Gender-specific movement strategies using a computer-pointing task

Decline in Sensory Integration in Old Age and Its Related Functional Brain Connectivity Correlates Observed during a Virtual Reality Task

Sensory integration is an essential human function whose decline impacts quality of life, particularly in older adults. Herein, we propose an arm-reaching task based on a virtual reality head-mounted display system to assess sensory integration in daily life, and we examined whether reaching task performance was associated with resting-state functional connectivity (rsFC) between the brain regions involved in sensory integration. We hypothesized that declining sensory integration would affect performance during a reaching task with multiple cognitive loads. Using a task in which a young/middle-aged group showed only small individual differences, older adults showed large individual differences in the gap angle between the reaching hand and the target position, which was used to assess sensory integration function. Additionally, rsfMRI data were used to identify correlations between rsFC and performance in older adults, showing that performance was correlated with connectivity between the primary motor area and the left inferior temporal gyrus and temporo-occipital region. Connectivity between areas is related to visuomotor integration; thus, the results suggest the involvement of visuomotor integration in the decline of sensory integration function and the validity of the gap angle during this VR reaching task as an index of functional decline.

Hand differences in aiming task: A complementary spatial approach and analysis of dynamic brain networks with EEG

Left and right-hand exhibit differences in the execution of movements. Particularly, it has been shown that manual goal-directed aiming is more accurate with the right hand than with the left, which has been explained through the shorter time spent by the right hand in the feedback phase (FB). This explanation makes sense for the temporal aspects of the task; however, there is a lack of explanations for the spatial aspects. The present study hypothesizes that the right hand is more associated with the FB, while the left hand is more strongly associated with the pre-programming phase (PP). In addition, the present study aims to investigate differences between hands in functional brain connectivity (FBC). We hypothesize an increase in FBC of the right hand compared to the left hand. Twenty-two participants performed 20 trials of the goal-directed aiming task with both hands. Overall, the results confirm the study's hypotheses. Although the right hand stopped far from the target at the PP, it exhibited a lower final position error than the left hand. These findings imply that during the FB, the right hand compensates for the higher error observed in the PP, using the visual feedback to approach the target more closely than the left hand. Conversely, the left hand displayed a lower error at the PP than the right. Also, the right hand displayed greater FBC within and between brain hemispheres. This heightened connectivity in the right hand might be associated with inhibitory mechanisms between hemispheres.

Sex-Related Differences in Shoulder Complex Joint Dynamics Variability During Pediatric Manual Wheelchair Propulsion

More than 80% of adult manual wheelchair users with spinal cord injuries will experience shoulder pain. Females and those with decreased shoulder dynamics variability are more likely to experience pain in adulthood. Sex-related differences in shoulder dynamics variability during pediatric manual wheelchair propulsion may influence the lifetime risk of pain. We evaluated the influence of sex on 3-dimensional shoulder complex joint dynamics variability in 25 (12 females and 13 males) pediatric manual wheelchair users with spinal cord injury. Within-subject variability was quantified using the coefficient of variation. Permutation tests evaluated sex-related differences in variability using an adjusted critical alpha of P = .001. No sex-related differences in sternoclavicular or acromioclavicular joint kinematics or glenohumeral joint dynamics variability were observed (all P ≥ .042). Variability in motion, forces, and moments are considered important components of healthy joint function, as reduced variability may increase the likelihood of repetitive strain injury and pain. While further work is needed to generalize our results to other manual wheelchair user populations across the life span, our findings suggest that sex does not influence joint dynamics variability in pediatric manual wheelchair users with spinal cord injury.

A Sex-Specific Evaluation of Dental Students' Ability to Perform Subgingival Debridement: Randomized Trial

BACKGROUND

A successful periodontitis treatment demands good manual skills. A correlation between biological sex and dental students' manual dexterity is currently unknown.

OBJECTIVE

This study examines performance differences between male and female students within subgingival debridement.

METHODS

A total of 75 third-year dental students were divided by biological sex (male/female) and randomly assigned to one of two work methods (manual curettes n=38; power-driven instruments n=37). Students were trained on periodontitis models for 25 minutes daily over 10 days using the assigned manual or power-driven instrument. Practical training included subgingival debridement of all tooth types on phantom heads. Practical exams were performed after the training session (T1) and after 6 months (T2), and comprised subgingival debridement of four teeth within 20 minutes. The percentage of debrided root surface was assessed and statistically analyzed using a linear mixed-effects regression model (P<.05).

RESULTS

The analysis is based on 68 students (both groups n=34). The percentage of cleaned surfaces was not significantly different (P=.40) between male (mean 81.6%, SD 18.2%) and female (mean 76.3%, SD 21.1%) students, irrespective of the instrument used. The use of power-driven instruments (mean 81.3%, SD 20.5%) led to significantly better results than the use of manual curettes (mean 75.4%, SD 19.4%; P=.02), and the overall performance decreased over time (T1: mean 84.5%, SD 17.5%; T2: mean 72.3%, SD 20.8%; P<.001).

CONCLUSIONS

Female and male students performed equally well in subgingival debridement. Therefore, sex-differentiated teaching methods are not necessary.

Exploring Sex Differences and Force Level Effects on Grip Force Perception in Healthy Adults

This study aimed to explore the effect of sex and force level on grip force reproduction in healthy adults by conducting a force reproduction task. Participants (n = 28) were instructed to replicate a range of reference grip force levels (10-130 N in 10 N increments). We found that women (absolute error: 16.2 ± 8.7 N) replicated these force levels more accurately than men (absolute error: 23.1 ± 9.5 N) at higher force levels (90-130 N). Furthermore, the force reproductions were most accurate at the 30-50 N range for men and the 50-60 N range for women. These results may offer significant insights into the higher rates of musculoskeletal disorders among women, enabling researchers and clinicians to design novel interventions and tools that can improve grip force perception and reduce hand injury rates in both men and women.

Biological Sex-Related Differences in Glenohumeral Dynamics Variability during Pediatric Manual Wheelchair Propulsion

Shoulder pain and pathology are extremely common in adult manual wheelchair users with spinal cord injury (SCI). Within this population, biological sex and variability in shoulder joint dynamics have been shown to be important contributors to both shoulder pain and pathology. Sex-related differences in shoulder dynamics variability during pediatric manual wheelchair propulsion may influence a user's lifetime risk of shoulder pain and pathology. The purpose of this study was to assess the influence of biological sex on variability in three-dimensional (3-D) glenohumeral joint dynamics in pediatric manual wheelchair users with SCI. An inverse dynamics model computed 3-D glenohumeral joint angles, forces, and moments of 20 pediatric manual wheelchair users. Levene's tests assessed biological sex-related differences in variability. Females exhibited less variability in glenohumeral joint kinematics and forces, but greater variability in joint moments than males. Evaluation of glenohumeral joint dynamics with consideration for biological sex and variability strengthens our interpretation of the relationships among shoulder function, pain, and pathology in pediatric manual wheelchair users.Clinical Relevance- Female pediatric manual wheelchair users may be at an increased risk of shoulder repetitive strain injuries due to decreased glenohumeral joint motion and force variability during propulsion. This work establishes quantitative methods for determining the effects of biological sex on the variability of shoulder joint dynamics.

Influence of visual feedback, hand dominance and sex on individuated finger movements

The ability to perform individual finger movements, highly important in daily activities, involves visual monitoring and proprioception. We investigated the influence of vision on the spatial and temporal control of independent finger movements, for the dominant and non-dominant hand and in relation to sex. Twenty-six healthy middle-aged to old adults (M age = 61 years; range 46–79 years; females n = 13) participated. Participants performed cyclic flexion–extension movements at the metacarpophalangeal joint of one finger at a time while keeping the other fingers as still as possible. Movements were recorded using 3D optoelectronic motion technique (120 Hz). The movement trajectory distance; speed peaks (movement smoothness); Individuation Index (II; the degree a finger can move in isolation from the other fingers) and Stationarity Index (SI; how still a finger remains while the other fingers move) were extracted. The main findings were: (1) vision only improved the II and SI marginally; (2) longer trajectories were evident in the no-vision condition for the fingers of the dominant hand in the female group; (3) longer trajectories were specifically evident for the middle and ring fingers within the female group; (4) females had marginally higher II and SI compared with males; and (5) females had fewer speed peaks than males, particularly for the ring finger. Our results suggest that visual monitoring of finger movements marginally improves performance of our non-manipulative finger movement task. A consistent finding was that females showed greater independent finger control compared with males.

Sex differences in visuomotor tracking

There is a growing interest in sex differences in human and animal cognition. However, empirical evidences supporting behavioral and neural sex differences in humans remain sparse. Visuomotor behaviors offer a robust and naturalistic empirical framework to seek for the computational mechanisms underlying sex biases in cognition. In a large group of human participants (N = 127), we investigated sex differences in a visuo-oculo-manual motor task that consists of tracking with the hand a target moving unpredictably. We report a clear male advantage in hand tracking accuracy. We tested whether men and women employ different gaze strategy or hand movement kinematics. Results show no key difference in these distinct visuomotor components. However, highly consistent differences in eye-hand coordination were evidenced by a larger temporal lag between hand motion and target motion in women. This observation echoes with other studies showing a male advantage in manual reaction time to visual stimuli. We propose that the male advantage for visuomotor tracking does not reside in a more reliable gaze strategy, or in more sophisticated hand movements, but rather in a faster decisional process linking visual information about target motion with forthcoming hand, but not eye, actions.

Evaluation of the preclinical analgesic efficacy of naturally derived, orally administered oil forms of Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD), and their 1:1 combination

Chronic neuropathic pain (NP) is a growing clinical problem for which effective treatments, aside from non-steroidal anti-inflammatory drugs and opioids, are lacking. Cannabinoids are emerging as potentially promising agents to manage neuroimmune effects associated with nociception. In particular, Δ9-tetrahydrocannabinol (THC), cannabidiol (CBD), and their combination are being considered as therapeutic alternatives for treatment of NP. This study aimed to examine whether sex affects long-term outcomes on persistent mechanical hypersensitivity 7 weeks after ceasing cannabinoid administration. Clinically relevant low doses of THC, CBD, and a 1:1 combination of THC:CBD extracts, in medium chain triglyceride (MCT) oil, were orally gavaged for 14 consecutive days to age-matched groups of male and female sexually mature Sprague Dawley rats. Treatments commenced one day after surgically inducing a pro-nociceptive state using a peripheral sciatic nerve cuff. The analgesic efficacy of each phytocannabinoid was assessed relative to MCT oil using hind paw mechanical behavioural testing once a week for 9 weeks. In vivo intracellular electrophysiology was recorded at endpoint to characterize soma threshold changes in primary afferent sensory neurons within dorsal root ganglia (DRG) innervated by the affected sciatic nerve. The thymus, spleen, and DRG were collected post-sacrifice and analyzed for long-term effects on markers associated with T lymphocytes at the RNA level using qPCR. Administration of cannabinoids, particularly the 1:1 combination of THC, elicited a sustained mechanical anti-hypersensitive effect in males with persistent peripheral NP, which corresponded to beneficial changes in myelinated Aβ mechanoreceptive fibers. Specific immune cell markers associated with T cell differentiation and pro-inflammatory cytokines, previously implicated in repair processes, were differentially up-regulated by cannabinoids in males treated with cannabinoids, but not in females, warranting further investigation into sexual dimorphisms that may underlie treatment outcomes.

Learning spinal manipulation: Gender and expertise differences in biomechanical parameters, accuracy, and variability

OBJECTIVE:

The purpose of this study was to investigate gender differences and expertise effects on biomechanical parameters as well as force accuracy and variability for students learning spinal manipulation.

METHODS:

A total of 137 fourth- and fifth-year students were recruited for the study. Biomechanical parameters (preload, time to peak force, peak force, rate of force), as well as accuracy and variability of thoracic spine manipulation performance, were evaluated during 5 consecutive trials using a force-sensing table and a target force of 450 N. Gender, expertise differences on biomechanical parameters, as well as constant, variable, and absolute error were assessed using 2-way analysis of variance.

RESULTS:

Analyses showed significant gender differences for several biomechanical parameters, as well as significant gender differences in accuracy and variability. Although women showed lower time to peak force and rate of force values, they were more precise and showed less variability than men when performing thoracic spine manipulations. Students with clinical expertise (fifth-year students) used less force and were more precise.

CONCLUSION:

Our results showed that gender differences in spinal manipulation performance exist and that these differences seem to be mainly explained by alternative motor strategies. To develop gender-specific teaching methods, future studies should explore why men and women approach spinal manipulation tasks differently.

The Effects of Handedness and Dominance on Motor Task Performance

Two studies were carried out to examine the effects of user handedness and hand dominance on a motor task using Fitts’ law. Study one was designed to validate our previous findings showing differences between left- and right-handed participants who completed a mouse-pointing task using Fitts’ law. Results showed that right-handed participants were significantly faster than their left-handed peers, thereby validating our previous findings. Study two examined the effect of handedness and hand dominance on motor task performance by requiring two groups of left- and right-handed participants perform the motor task using both their dominant and non-dominant hands. Results showed a significant interaction between handedness and hand dominance on task performance. Right-handed participants were again significantly faster than their left-handed peers when both groups were using their dominant hand. However, left-handed participants were significantly faster than their right-handed peers when both groups were using their non-dominant hand. These findings might be attributed to prior training with computer mice designs that do not account for user handedness. Both theoretical and practical implications, as well as directions for future studies are also discussed.

Implications on older women of age- and sex-related differences in activation patterns of shoulder muscles: A cross-sectional study

We conducted a cross-sectional study to assess differences in neuromotor attributes of shoulder muscles between age groups in both sexes and to better understand functional disorders in older women. Twenty young (20-42 years old), 20 middle-aged (43-67), and 20 older (> 68) adults participated in a comparative surface-electromyography study of five muscles. We identified age-related differences in women, especially in scapula stabilizer muscles. There was a tendency for both sexes of delayed onset times with increasing age, excepting the upper trapezius muscle in females. The results highlight the importance of understanding musculoskeletal aging in women to adequately guide physical therapeutic approaches.

Manual dexterity in young and healthy older adults. 1. Age- and gender-related differences in unimanual and bimanual performance

This study aimed to better characterize age-related differences in dexterity by using an integrative approach where movement times and kinematics were measured for both hands. Forty-five young (age 19-31) and 55 healthy older adults (age 60-88) were evaluated during unimanual and bimanual performance of the Purdue Pegboard Test. Gender effects were also assessed. From video-recorded data, movement times and kinematics were obtained for reaching, grasping, transport, and inserting. Results showed that older adults had longer movement times for grasping and inserting with the right hand, and across all movements with the left hand. Kinematic differences were found in path length, linear, and angular velocity. The patterns of slowing were similar in unimanual and bimanual tasks. Gender effects showed more slowing in older males than older females. Age differences in dexterity not only comprise slowing of movements but also kinematic alterations. The importance of gender in hand function was demonstrated.

THE SEX DIFFERENCE IN ROD BALANCING: CONFIRMATION OF THE DIFFERENCE AND A TEST OF THREE HYPOTHETICAL EXPLANATIONS

Previous studies have shown that men can balance a dowel rod on the index finger for a longer time than women can. The factors that account for the difference are unknown, but the difference may be attributable either to a difference in whole-body agility or a difference in the use of visual cues. Three experiments involving a total of 62 adult women with a mean age of 21.2 yr. (SD=3.8) and 62 adult men with a mean age of 21.9 yr. (SD=6.6) tested these potential explanations. Experiment 1 replicated the sex difference and assessed the relevance of whole-body agility by comparing standing and seated conditions. Experiments 2 and 3 explored the role of rod length and visual fixation point, respectively. Each experiment yielded a significant sex difference, but the difference was not affected by the participant's posture, the length of the rod, or the fixation point. Possible alternative explanations for the difference include differences in (1) the speed of processing degree of visual tilt; (2) arm mass, which affects the inertia of the balancing system; and (3) experience in open-skill sports.

Sex differences in the shoulder joint position sense acuity: a cross-sectional study

Background

Work-related musculoskeletal disorders (WMSD) is the most expensive form of work disability. Female sex has been considered as an individual risk factor for the development of WMSD, specifically in the neck and shoulder region. One of the factors that might contribute to the higher injury rate in women is possible differences in neuromuscular control. Accordingly the purpose of this study was to estimate the effect of sex on shoulder joint position sense acuity (as a part of shoulder neuromuscular control) in healthy individuals.

Methods

Twenty-eight healthy participants, 14 females and 14 males were recruited for this study. To test position sense acuity, subjects were asked to flex their dominant shoulder to one of the three pre-defined angle ranges (low, mid and high-ranges) with eyes closed, hold their arm in that position for three seconds, go back to the starting position and then immediately replicate the same joint flexion angle, while the difference between the reproduced and original angle was taken as the measure of position sense error. The errors were measured using Vicon motion capture system. Subjects reproduced nine positions in total (3 ranges × 3 trials each).

Results

Calculation of absolute repositioning error (magnitude of error) showed no significant difference between men and women (p-value ≥ 0.05). However, the analysis of the direction of error (constant error) showed a significant difference between the sexes, as women tended to mostly overestimate the target, whereas men tended to both overestimate and underestimate the target (p-value ≤ 0.01, observed power = 0.79). The results also showed that men had a significantly more variable error, indicating more variability in their position sense, compared to women (p-value ≤ 0.05, observed power = 0.78).

Discussion

Differences observed in the constant JPS error suggest that men and women might use different neuromuscular control strategies in the upper limb. In addition, higher JPS variability observed in men might be one of the factors that could contribute to their lower rate of musculoskeletal disorders, compared to women.

Conclusions

The result of this study showed that shoulder position sense, as part of the neuromuscular control system, differs between men and women. This finding can help us better understand the reasons behind the higher rate of musculoskeletal disorders in women, especially in the working environments.

Towards an automatic user profiling system for online information sites

Purpose

– The purpose of this paper is to identify demographic differences based on how users interact with web applications. The research is needed to develop future systems able to adapt the representation of online information to the user’s specific needs and preferences improving its usability. The following question guides this quest: is there a direct relationship between age and/or gender and interaction?

Design/methodology/approach

– GOMS (goals, operators, methods, and selection rules) analysis was used to reduce complex interaction tasks into basic operators like pointing, dragging, typing, etc. An experiment was designed to analyse the user performance in the use of these operators through five complex tasks: point-and-click, drag-and-drop, text selection, text edition and menu selection. The sample comprises 592 individuals which took part in the experiment. The performance was analysed using multivariate regression analysis. User laterality and the the user experience were used as control variables.

Findings

– The factors studied are significant enough to support user classification. The analysis evidenced that men performed significantly better than women when executing interaction pointing and dragging GOMS’s operators, but no significant differences arose with regard to the performance in the typing operators. Older users performed worse in all the interaction tasks. No significant performance differences were detected between left and right-handed users.

Research limitations/implications

– The study pretends to lay the ground for developing artificial intelligence-based classification systems (e.g. neural networks, decision trees, etc.) able to detect significant differences in user performance, classifying users according to their age, gender and laterality.

Practical implications

– This user profiling would drive the organisation, selection and representation of the online information according to the specific preferences and needs of each user. This would allow the design of new personalisation algorithms able to perform dynamic adaptation of user interfaces in order to improve the usability of online information systems.

Originality/value

– This work extends previous research on user performance under a new approach and improved accuracy. First, it relies on the combined and simultaneous analysis of ageing and gender and the use of user laterality and experience as control variables. Second, the use of the GOMS analysis allowed the design of tests that closely resemble the user interaction in online information systems. Third, the size of the sample used in this analysis is much bigger than those used in previous works, allowing a more thorough data analysis which includes the estimation of an advanced model which is quantile regression.

Evaluation of the leap motion controller as a new contact-free pointing device

This paper presents a Fitts' law-based analysis of the user's performance in selection tasks with the Leap Motion Controller compared with a standard mouse device. The Leap Motion Controller (LMC) is a new contact-free input system for gesture-based human-computer interaction with declared sub-millimeter accuracy. Up to this point, there has hardly been any systematic evaluation of this new system available. With an error rate of 7.8% for the LMC and 2.8% for the mouse device, movement times twice as large as for a mouse device and high overall effort ratings, the Leap Motion Controller's performance as an input device for everyday generic computer pointing tasks is rather limited, at least with regard to the selection recognition provided by the LMC.

Distinction between hand dominance and hand preference in primates: a behavioral investigation of manual dexterity in nonhuman primates (macaques) and human subjects

Background The present study aimed to determine and confront hand preference (hand chosen in priority to perform a manual dexterity task) and hand dominance (hand with best motor performance) in eight macaques (Macaca fascicularis) and in 20 human subjects (10 left-handers and 10 right-handers). Methods Four manual dexterity tests have been executed by the monkeys, over several weeks during learning and stable performance phases (in controlled body position): the modified Brinkman board, the reach and grasp drawer, the tube and the bimanual board tasks. Three behavioral tests, adapted versions from the monkeys tasks (modified Brinkman board, tube and bimanual board tasks), as well as a handedness questionnaire, have been conducted in human subjects. Results In monkeys, there was a large disparity across individuals and motor tasks. For hand dominance, two monkeys were rather right lateralized, three monkeys rather left lateralized, whereas in three monkeys, the different parameters measured were not consistent. For hand preference, none of the eight monkeys exhibited a homogeneous lateralization across the four motor tasks. Macaca fascicularis do not exhibit a clear hand preference. Furthermore, hand preference often changed with task repetition, both during training and plateau phases. For human subjects, the hand preference mostly followed the self-assessment of lateralization by the subjects and the questionnaire (in the latter, right-handers were more lateralized than left-handers), except a few discrepancies based on the tube task. There was no hand dominance in seven right-handers (the other three performed better with the right hand) and in four left-handers. Five left-handers showed left-hand dominance, whereas surprisingly, one left-hander performed better with the right hand. In the modified Brinkman board task, females performed better than males, right-handers better than left-handers. Conclusions The present study argues for a distinction between hand preference and hand dominance, especially in macaque monkeys.

Age, Task Complexity, and Sex as Potential Moderators of Attentional Focus Effects

The study tested whether age, sex, or task complexity moderate the effect of attentional focus on motor learning. Children (24 boys, 24 girls) and adults (24 men, 24 women) were assigned to an internal or external attentional focus, and were timed while riding either a Double Pedalo with handles (simple task) or without handles (complex task) over a distance of 7 meters. A Double Pedalo is a four-wheeled device that involves standing on two connected platforms, and alternately pushing them forward to make it move. Participants completed 20 acquisition trials, followed by a 24-hour retention test. For the simpler task, no time differences due to attentional focus emerged. With the complex task, an external focus resulted in faster times in retention than an internal focus, but only for males. These findings suggest that attentional focus affects children and adults similarly, but task complexity and sex moderate these effects.

A critical review on physical factors and functional characteristics that may explain a sex/gender difference in work-related neck/shoulder disorders

The objective of this paper is to critically review recent literature on physical and functional sex/gender (s/g) differences, with focus on physical determinants associated with neck/shoulder musculoskeletal injuries. It is well known that there are s/g differences in anthropometrical and functional body characteristics (e.g. size and strength). However, s/g differences may be wrongly attributed if data analysis does not include appropriate corrections (e.g. by strength for endurance). Recent literature on motor control shows that there may indeed be s/g differences in muscle coordination and movement strategies during upper limb tasks that are not currently explained by methodological inadequacies. Moreover, recent studies have shown differences between men and women in sensory hypersensitivity characteristics associated with neck/shoulder injuries. Taken together, the literature points to the importance of accounting for possible s/g differences at all levels of the biopsychosocial system in order to better understand sex- and gender-specific issues relevant to workplace health.

PRACTITIONER SUMMARY

This article critically reviews recent literature and a conceptual model highlighting s/g differences in physical and functional characteristics related to neck/shoulder musculoskeletal disorders (NSMSD). Findings have implications on understanding how personal factors may affect NSMSD risk. With better understanding, practitioners can make more appropriate decisions to prevent work-related NSMSD.

Differences in final product of a bowel anastomosis of male and female novice surgeons

INTRODUCTION

There is a disproportionate ratio of male to female surgeons when compared with the ratio at medical school. Although gender differences in surgical technical ability is not known, studies have shown gender differences in visuospatial ability and manual dexterity. We devised a study to assess objectively the quality of final product of small bowel anastomosis in male and female novice surgeons to explore differences in surgical technical ability.

METHODS

Thirty-six novice surgeons in the final year of medical school with minimal surgical experience were taught surgical knot tying and small bowel suturing. The students were asked to complete 7 small bowel anastomosis in 7 separate sessions. The quality of the final product was assessed looking at the "fine details" (number of sutures and accuracy, ie, ratio of sutures piercing the full thickness of the bowel) and the "gross apposition" of the bowel ends at the anastomotic site. A grading system for apposition was devised to assess apposition.

RESULTS

The results with fine details and accuracy of suturing revealed that female surgeons were significantly better in the fourth to the sixth sessions with no gender difference in the number of sutures placed. With gross apposition at the anastomotic ends, male surgeons were consistently better between the third to the sixth session. However, these differences were eliminated with training.

CONCLUSIONS

Known gender differences in visuospatial ability and manual dexterity may explain the initial gender differences in the quality of the final product. However, these differences were not present by the end of the training sessions. Therefore, with training, no difference in surgical technical ability was found between male and female novice surgeons.