Visuospatial and technical ability in the selection and assessment of higher surgical trainees in the London deanery

Visuo-spatial ability and speed of execution of a complex surgical task

OBJECTIVE

Visuo-spatial ability (VSA) plays a role in preoperative planning, anatomical navigation and decision-making during surgery. This study aimed to test hypothesis that a correlation link existed between VSA and the speed of execution of a complex surgical task.

METHOD

The study was carried out on 49 students just before starting their surgical internship, at Lille Medical Faculty in October 2023. They answered a biographical questionnaire including confounding factors on VSA, then completed the Mental Rotation Test - A (MRT-A). They were timed on two separate tasks: conforming a titanium plate to mandibular angles on a 3D printed model, and excising a lesion from the helix of a silicone cast ear model, followed by a reconstruction using a "small ear" flap.

RESULTS

A weak correlation between the MRT-A score and the time required to complete the right and left plates conformation (r = -0.377, p = 0.007; r = -0.349, p = 0.014 respectively). There was a moderate correlation between the MRT-A score and the time required to complete the entire plate conformation workshop (r = -0.457, p = 0.001). There was no significant correlation between the MRT-A score and the time required to complete the ear workshop (r = -0.127; p = 0.375). A significant regression equation was found [F(2,48) = 104.960; p < 0.0001)], with a R2 of 0.814.

CONCLUSION

A correlation was found between VSA and the speed of a conformation of titanium plate on mandibular angle, but no link was established between speed and performance of a complex surgical task on flapless excision suture workshop.

Efficacy of Corsi Block Tapping Task training for improving visuospatial skills: a non-randomized two-group study

Even though impaired visuospatial abilities can negatively affect daily functioning, there are very few training programs that attempt to improve visuospatial abilities. The purpose of this study was to examine if a single training session with a computerized version of the Corsi Block Tapping Task could improve mental rotation skills. Fifty-three young adults were assigned to one of two groups: (1) control group (mean age = 21.4; 10 females), who had 20 min of rest after their baseline assessment, or (2) training group (mean age = 21.5; 17 females), who had 20 min of training on the Corsi Block Tapping Task after their baseline assessment. The primary outcome was reaction time on a computer-based mental rotation task, and it was assessed both before and after the rest or training. There was a significant interaction between time (pre vs. post) and group (control vs. training) on mental rotation performance (p = 0.04), with the training group performing on average 124 ms faster on accurate trials than the control group at post-test. This preliminary study suggested that improving mental rotation may be feasible through targeted cognitive training. Future studies will consider multiple sessions of Corsi Block Tapping Task training to maximize training benefits (i.e., dose-response), as well as longer term retention in cognitively intact and impaired individuals.

Recent evidence on visual-spatial ability in surgical education: A scoping review

BACKGROUND

Understanding the relationships between structures is critical for surgical trainees. However, the heterogeneity of the literature on visual-spatial ability (VSA) in surgery makes it challenging for educators to make informed decisions on incorporating VSA into their programs. We conducted a scoping review of the literature on VSA in surgery to provide a map of the literature and identify where gaps still exist for future research.

METHODS

We searched databases until December 2019 using keywords related to VSA and surgery. The resulting articles were independently screened by two researchers for inclusion in our review.

RESULTS

We included 117 articles in the final review. Fifty-nine articles reported significant correlations between VSA tests and surgical performance, and this association is supported by neuroimaging studies. However, it remains unclear whether VSA should be incorporated into trainee selection and whether there is a benefit of three-dimensional (3D) over two-dimensional (2D) training.

CONCLUSIONS

It appears that VSA correlates with surgical performance in the simulated environment, particularly for novice learners. Based on our findings, we make suggestions for how surgical educators may use VSA to support novice learners. Further research should determine whether VSA remains correlated to surgical performance when trainees move into the operative environment.

Spatial abilities training in the field of technical skills in health care: A systematic review

OBJECTIVE

To conduct a systematic review of the effect of interventions on spatial abilities in the field of technical skills in health care.

METHODS

A literature search was conducted up to November 14, 2017 in Scopus and in several databases on EBSCOhost platform. Citations were obtained, articles related to retained citations were reviewed and a final list of included studies was identified. Methods in the field of technical skills relating an intervention to spatial abilities test scores between intervention groups or obtained before and after the intervention were identified as eligible. The quality of included studies was assessed and data were extracted in a systematic way.

RESULTS

A series of 5513 citations was obtained. Ninety-nine articles were retained and fully reviewed, yielding four included studies. No difference in the Hidden Figure Test score after one year was observed after residency training in General Surgery of at least nine months. A first-year dental curriculum was not found to elevate the Novel Object Cross-Sections Test score (P = 0.07). A two-semester learning period of abdominal sonography was found to increase the Revised Minnesota Paper Form Board Test score (P < 0.05). A hands-on radiology course using interactive three-dimensional image post-processing software consisting of seven two-hour long seminars on a weekly basis was found to amplify the Cube Perspective Test score (P < 0.001).

CONCLUSION

Spatial abilities tests scores were enhanced by courses in abdominal sonography and hands-on radiology, but were not improved by residency training in General Surgery and first-year dental curriculum.

Proficiency-based progression training: an 'end to end' model for decreasing error applied to achievement of effective epidural analgesia during labour: a randomised control study

BACKGROUND

Training procedural skills using proficiency-based progression (PBP) methodology has consistently resulted in error reduction. We hypothesised that implementation of metric-based PBP training and a valid assessment tool would decrease the failure rate of epidural analgesia during labour when compared to standard simulation-based training.

METHODS

Detailed, procedure-specific metrics for labour epidural catheter placement were developed based on carefully elicited expert input. Proficiency was defined using criteria derived from clinical performance of experienced practitioners. A PBP curriculum was developed to train medical personnel on these specific metrics and to eliminate errors in a simulation environment.Seventeen novice anaesthetic trainees were randomly allocated to undergo PBP training (Group P) or simulation only training (Group S). Following training, data from the first 10 labour epidurals performed by each participant were recorded. The primary outcome measure was epidural failure rate.

RESULTS

A total of 74 metrics were developed and validated. The inter-rater reliability (IRR) of the derived assessment tool was 0.88. Of 17 trainees recruited, eight were randomly allocated to group S and six to group P (three trainees did not complete the study). Data from 140 clinical procedures were collected. The incidence of epidural failure was reduced by 54% with PBP training (28.7% in Group S vs 13.3% in Group P, absolute risk reduction 15.4% with 95% CI 2% to 28.8%, p=0.04).

CONCLUSION

Procedure-specific metrics developed for labour epidural catheter placement discriminated the performance of experts and novices with an IRR of 0.88. Proficiency-based progression training resulted in a lower incidence of epidural failure compared to simulation only training.

TRIAL REGISTRATION NUMBER

NCT02179879. NCT02185079; Post-results.

The Fundamentals of Laparoscopic Surgery and LapVR evaluation metrics may not correlate with operative performance in a novice cohort

BACKGROUND

Considerable resources have been invested in both low- and high-fidelity simulators in surgical training. The purpose of this study was to investigate if the Fundamentals of Laparoscopic Surgery (FLS, low-fidelity box trainer) and LapVR (high-fidelity virtual reality) training systems correlate with operative performance on the Global Operative Assessment of Laparoscopic Skills (GOALS) global rating scale using a porcine cholecystectomy model in a novice surgical group with minimal laparoscopic experience.

METHODS

Fourteen postgraduate year 1 surgical residents with minimal laparoscopic experience performed tasks from the FLS program and the LapVR simulator as well as a live porcine laparoscopic cholecystectomy. Performance was evaluated using standardized FLS metrics, automatic computer evaluations, and a validated global rating scale.

RESULTS

Overall, FLS score did not show an association with GOALS global rating scale score on the porcine cholecystectomy. None of the five LapVR task scores were significantly associated with GOALS score on the porcine cholecystectomy.

CONCLUSIONS

Neither the low-fidelity box trainer or the high-fidelity virtual simulator demonstrated significant correlation with GOALS operative scores. These findings offer caution against the use of these modalities for brief assessments of novice surgical trainees, especially for predictive or selection purposes.

Spatial abilities of medical graduates and choice of residency programs

Spatial abilities have been related in previous studies to three-dimensional (3D) anatomy knowledge and the performance in technical skills. The objective of this study was to relate spatial abilities to residency programs with different levels of content of 3D anatomy knowledge and technical skills. The hypothesis was that the choice of residency program is related to spatial abilities. A cohort of 210 medical graduates was enrolled in a prospective study in a 5-year experiment. Spatial abilities were measured with a redrawn Vandenberg and Kuse Mental Rotations Test (MRT) in two (MRTA) and three (MRTC) dimensions. Medical graduates were enrolled in Family Medicine (n = 76, 36.2%), Internal Medicine (64, 30.5%), Surgery (52, 24.8%), and Anesthesia (18, 8.6%). The assumption was that the level of 3D anatomy knowledge and technical skills content was higher in Surgery and Anesthesia compared to Family Medicine and Internal Medicine. Mean MRTA score of 12.4 (±SD 4.6), 12.0 (±4.3), 14.1 (±4.3), and 14.6 (±4.0) was obtained in Family Medicine, Internal Medicine, Surgery, and Anesthesia, respectively (P = 0.0176). Similarly, mean MRTC score of 8.0 (±4.4), 7.5 (±3.6), 8.5 (±3.9), and 7.9 (±4.1) was obtained (P = 0.5647). Although there was a tendency for lower MRTA score in Family Medicine and Internal Medicine compared to Surgery and Anesthesia, no statistically significant main effect of residency, year, sex, or the interactions were observed for the MRTA and MRTC. Studied sample of medical graduates was not found to choose their residency programs based on their innate spatial abilities.

Assessment centres for core medical training: how do the assessors feel this compares with the traditional interview?

In 2007, an assessment centre approach (a structured interview, a case-based discussion and a communication exercise) was implemented to replace the traditional interview for entry to core medical training. Feedback was obtained from 53 of 69 assessors, all consultants and most with extensive experience of the traditional system. Each station was rated by around 20 interviewers. This overwhelmingly rated the new process as useful in assessing the candidate (>90% for all stations). Comparison with the previous system was only provided by between 12 and 21 people per station. The structured interview was rated better (n=12), undecided (8), or worse (1); the case-based discussion better (16), or undecided (3); the communication station better (8), undecided (3), or worse (1). There is still work to do on the best components to include but the principle of multiple assessments to examine differing parts of the person specification seems, subjectively, to be supported.