BACKGROUND: Video game experience (VGE) has been identified as a possible predictive factor for surgical skill. We hypothesized that surgical novices with previous VGE would acquire new surgical skills faster than those without.
METHODS: Fourth-year medical students (M4) and first-year surgical residents (PG-1) completed a survey asking about standard demographic data and previous VGE. Gamers had high VGE, defined as more than 3 h per week of videogame playing. Nongamers had little or no VGE. Both groups trained to proficiency on two tasks (AcquirePlace and Traversal) of the MIST-VR simulator, with proficiency defined as meeting previously validated criteria on two consecutive trials. The number of trials required to achieve proficiency for each task was recorded.
RESULTS: The 26 participants included 11 M4s and 15 PG-1s: 17 males (8 gamers/9 nongamers) and 9 females (3 gamers/6 nongamers), mean age 27.8 years. There were no differences in time to proficiency between the M4 and PG-1 residents, and there were no significant differences in the relative number of gamers per gender. All participants eventually met proficiency criteria. The 11 gamers reached proficiency more quickly than the 15 nongamers (median 0 trials versus 6 trials, p = 0.01). Gamers scored lower than nongamers on their initial attempts. Women overall took longer to reach proficiency than did men (median 10 trials versus 0 trials, p = 0.002). When stratified according to VGE, female nongamers took longer to reach proficiency than male nongamers (median 11 trials versus 1 trial, p = 0.006) but among gamers, there was no difference between females and males (median 0 trials versus 0.5 trials, NS).
CONCLUSION: Previous VGE shortens time to achieve proficiency on two tasks on a validated surgical simulator. The possibility that VGE may ameliorate gender differences in length of time required to acquire surgical skills should be explored further.
BACKGROUND: Administrative and financial pressures on surgical education have created a need for efficient training curricula. Predictors of innate technical ability, which would guide the optimization of such a curriculum, are not well described. The goal of this study was to identify student characteristics predictive of innate pretraining skill level and response to training during the course of a four-week laparoscopic skills development program.
METHODS: Laparoscopic skills in 35 first-year surgical residents were assessed with the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) before and after a four-week skills training program and after an interval of approximately 1 year. The correlation between trainee characteristics, including age, sex, designated surgical specialty, and laparoscopic skill level was assessed by using Pearson's correlation and paired t-test studies.
RESULTS: Intake MISTELS scores showed no significant correlation to age, sex, or designated field. Interns designated for the general surgery training program had significantly higher final scores than those entering other fields (p = 0.02). There was a negative correlation between trainee age and both degree of improvement during training and final scores (p = 0.02 and 0.05). A history of video game use correlated with significantly higher initial scores and better skills retention (p = 0.03 and 0.04).
CONCLUSIONS: A laparoscopic technical curriculum can achieve basic proficiency even when taught to a diverse group of trainees. Older residents beginning their surgical careers may be slower to develop technical skills. Choice of subspecialty seems to predict higher level of proficiency after completion of a skills training program among resident students.
We report on a pilot study that investigates the transfer effect of systematic computer game training on performance in image guided surgery. In a group of 22 surgical novices, subjects were matched and randomized into one group training with a 3-D first person shooter (FPS) game and one group training with a 2-D non-FPS game. We also included a control group. Subjects were tested pre- and post training in the MIST-VR and GI-Mentor surgical simulators. We found that subjects with past experience specific to FPS games were significantly better in performing the simulated endoscopy task, both regarding time and efficiency of screening, compared to subjects lacking FPS game experience. Furthermore subjects who underwent systematic FPS game training performed better in the MIST-VR than those training with a 2-D game. Our findings indicate a transfer effect and that experience of video games are important for training outcome in simulated surgical procedures. Video game training can become useful when designing future skills training curricula for surgeons.
BACKGROUND: Video games have become extensively integrated into popular culture. Anecdotal observations of young surgeons suggest that video game play contributes to performance excellence in laparoscopic surgery. Training benefits for surgeons who play video games should be quantifiable.
HYPOTHESIS: There is a potential link between video game play and laparoscopic surgical skill and suturing.
DESIGN: Cross-sectional analysis of the performance of surgical residents and attending physicians participating in the Rosser Top Gun Laparoscopic Skills and Suturing Program (Top Gun). Three different video game exercises were performed, and surveys were completed to assess past experience with video games and current level of play, and each subject's level of surgical training, number of laparoscopic cases performed, and number of years in medical practice.
SETTING: Academic medical center and surgical training program.
PARTICIPANTS: Thirty-three residents and attending physicians participating in Top Gun from May 10 to August 24, 2002.
MAIN OUTCOME MEASURES: The primary outcome measures were compared between participants' laparoscopic skills and suturing capability, video game scores, and video game experience.
RESULTS: Past video game play in excess of 3 h/wk correlated with 37% fewer errors (P<.02) and 27% faster completion (P<.03). Overall Top Gun score (time and errors) was 33% better (P<.005) for video game players and 42% better (P<.01) if they played more than 3 h/wk. Current video game players made 32% fewer errors (P=.04), performed 24% faster (P<.04), and scored 26% better overall (time and errors) (P<.005) than their nonplaying colleagues. When comparing demonstrated video gaming skills, those in the top tertile made 47% fewer errors, performed 39% faster, and scored 41% better (P<.001 for all) on the overall Top Gun score. Regression analysis also indicated that video game skill and past video game experience are significant predictors of demonstrated laparoscopic skills.
CONCLUSIONS: Video game skill correlates with laparoscopic surgical skills. Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery. Video games may be a practical teaching tool to help train surgeons.
BACKGROUND AND PURPOSE: Prior research has demonstrated that counterintuitive laparoscopic surgical skills are enhanced by experience with video games. A similar relation with robotic surgical skills has not been tested. The purpose of this study was to determine whether prior video-game experience enhances the acquisition of robotic surgical skills.
SUBJECTS AND METHODS: A series of 242 preclinical medical students completed a self-reported video-game questionnaire detailing the frequency, duration, and peak playing time. The 10 students with the highest and lowest video-game exposure completed a follow-up questionnaire further quantifying video game, sports, musical instrument, and craft and hobby exposure. Each subject viewed a training video demonstrating the use of the da Vinci surgical robot in tying knots, followed by 3 minutes of proctored practice time. Subjects then tied knots for 5 minutes while an independent blinded observer recorded the number of knots tied, missed knots, frayed sutures, broken sutures, and mechanical errors.
RESULTS: The mean playing time for the 10 game players was 15,136 total hours (range 5,840-30,000 hours). Video-game players tied fewer knots than nonplayers (5.8 v 9.0; P = 0.04). Subjects who had played sports for at least 4 years had fewer mechanical errors (P = 0.04), broke fewer sutures (P = 0.01), and committed fewer total errors (P = 0.01). Similarly, those playing musical instruments longer than 5 years missed fewer knots (P = 0.05).
CONCLUSIONS: In the extremes of video-game experience tested in this study, game playing was inversely correlated with the ability to learn robotic suturing. This study suggests that advanced surgical skills such as robotic suturing may be learned more quickly by athletes and musicians. Prior extensive video-game exposure had a negative impact on robotic performance.
OBJECTIVE: Prior work has established that performance on an endovascular simulator incorporating tactile feedback (haptics) correlates with previous endovascular experience and can be improved by training. This study was designed to test the ability to define and measure innate endovascular aptitude and empirically correct performance and to determine whether these are two different things.
METHODS: Subjects ranging in endovascular skill level from novice to expert were surveyed to determine video game experience and skill, endovascular level of training, and endovascular experience. They were then tested by using a standard protocol requiring timed advancement of a catheter and wire sequentially into each of three vessels arising from a simulated type I arch. Recorded trials were independently and blindly scored by two experienced endovascular faculty members by using a modification of a previously validated scale (Modified Reznick Scale; MRS). Summed scores were analyzed by frequency analysis and categorized as satisfactory and unsatisfactory on the basis of a clear bimodal distribution. Categorical outcome, time to task completion, and other variables were analyzed by means of linear regression, analysis of variance, and Welch modified two-sample t tests, as indicated.
RESULTS: A total of 61 subjects were enrolled: 42% students, 8% technicians, 19% surgeons, 13% cardiologists, and 18% radiologists. Of these, 62% were considered novices and 30% experts on the basis of previous experience; 56% of subjects worked in an endovascular-related occupation. MRS scores were highly correlated between raters (P < .0001) and showed a clear bimodal distribution, with subjects in any endovascular occupation (including technicians) scoring significantly better than all others (P < .0001). Hours of video games played per week were correlated highly with completion times (P < .001) and MRS scores (P < .001). Measures of formal training (number of endovascular cases and occupation) correlated highly with completion times (all P < .03) and MRS scores (all P < .008). In comparing completion times vs MRS scores, three groups were apparent: unskilled-inexperienced, skilled-inexperienced, and skilled-experienced, corresponding primarily to senior subjects without endovascular experience, younger subjects without endovascular experience, and formally trained endovascular physicians, respectively. Those judged intermediate in aptitude reduced times to the lowest possible level before improving their MRS scores.
CONCLUSIONS: Although inherently subjective, the MRS yields reproducible scores that correlate with endovascular experience and formal training. Experts and novices with extensive video game experience achieve short completion times, whereas high MRS scores are achieved only by formally trained subjects. Innate endovascular aptitude and empirically correct performance may be two separate things, and aptitude may be acquirable through (or identified by) extensive nonmedical video game experience.
BACKGROUND: Laparoscopic surgery requires specialized dexterity even beyond that required for open surgery. Decreased tactile feedback, different eye-hand coordination, and translation of a two-dimensional video image into a three-dimensional working area are just some of the obstacles in the performance of laparoscopic surgery. Possession of certain nonsurgical skills may help in overcoming some of these obstacles. Prediction of baseline laparoscopic surgery skills may help further to refine the education of basic laparoscopic surgery skills. This investigation explores whether nonsurgical skills and demographic data can predict baseline laparoscopic surgery tasks.
METHODS: First- and second-year students were given a survey regarding nonsurgical dexterity skills. The survey inquired about typing skills, play with computer games, ability to sew, skill with music instruments, use of chopsticks, and experience operating tools. Demographic data were requested as well. All the students underwent four tasks: placing a piece of bowel in a retrieval bag, placing a stapler on the bowel, measuring a piece of bowel, and performing a liver biopsy in a porcine animal model. Both objective (time and error) and subjective evaluation were assessed for all the tasks. Statistical analysis using analysis of variances (ANOVA) Kruskal-Wallis test with post hoc tests, two-tailed unpaired t-tests/Mann-Whitney test, and Fischer's exact tests/chi-square tests was performed when appropriate.
RESULTS: There were 68 students in this investigation. Gender, medical student year, ethnicity, desire to enter a surgical field, and age were not associated with increased performance in any of the tasks. Chopstick use was associated with statistically significantly better mean time in placing a piece of bowel in a retrieval bag and measuring a piece of bowel (p < 0.04). The other nonsurgical dexterity skills did not statistically increase performance, as indicated by time, errors, or subjective scores, for the four tasks.
CONCLUSIONS: It is difficult to predict baseline laparoscopic surgery skills.
BACKGROUND AND PURPOSE: Performance of laparoscopic surgery requires adequate hand-eye coordination. Video games are an effective way to judge one's hand-eye coordination, and practicing these games may improve one's skills. Our goal was to see if there is a correlation between skill in video games and skill in laparoscopy. Also, we hoped to demonstrate that practicing video games can improve one's laparoscopic skills.
SUBJECTS AND METHODS: Eleven medical students (nine male, two female) volunteered to participate. On day 1, each student played three commercially available video games (Top Spin, XSN Sports; Project Gotham Racing 2, Bizarre Creations; and Amped 2, XSN Sports) for 30 minutes on an X-box (Microsoft, Seattle, WA) and was judged both objectively and subjectively. Next, the students performed four laparoscopic tasks (object transfer, tracing a figure-of-eight, suture placement, and knot-tying) in a swine model and were assessed for time to complete the task, number of errors committed, and hand-eye coordination. The students were then randomized to control (group A) or "training" (i.e., video game practicing; group B) arms. Two weeks later, all students repeated the laparoscopic skills laboratory and were reassessed.
RESULTS: Spearman correlation coefficients demonstrated a significant relation between many of the parameters, particularly time to complete each task and hand-eye coordination at the different games. There was a weaker association between video game performance and both laparoscopic errors committed and hand-eye coordination. Group B subjects did not improve significantly over those in group A in any measure (P >0.05 for all).
CONCLUSION: Video game aptitude appears to predict the level of laparoscopic skill in the novice surgeon. In this study, practicing video games did not improve one's laparoscopic skill significantly, but a larger study with more practice time could prove games to be helpful.
OBJECTIVE: The Endoscopic Sinus Surgery Simulator is currently being studied as a tool for otolaryngology resident training. While examining performance patterns on the simulator, we sought to define any relationships that may exist between students' previously acquired skills and their performance on the simulator.
METHODS: Twenty-six medical students were enrolled in our study. After completing their trials, they were asked to complete a 28-item questionnaire. This questionnaire included yes/no questions as well as 10-point Likert scale instruments.
RESULTS: Only 4 students did not respond to the questionnaire. Significant contributions to simulator performance were elucidated for a number of previously learned skills, but most were short-lived. For example, experienced video gamers were significantly better at hazard avoidance in the simulator's novice mode (P = .03), but their advantage dissipated as they advanced to intermediate mode trials. In addition, students' handedness contributed to simulator performance for only the first 3 trials (P = .04), but this relationship, too, was no longer statistically significant in later trials.
CONCLUSIONS: Some study students had skills and characteristics that significantly aided them in their ability to perform surgery on the simulator. However, these benefits were short-lived, and these results suggest that practicing plays a more important and long-standing role than other factors in surgical simulator performance. It follows that surgical simulation should play a more prominent role in surgical education because residents who practice on simulators such as this are, in turn, practicing for the reality of the operating room.
