Original reportVideo Gaming Enhances Psychomotor Skills But Not Visuospatial and Perceptual Abilities in Surgical Trainees
Introduction
There is considerable interest in the identification and assessment of the innate abilities of surgical trainees as these abilities have the potential to predict technical operative performance.1 Although technical skill is only one desirable competency for a surgeon, it is vital for successful surgical practice. Technical skill is thought to be influenced by innate or inborn psychomotor, visuospatial, and perceptual abilities.2 Technical skill may be likened to a motor skill where a good technique is the result of a specific combination of innate abilities in addition to practice that is applied to a particular task. Skill contrasts with ability, which is considered a set of innate attributes that determine potential for a given activity. It is believed that abilities are present at birth, are relatively unchanging through life, and are not generally affected by training or other possible intervention.3
Psychomotor ability is the ability to perform body motor movements with precision, coordination, or strength. Expert technical skill is considered a combination of both innate psychomotor ability and practice or experience. Visuospatial ability (the ability to generate, retain, retrieve, and transform well-structured visual images) is thought to be essential in the interpretation of images, such as those generated by X-ray, computed tomography, magnetic resonance imaging, or ultrasound. When interpreting such images, medical personnel have to picture mentally and infer the patients' three-dimensional (3D) anatomy from a two-dimensional (2D) image.4 In the same way, the ability to interpret images has become even more important given the expansion of minimally invasive techniques in surgery. In addition to visuospatial ability, pictorial depth perception (the ability to use visual clues from a 2D image to perceive objects' distances and layout in 3D space) is also considered important in laparoscopic surgery.5 Operating surgeons manipulate instruments in 3D space while viewing 2D images on a monitor, and they must deal also with challenges like the fulcrum effect, loss of binocular vision, and difficulties with depth perception and image quality.
Overcoming the technical challenges associated with surgery in general and laparoscopic surgery in particular makes demands on the surgeon's visuospatial, perceptual, and psychomotor abilities. It has been shown, for example, that differences in innate abilities can predict the rate of endoscopy skill acquisition.6, 7
Therefore, the assessment of these abilities may be an appropriate part of the selection process for trainees for higher surgical training as the results of such assessments may indicate which candidates are best suited to a career in surgery.8 This is particularly relevant as surgery requires a lengthy training period.
However, before the widespread introduction of innate ability testing to a selection process, it is essential to determine that these abilities are innate (ie, unchanging from birth) and are not influenced by surgical practice or experience. If this were the case, then those trainees who gained more operative experience might be at an unfair advantage. In addition, the impact of nonsurgical abilities and dexterities, such as video gaming ability on laparoscopic surgical skills, is not yet fully understood, which might be a confounding factor.
Recent studies have provided evidence for the beneficial effects of video games on both visual attention and hand–eye coordination. Green and Bavelier9 assessed video gaming enhancement of visual attention and spatial distribution, both of which might be relevant to surgical practice. A positive correlation was found between video gaming and visual attention processing.
In addition, Rosser et al10 demonstrated that surgeons who played video games in the past for more than 3 hours/week made 37% fewer errors, were 27% faster, and scored 42% better overall on a laparoscopic training course than surgeons who never played video games. It has been suggested that younger surgeons might acquire skills in laparoscopic surgery more rapidly than their elder colleagues, possibly because they have been exposed to video games at a young age and, thus, have had more experience with screen-mediated task execution.11 However, Rosenberg et al12 showed that although video game aptitude seems to predict the baseline level of laparoscopic skill in the novice surgeon, practicing video games did not improve laparoscopic skill significantly.
However, other studies provide conflicting and contrary evidence for the positive benefits of video games. Harper et al13 concluded that game playing is correlated inversely with the ability to learn robotic suturing but that there is a positive relationship between the ability to learn robotic suturing and musical or athletic ability. In addition, Madan et al14 considered that nonsurgical skills, including video game experience, did not predict baseline scores on a surgical simulator.
To date, studies have focused on the effect of video gaming on hand eye coordination/psychomotor abilities. Proficiency at a motor skill is considered a combination of both innate psychomotor ability and practice; in other words, practice makes perfect. However, it is still uncertain if video gaming has an influence on other innate abilities, such as visuo-spatial or perceptual abilities.
We therefore wished to test the following two hypotheses: (a) video game experience will predict psychomotor performance on a laparoscopic simulator and (b) video game experience will have no influence of tests of visuo-spatial and perceptual abilities (if they are indeed innate abilities).
Section snippets
Materials and Methods
Institutional ethics approval was granted for this study. In all, 38 undergraduate medical students from the Royal College of Surgeons in Ireland volunteered to participate in the study. No participating students had any previous operative surgical experience.
All students gave their consent to participate in the study. All participants completed a self-reported questionnaire that asked them to detail their video-game participation. They were asked to categorize themselves according to the
Results
All participants completed all assessments and there were no missing data. The average age of the participants was 25.6 years (±2.8 years). In total, 16 of the 38 participants played video games (“gamers”) according to the criteria outlined in the methods section. No participants had any previous laparoscopic surgical or simulator experience.
Discussion
The impact of video games on psychomotor abilities is a topic of much research, and there is good evidence of skills transfer between playing video games and performance on surgical simulators. It is likely that frequent and repetitive video game playing can improve psychomotor abilities. A recent review of the link between video games and surgical ability concluded that there is some evidence that training on video games over a short periods can improve laparoscopic ability.18
Hislop et al19
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