Important aspects of personality include decision-making ability, insight, team spirit, and emotional stability. Assessment during training—the majority view was that this should be based on clinical judgement/skills, operative skills, and cognitive ability. Assessment of technical ability should be based on standardized checklists. Research within training programs was encouraged but academic achievement does not reflect surgical competence. There was a majority verdict for an exit clinical examination. Revalidation—the group agreed on the need for competence checks during the professional career of surgeons. These should cover knowledge, clinical, operative, and humanistic skills; but expressed concern on the feasibility of a revalidation system that can reliably assess the range of skills needed for surgical competence. There was a majority vote against an internal appraisal system. External assessment by nationally appointed ‘assessors’ was considered preferable. Conclusions: Both selection and assessment of surgical trainees require changes and standardization. Although revalidation is necessary, concern was expressed on the reliability and validity of existing and proposed systems.