Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training. A Randomized Control Trial Exploring the Effect of Mental Rehearsal and Cognitive Visualization on Microsurgery Skills. Visual-spatial ability, learning modality and surgical knot tying. Visuospatial ability correlates with performance in simulated gynecological laparoscopy. Spatial awareness in urologists: are they different? Impact of cognitive imaging and sex differences on the development of laparoscopic suturing skills. Interpretation of three-dimensional structure from two-dimensional endovascular images: implications for educators in vascular surgery. Impact of Perceptual Ability and Mental Imagery Training on Simulated Laparoscopic Knot-Tying in Surgical Novices Using a Nissen Fundoplication Model Virtual fracture carving improves understanding of a complex fracture: a randomized controlled study. The impact of active versus passive use of 3D technology: a study of dental students at Wuhan University, China. Perceptual Speed and Psychomotor Ability Predict Laparoscopic Skill Acquisition on a Simulator. Systematic Video Game Training in Surgical Novices Improves Performance in Virtual Reality Endoscopic Surgical Simulators: A Prospective Randomized Study The performance of master surgeons on standard aptitude testing. Early exposure to haptic feedback enhances performance in surgical simulator training: a prospective randomized crossover study in surgical residents A Randomized Trial of Simulation-Based Versus Conventional Training of Dental Student Skill at Interpreting Spatial Information in Radiographs The Effects of Sex, Sexual Orientation, and Digit Ratio (2D:4D) on Mental Rotation Performance Sex differences in spatial abilities of medical graduates entering residency programs
BACKGROUND  Laparoscopic simulator training translates into improved operative performance . Proficiency-based curricula maximize efficiency by tailoring training to meet the needs of each individual ; however , because rates of skill acquisition vary widely , such curricula may be difficult to implement . We hypothesized that psychomotor testing would predict baseline performance and training duration in a proficiency-based laparoscopic simulator curriculum . METHODS Residents ( R1 , n = 20 ) were enrolled in an IRB-approved prospect i ve study at the beginning of the academic year . All completed the following : a background information survey , a battery of 12 innate ability measures ( 5 motor , and 7 visual-spatial ) , and baseline testing on 3 vali date d simulators ( 5 videotrainer [ VT ] tasks , 12 virtual reality [ minimally invasive surgical trainer-virtual reality , MIST-VR ] tasks , and 2 laparoscopic camera navigation [ LCN ] tasks ) . Participants trained to proficiency , and training duration and number of repetitions were recorded . Baseline test scores were correlated to skill acquisition rate . Cutoff scores for each predictive test were calculated based on a receiver operator curve , and their sensitivity and specificity were determined in identifying slow learners . RESULTS Only the Cards Rotation test correlated with baseline simulator ability on VT and LCN . Curriculum implementation required 347 man-hours ( 6-person team ) and 795,000 dollars of capital equipment . With an attendance rate of 75 % , 19 of 20 residents ( 95 % ) completed the curriculum by the end of the academic year . To complete training , a median of 12 hours ( range , 5.5 - 21 ) , and 325 repetitions ( range , 171 - 782 ) were required . Simulator score improvement was 50 % . Training duration and repetitions correlated with prior video game and billiard exposure , grooved pegboard , finger tap , map planning , Rey Figure Immediate Recall score , and baseline performance on VT and LCN . The map planning cutoff score proved most specific in identifying slow learners . CONCLUSIONS Proficiency-based laparoscopic simulator training provides improvement in performance and can be effectively implemented as a routine part of resident education , but may require significant re sources . Although psychomotor testing may be of limited value in the prediction of baseline laparoscopic performance , its importance may lie in the prediction of the rapidity of skill acquisition . These tests may be useful in optimizing curricular design by allowing the tailoring of training to individual needs Background Many factors are known to influence the performance of surgeons within the operating theater , including tiredness , previous experience , and stress levels . The effects of mental rehearsal and cognitive visualization on microsurgical skills have not been assessed . Methods Thirty-six subjects recruited from the Northwick Park Microsurgery Skills Course were r and omized into three groups ; ( 1 ) a control group ( C ) with no mental rehearsal script , ( 2 ) a visual anastomosis group ( VA ) , with a detailed rat anastomosis script , and ( 3 ) a visual relaxation ( VR ) group with a relaxation script , unrelated to the anastomosis . Participants ran through relevant scripts from day 2 to 5 and were assessed through recorded arterial rat anastomosis , scored using the structured assessment of microsurgery skills . Results Results were analyzed by double-blinded assessors . No statistical significance was found on Monday and Tuesday ( first day post intervention ) , p = 0.326 ( VA vs. C ) and p = 0.283 ( VR vs. C ) . A statistically significant difference was noted at the end of day 4 ; p < 0.001 ( VA vs. VR ) and p = 0.001 ( VA vs. C ) . Further analysis demonstrated that domains within the global rating scoring system showed statistical significance for ( 1 ) dexterity : VA versus VR , p = 0.001 , ( 2 ) visuospatial skills : VA versus VR , p = 0.001 , and VA versus C , p = 0.002 , and ( 3 ) operative flow : VA versus VR , p = 0.044 , and VA versus C , p = 0.026 . Conclusion The benefits of cognitive visualization and mental rehearsal in microsurgery may result in fewer complications from errors and thus lead to enhanced patient safety and better operative outcomes INTRODUCTION The ability to mentally rotate an object in 3 dimensions has been shown with an individual 's score on the V and enberg and Kuse Mental Rotations Test . The was to determine whether this Mental Rotations Test could be used to predict performance complex surgical skill - the tying of a 1-h and ed surgical reef knot . In addition , we learning a spatially complex surgical skill could be achieved more effectively via a computer-based selfdirected learning approach than with a didactic lecture-based teaching method . METHODS preclerkship medical students at the University of Western Ontario were r and omized into computer-based self-directed learning group and a didactic lecture-style learning group . administration of the Mental Rotations Test , the students were taught how to tie a reef knot via the learning modality assigned to their respective group . RESULTS Students Mental Rotations Test scores were able to tie more surgical knots in the allocated time Students learning how to tie the surgical knot via the computer-based self-directed showed improvement on their knot tying abilities more rapidly than their didactically trained colleagues . CONCLUSION The ability to mentally rotate an object in 3 dimensions played an important initial learning of a spatially complex surgical technical skill . Our data demonstrated learning was as effective and more practical than traditional lecture-based learning OBJECTIVE To analyze the relationship between visuospatial ability and simulated laparoscopy performed by consultants in obstetrics and gynecology ( OBGYN ) . STUDY DESIGN This was a prospect i ve cohort study carried out at two community hospitals in Sweden . Thirteen consultants in obstetrics and gynecology were included . They had previously independently performed 10 - 100 advanced laparoscopies .  Participants were tested for visuospatial ability by the Mental Rotations Test version A ( MRT-A ) . After a familiarization session and st and ardized instruction , all participants subsequently conducted three consecutive virtual tubal occlusions followed by three virtual salpingectomies . Performance in the simulator was measured by Total Time , Score and Ovarian Diathermy Damage . Linear regression was used to analyze the relationship between visuospatial ability and simulated laparoscopic performance . The learning curves in the simulator were assessed in order to interpret the relationship with the visuospatial ability . RESULTS Visuospatial ability correlated with Total Time ( r=-0.62 ; p=0.03 ) and Score ( r=0.57 ; p=0.05 ) in the medium level of the virtual tubal occlusion . In the technically more advanced virtual salpingectomy the visuospatial ability correlated with Total Time ( r=-0.64 ; p=0.02 ) , Ovarian Diathermy Damage ( r=-0.65 ; p=0.02 ) and with overall Score ( r=0.64 ; p=0.02 ) . CONCLUSIONS Visuospatial ability appears to be related to the performance of gynecological laparoscopic procedures in a simulator . Testing visuospatial ability might be helpful when design ing individual training programs Objective To compare innate spatial awareness skills , using the MIST‐VR system ( Ethicon Ltd , Edinburgh , a computer‐based virtual reality system that objective ly tests spatial awareness ) among three groups of people ( consultant urologists , urological trainees and controls who were not surgeons ) , because urological surgeons require spatial awareness for endoscopic and laparoscopic surgery , but trainees are selected by academic prowess rather than surgical aptitude BACKGROUND The introduction of noninvasive laparoscopic surgery has raised concerns about appropriate teaching techniques for medical students considering surgery as a specialization . The principal aim of this study was to determine the effect , between the sexes , of cognitive imaging as a teaching method in the context of learning a surgical technique . METHODS A r and omized treatment-control sample of 42 medical student volunteers was used to test the effect of cognitive imaging on performance and on traditional instructional techniques to help medical students acquire suturing skills specific to laparoscopic surgery . RESULTS Repeated- measures analysis of variance showed no significant effect for the use of cognitive imaging ( F1,40 = 0.97 , p > 0.05 ) . Males tended to perform better than females in completing tasks that required the use of visual-spatial manipulation of the instruments within a simulated laparoscopic environment ( F1,40 = 5.08 , p < 0.05 ) . CONCLUSIONS These results , which are in concordance with other research findings , indicate that females generally have lower visual-spatial abilities than males . Enhanced performance for both sexes , however , increases rapidly with practice . Other than verbal one-on-one instruction , males on average rank instructional approaches that are applied and visual higher than do females PURPOSE Endovascular therapy has had a major effect on vascular surgery ; surgeons perform tasks in three dimensions ( 3D ) while viewing two-dimensional ( 2D ) displays . This fundamental change in how surgeons perform operations has educational implication s related to learning curves and patient safety . We studied the effects of experience , training , and visual-spatial ability on 3D perception of 2D angiographic images of abdominal aortic aneurysms ( AAA ) . METHODS A novel computer-based method was developed to produce 3D depth maps based on subjects ' interpretations of 2D images . Seven experts ( certified vascular surgeons ) and 20 novices ( medical or surgical trainees ) were presented with a 2D AAA angiographic image .  With software specifically design ed for this study , a depth map representing each subject 's 3D interpretation of the 2D angiogram was produced . The novices were then r and omized into a control group and a treatment group , who received a 5-minute AAA anatomy educational session . All subjects repeated the exercise on a second AAA image . Finally , all novices were given tests of visual-spatial ability , including the Surface Development Test and the Mental Rotations Test . Comparisons between experts and novices were made with depth map comparison , a subject 's perception of overall object contour . RESULTS The depth maps were significantly different ( depth map comparison , P < .001 ) between the expert and both novice groups for the first image . After the educational intervention , the control group and the treatment group exhibited significantly different depth maps ( depth map comparison , P < .001 ) , with treatment group depth maps more similar to those of the expert group . There were no significant correlations between the visual-spatial tests and the novice depth map comparison with the expert group . CONCLUSIONS This is the first study to examine perception of endovascular images in an educational context . Perception of overall surface contour of 3D structures from 2D angiographic images is affected by experience and training . With application of methods of vision science to an important problem in surgery , this research represents a first step in underst and ing the nature of visual perceptual processes involved in execution of an increasingly common clinical task . These results have implication s for underst and ing and study ing the endovascular learning curve . CLINICAL RELEVANCE This research represents a unique collaboration in an effort to underst and and solve one of the greatest problems facing surgical educators and surgeons . This research uses applied tools in vision science to underst and the perceptual constraints involved in minimally invasive surgery . Specifically , we examined the mental three-dimensional maps experts use when viewing two-dimensional displays . Furthermore , we compared experts with novices in an effort to assist surgical trainees Background : Performing minimally invasive surgery requires training and visual-spatial intelligence . The aim of our study was to examine the impact of visual-spatial perception and additional mental training on the simulated laparoscopic knot-tying task performed by surgical novices . Methods : A total of 40 medical students r and omly assigned to two groups underwent two sessions of laparoscopic basic training on a VR simulator  ( SimSurgery ® , Oslo , Norway ) . The variables time and tip trajectory ( total path length of the instrument tip trajectory ) were used to assess the performance of the intracorporeal knot-tying task using a laparoscopic Nissen fundoplication model . The experimental group completed additional mental practice during the interval between the two training sessions . All performed a cube subtest of a st and ard intelligence test ( I-S-T 2000 R ) to evaluate visual-spatial ability . Results : All participants achieved an improvement in time ( t = 9.861 ; p < 0.001 ) and tip trajectory ( t = 6.833 ; p < 0.001 ) in the second training session . High scores on the visual-spatial test correlated with a faster performance ( r = −0.557 ; p < 0.001 ) and more precise movements ( r = −0.377 ; p = 0.016 ) . Comparison of the two groups did not show any statistical significant differences in the parameters time and tip trajectory . Conclusions : Visual-spatial intelligence tested by a cube test correlated with simulated laparoscopic knot-tying skills in surgical novices . Additional mental practice did not improve the overall knot-tying performance . Further studies are therefore required to determine whether mental practice might be beneficial for experienced laparoscopic surgeons or for more complex tasks BACKGROUND The visual overlay technique for surgical planning is difficult to apply to spatially complex fractures . Virtual reality can be applied by virtual fracture carving to adapt the visual overlay technique to three-dimensional ( 3D ) images . In this study , we evaluated whether virtual fracture carving is a useful exercise by performing two experiments comparing trainees ' underst and ing of a complex fracture with the application of either current preoperative techniques or the use of the Virtual-Fracture-Carving Simulator . METHODS Forty-eight participants -senior medical students and residents in postgraduate year 1 (PGY1)-were asked to learn the anatomy of an associated both-column acetabular fracture . The participants were r and omized into three groups : control , Sawbones , and virtual ( Virtual-Fracture-Carving Simulator ) . The r and omization protocol was stratified for sex and visuospatial ability . The measure of learning was a fracture line-drawing task evaluated for nineteen anatomic relationships . RESULTS The virtual group performed better than both the control and the Sawbones group , with an absolute difference in score of 22.7 % ( p = 0.0001 ) and 17.8 % ( p = 0.0026 ) , respectively . There was no significant difference between the control and Sawbones groups . The virtual group drew fracture characteristics requiring a higher level of spatial underst and ing with greater accuracy . CONCLUSIONS The results of this study vali date the concept behind the visual overlay planning technique-i.e . , that thoughtful play promotes underst and ing of fracture anatomy . These results objective ly demonstrate that the use of a Virtual-Fracture-Carving Simulator is feasible , and superior to conventional preoperative planning strategies in terms of quantity and quality of underst and ing of a spatially complex fracture A variety of computer-based 3D applications are becoming regular tools for dental students for self-learning . This study investigated the learning effectiveness of junior dental students in passively versus actively controlling the 3D virtual scenes of implant dentistry . Participants were r and omized into three groups and were exposed to three design s of educational material s : traditional 2D webpages ( 2D ) ; active-controlling 3D webpages ( A3 ) ; and passive-controlling 3D webpages ( P3 ) . After review ing the webpages , the participants were asked to complete a posttest to assess the relative quality of information acquisition . Their responses were compared and analyzed . The results indicated that the P3 group received the highest score of 26.4±3.1 on the post-test , significantly better than the A3 group , which had the worst performance with a score of 20.3±4.0 . The 2D group received a score of 24.2±4.6 . There was a significant correlation between the scores on a mental rotations test and the subjects ' performance on the posttest ( p<0.001 ) . A serious disadvantage of active control was indicated for individuals with low spatial ability . In 3D virtual reality assisted self-learning , passive control produces higher learning effects compared to active control . Too much active control may generate significantly negative impacts on students , especially for individuals with low spatial ability OBJECTIVE Performing minimally invasive surgery  puts high dem and s on a surgeon 's cognitive and psychomotor abilities . Assessment of these abilities can be used to predict a surgeon 's learning curve , to create individualized training programs , and ultimately in selection programs for surgical training . The aim of this study was to examine the influence of cognitive and psychomotor ability on the training duration and learning rate . DESIGN A prospect i ve quasiexperimental field study regarding the influence of cognitive and psychomotor ability , baseline measures of time to complete task , damage to tissue , and efficiency of movement , age , and gender on the number of sessions needed to reach a predefined performance level on a laparoscopy simulator . The same variables were investigated as predictors of the learning rate . SETTING The study was performed at the Experimental Center for Technical Medicine at the University of Twente , The Netherl and s. PARTICIPANTS In all , 98 novices from the Master program of Technical Medicine followed a proficiency-based basic laparoscopic skills training .  RESULTS Perceptual speed ( PS ) predicted training duration ( hazard ratio = 1.578 ; 95 % CI = 1.084 , 2.300 ; p = 0.017 ) . Cognitive ( b = -0.721 , p = 0.014 ) and psychomotor ability ( b = 0.182 , p = 0.009 ) predicted the learning rate of time to complete the task . Also , the learning rate for participants with higher levels of PS was lower ( b = 0.167 , p = 0.036 ) . Psychomotor ability also predicted the learning rate for damage to tissue ( b = 0.194 , p = 0.015 ) and efficiency of movement ( b = 0.229 , p = 0.004 ) . Participants with better psychomotor ability outperformed other participants across all sessions on all outcome measures . CONCLUSIONS PS predicted training duration in a basic laparoscopic skills training and the learning rate for the time to complete the task . Psychomotor ability predicted the learning rate for laparoscopic skill acquisition in terms of time to complete task , damage to tissue , and efficiency of movements . These results indicate early automation of basic laparoscopic skill . Careful selection of the cognitive abilities tests is advised for use in training programs and to identify individuals who need more training Background Previous studies have shown a correlation between previous video game experience and performance in minimally invasive surgical simulators . The hypothesis is that systematic video game training with high visual-spatial dem and s and visual similarity to endoscopy would show a transfer effect on performance in virtual reality endoscopic surgical simulation . Methods A prospect i ve r and omized study was performed . Thirty surgical novices were matched and r and omized to five weeks of systematic video game training in either a first-person shooter game ( Half Life ) with high visual-spatial dem and s and visual similarities to endoscopy or a video game with mainly cognitive dem and s ( Chessmaster ) . A matched control group ( n = 10 ) performed no video game training during five weeks . Performance in two virtual reality endoscopic surgical simulators ( MIST-VR and GI Mentor II ) was measured pre- and post-training . Before simulator training we also controlled for students ’ visual-spatial ability , visual working memory , age , and previous video game experience . Results The group training with Half Life showed significant improvement in two GI Mentor II variables and the MIST-VR task MD level medium . The group training with Chessmaster only showed an improvement in the MIST-VR task . No effect was observed in the control group . As recently shown in other studies , current and previous video game experience was important for simulator performance . Conclusions Systematic video game training improved surgical performance in advanced virtual reality endoscopic simulators . The transfer effect increased when increasing visual similarity . The performance in intense , visual-spatially challenging video games might be a predictive factor for the outcome in surgical simulation BACKGROUND Identification of the desired psychomotor abilities of optimal surgical performance , if possible , would be useful in the selection of surgical trainees . The aim of this study was to determine the level of these abilities among endoscopic consultant surgeons held in high regard by their peers . METHODS Twenty endoscopic consultant " master " surgeons were tested on three aptitude tests : the Gibson Spiral Maze Test ( error score measures eye-h and coordination ) , the Crawford Small Parts Dexterity Test ( execution time indicates manual dexterity ) , and the Space Relations Test ( correct scores reflect visuo-spatial ability ) . Their performance was compared with that of 20 medical students and the reference norm as provided by the tests ' manuals . RESULTS The median scores of master surgeons fell in the 20th , 24th , and 30th percentiles , whereas the scores of medical students fell in the 50th , 20th , and 65th percentile of norm reference for the Gibson Spiral Maze , Crawford Small Parts Dexterity , and Space Relations tests , respectively . The master surgeons enacted significantly fewer errors ( Gibson Spiral Maze ) , had similar execution times ( Crawford Small Parts Dexterity ) , and lower visuo-spatial scores ( Space Relations ) than medical students . CONCLUSION The level of eye-h and coordination and manual dexterity of master surgeons was found to be higher than that of the average norm including medical students , while their visuo-spatial ability was lower Background In the literature of skill acquisition and transfer of skills , it often is assumed that the rate of skill acquisition depends on what has been learned in a similar context ( i.e. , surgical simulators providing haptic feedback ) . This study aim ed to analyze whether the addition of haptic feedback early in the training phase for image-guided surgical simulation improves performance . Methods A r and omized crossover study design was used , in which 38 surgical residents were r and omized to begin a 2-h simulator training session with either haptic or nonhaptic training followed by crossover after 1 h. The graphic context was a virtual upper abdomen . The residents performed two diathermy tasks . Two vali date d tests were used to control for differences in visual – spatial ability : the BasIQ general cognitive ability test and Mental Rotation Test A ( MRT-A ) . Results After 2 h of training , the group that had started with haptic feedback performed the two diathermy tasks significantly better ( p < 0.05 , unpaired t-test ) . Only the group that had started with haptic training significantly improved during the last 1-h session ( p < 0.01 , paired t-test ) . Conclusion The findings indicate that haptic feedback could be important in the early training phase of skill acquisition in image-guided surgical simulator training Introduction : A radiology simulator has been developed . We tested the simulator with students in an oral radiology program for training interpretation of spatial relations in radiographs utilizing parallax . The aim of the study was to compare learning outcome regarding interpretative skill after training in the simulator vs. after conventional training . Methods : Fifty-seven dental students voluntarily participated in a r and omized experimental study . The participants ' proficiency in interpretation of spatial information in radiographs and their visual-spatial ability was assessed . Proficiency was assessed by a test instrument design ed by the authors and visual-spatial ability with the Mental Rotations Test , version A ( MRT-A ) . R and omization to training group was based on pre-training proficiency test results . The experimental group trained in the simulator and the control group received conventional training . Training lasted for 90 minutes for both groups . Immediately after training a second proficiency test was performed . Results : The proficiency test results were significantly higher after training for the experimental group ( P ≤ 0.01 ) , but not for the control group . Univariate variance analysis of difference in proficiency test score revealed a significant interaction effect ( P = 0.03 ) between training group and MRT-A category ; in the experimental group there was a stronger training effect among students with low level of MRT-A. Conclusions : Training in the simulator  improved skill in interpreting spatial information in radiographs when evaluated immediately after training . For individuals with low visual-spatial ability  simulator based training seems to be more beneficial than conventional training In spite of the reduced level of experimental control , this large scale study brought some clarity into the relation between mental rotation task ( MRT ) performance and a number of variables where contradictory associations had previously been reported in the literature . Clear sex differences in  MRT  were observed for a sample of 134,317 men and 120,783 women , with men outperforming women . There were also MRT differences as a function of sexual orientation : heterosexual men performed better than homosexual men and homosexual women performed better than heterosexual women . Although bisexual men performed better than homosexual men but less well than heterosexual men , no significant differences were observed between bisexual and homosexual women . MRT performance in both men and women peaked in the 20–30 year range , and declined significantly and markedly thereafter . Both men and women showed a significant negative correlation between left and right digit finger ratio and MRT scores , such that individuals with smaller digit ratios ( relatively longer ring finger than index finger ) performed better than individuals with larger digit ratios Sex differences favoring males in spatial abilities have been known by cognitive psychologists for more than half a century . Spatial abilities have been related to three‐dimensional anatomy knowledge and the performance in technical skills . The issue of sex differences in spatial abilities has not been addressed formally in the medical field . The objective of this study was to test an a priori hypothesis of sex differences in spatial abilities in a group of medical graduates entering their residency programs over a five‐year period . A cohort of 214 medical graduates entering their specialist residency training programs was enrolled in a prospect i ve study . Spatial abilities were measured with a  redrawn V and enberg and Kuse Mental Rotations Tests in two ( MRTA ) and three ( MRTC ) dimensions . Sex differences favoring males were identified in 131 ( 61.2 % ) female and 83 ( 38.8 % ) male medical graduates with the median ( Q1 , Q3 ) MRTA score [ 12 ( 8 , 14 ) vs. 15 ( 12 , 18 ) , respectively ; P < 0.0001 ] and MRTC score [ 7 ( 5 , 9 ) vs. 9 ( 7 , 12 ) , respectively ; P < 0.0001 ] . Sex differences in spatial abilities favoring males were demonstrated in the field of medical education , in a group of medical graduates entering their residency programs in a five‐year experiment . Caution should be exerted in applying our group finding to individuals because a particular female may have higher spatial abilities and a particular male may have lower spatial abilities . Anat Sci Educ 6 : 368–375 . © 2013 American Association of Anatomists
Objective To conduct a systematic review of the effect of interventions on spatial abilities in the field of technical skills in health care .