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Visual Spatial Ability – Are Surgeons Born or Made?
Zackary Boom-Saad, Pamela Andreatta, EdD, Miranda L. Hillard, Anthony G. Gallagher, PhD†, Scott Langenecker, PhD, Angela Caveny, PhD,
Paul G. Gauger, MD, and Rebecca M. Minter, MD
University of Michigan and Royal College of Surgeons in Ireland†
Background
• “…ultimately the level of surgical technical performance at the end of training that an individual can achieve is determined by…innate ability…”1
• “…advanced trainees and experts do not score higher on carefully selected visual-spatial tests, suggesting that practice and surgical experience may supplant the influence of visual-spatial ability over time…”2
1 MacMillan et al. Am Jour Surg 1999.:177: 274-2772 Wanzel et al. Surgery 2003:134: 750-7
Hypothesis
No significant baseline differences in visual-spatial, psychomotor, and minimally invasive surgical skills exist between students entering procedural and non-procedural fields.
Methodology: Protocol
Thirty M4s
Procedural Group(n=17)
Non-procedural Group(n=13)
1. Visual-Spatial Ability and Psychomotor Testing2. PicSOr and LapSim Exercises
Comparison of Group Performance
Subject Demographics
• Procedural (n=17)– General surgery– Urology– Orthopaedics– Ophthalmology– Plastic surgery– ENT– Ob/Gyn
• Non-procedural (n=13)– Internal medicine– Pediatrics– Med/Peds– Anesthesiology– Radiation oncology– PM&R– Pathology– Emergency Medicine– Family medicine
Subject Demographics
Procedural: Non-Procedural:
Gender Male 14 5 Female 3 8 Handedness Right 16 13 Left 1 0 Video game experience: Prior 11/17 6/13 Current 6/17 4/13
Mental Rotations Test
Surface Development Test
Put picture here
CANTAB
• Cambridge Neuropsychological Test Automated Battery
• Three component assessments– Procedural learning and visual memory– Rapid visual information processing– Motor dexterity and reaction time
PicSOr
• Tests subject’s ability to discern orientation of a 3-D object shown in two-dimensions1
1 Gallagher et al. Surg Endosc 2003; 17: 168-71
LapSim™
• Virtual reality laparoscopic simulator
• Built-in metrics with established construct validity
• Performance on five basic skills tasks assessed
Statistical Analysis
• ANOVA for differences between groups on LapSim
• t-tests for MRT, CANTAB, SDT, and PicSOr
• Pearson correlation coefficient between PicSOr and LapSim
Results: MRT and SDTM
RT
Sco
re
0
5
10
15
20
25
30
35
Procedural Non-Procedural
SD
T S
core
0
10
20
30
40
50
60
Procedural Non-Procedural
Results: CANTAB
Procedural
(Mean±SD)
Non-procedural
(Mean±SD)
Significance
Procedural learning
Stages completed 1st trial
Mean errors to succes
Total errors (adjusted)
3.93±0.73
0.64±0.85
3.21±4.25
3.69±0.75
0.85±0.73
4.23±3.63
p=0.42
p=0.51
p=0.51
Rapid visual processing
Mean latency
Probability of false alarm
Probability of hit
392±47
0.003±0.006
0.89±0.07
394±39
0.001±0.003
0.84±0.11
p=0.88
p=0.29
p=0.15
Reaction time
5-ch movement time
5-ch reaction time
327±75
312±36
377±105
315±50
p=0.17
p=0.19
Results – PicSOr
Correlation Coefficient (Mean±SD)
Procedural students 0.93 ± 0.04*
Non-procedural students 0.82 ± 0.12 *p<0.01
Results – LapSim™
Procedural
(Mean±SD)
Non-procedural
(Mean±SD)
Significance
(p value)
Grasping
L instr time
L instr misses
L instr path length
L instr ang path
R instr time
R instr ang path
Max damage
47.26±9.71
0.90±1.10
2.16±0.44
454.79±69.29
37.78±7.00
372.20±65.57
4.34±1.78
59.42±13.74
5.77±7.19
2.73±0.71
581.41±186.14
48.41±9.52
486.95±122.17
8.83±6.71
0.016
0.024
0.022
0.031
0.003
0.006
0.029
Results – LapSim
Procedural
(Mean±SD)
Non-procedural
(Mean±SD)
Significance
(p value)
Lifting and Grasping Time
L instr path length
L instr ang path
R instr path length
R instr ang path
56.10 ±16.01
1.63 ±0.31
441.04±70.50
1.63±0.29
362.31±47.83
68.03±10.22
1.98±0.41
517.66±104
1.96±0.35
424.63±61.18
0.038
0.024
0.040
0.016
0.009
Clip Applying Blood loss 0.12±0.05 0.21±0.14 0.044
Performance Correlation – PicSOr and LapSim
• Coordination– 6/8 parameters, p<0.05
• Grasping– 7/11 parameters, p<0.05
• Lifting and Grasping – 8/10 parameters, p<0.05
• Clip Applying– 6/9 parameters, p<0.05
Summary
• No significant difference between groups– Visual spatial ability– Pyschomotor ability
• Procedural students demonstrate a higher baseline performance level with respect to minimally invasive surgical skills– PicSOr performance– LapSim performance
Conclusions
• Are surgeons born or made?– Differences in laparoscopic performance exist
and can be measured– Creates possibility of performing an early
needs assessment, and the ability to develop individualized curricula for MIS skills training
• Can individuals be trained to equivalent performance levels with focused instruction?
Limitations
• Small sample size– Type II error
– Inability to stratify by specialty
• Laparoscopic performance assessment was based only on simulated exercises, not on actual intra-operative performance
Acknowledgements
• Association for Surgical Education Foundation – Center for Excellence in Surgical Education, Research, and Training (CESERT)
• United States Surgical Corporation