Implicit Learning of Movement Skills for Surgery

Masters, Rich S. W.; Poolton, Jamie; Abernethy, Bruce; Patil, Niv G.

doi:10.1111/j.1445-2197.2008.04751.x

Cited by 25 publications

(9 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We previously contended that surgical educators should consider methods that promote dependence on more automated (implicit) processes as a means of training surgical skills [37–39]. Our findings suggest that multitask training is not detrimental to the rate and extent of surgical skill learning and may promote automatic control of laparoscopic skills.…”

Section: Resultsmentioning

confidence: 72%

Multitask training promotes automaticity of a fundamental laparoscopic skill without compromising the rate of skill learning

et al. 2016

View full text Add to dashboard Cite

BackgroundA defining characteristic of expertise is automated performance of skills, which frees attentional capacity to better cope with some common intraoperative stressors. There is a paucity of research on how best to foster automated performance by surgical trainees. This study examined the use of a multitask training approach to promote automated, robust laparoscopic skills. MethodsEighty-one medical students completed training of a fundamental laparoscopic task in either a traditional single-task training condition or a novel multitask training condition. Following training, participants’ laparoscopic performance was tested in a retention test, two stress transfer tests (distraction and time pressure) and a secondary task test, which was included to evaluate automaticity of performance. The laparoscopic task was also performed as part of a formal clinical examination (OSCE). ResultsThe training groups did not differ in the number of trials required to reach task proficiency (p = .72), retention of skill (ps > .45), or performance in the clinical examination (p = .14); however, the groups did differ with respect to the secondary task (p = .016). The movement efficiency (number of hand movements) of single-task trainees, but not multitask trainees, was negatively affected during the secondary task test. The two stress transfer tests had no discernable impact on the performance of either training group.ConclusionMultitask training was not detrimental to the rate of learning of a fundamental laparoscopic skill and added value by providing resilience in the face of a secondary task load, indicative of skill automaticity. Further work is needed to determine the extent of the clinical utility afforded by multitask training.

show abstract

Section: Resultsmentioning

confidence: 72%

Multitask training promotes automaticity of a fundamental laparoscopic skill without compromising the rate of skill learning

et al. 2016

View full text Add to dashboard Cite

show abstract

“…However, whether a gaze focused approach can be considered to be an implicit motor learning paradigm remains to be confirmed by future research. For example, Masters and colleagues have consistently shown that people who learn their movements implicitly can consciously report very little about the mechanics of the movements (see Masters et al [25] for a review related to surgery). Our study provides no evidence with respect to conscious reports.…”

Section: Discussionmentioning

confidence: 99%

“…In numerous studies, Masters and colleagues have shown that implicit motor learning promotes primarily the accretion of procedural knowledge, which is not readily available to conscious introspection by the performer and makes few demands on attention [22, 23]. By generating movement control that makes few demands on the already taxed cognitive resources of the surgeon, implicit motor learning results in stable motor performance under psychological stress, fatigue, multitasking, distractions, or over time [24, 25]. …”

mentioning

confidence: 99%

Gaze training enhances laparoscopic technical skill acquisition and multi-tasking performance: a randomized, controlled study

et al. 2011

View full text Add to dashboard Cite

BackgroundThe operating room environment is replete with stressors and distractions that increase the attention demands of what are already complex psychomotor procedures. Contemporary research in other fields (e.g., sport) has revealed that gaze training interventions may support the development of robust movement skills. This current study was designed to examine the utility of gaze training for technical laparoscopic skills and to test performance under multitasking conditions.MethodsThirty medical trainees with no laparoscopic experience were divided randomly into one of three treatment groups: gaze trained (GAZE), movement trained (MOVE), and discovery learning/control (DISCOVERY). Participants were fitted with a Mobile Eye gaze registration system, which measures eye-line of gaze at 25 Hz. Training consisted of ten repetitions of the “eye-hand coordination” task from the LAP Mentor VR laparoscopic surgical simulator while receiving instruction and video feedback (specific to each treatment condition). After training, all participants completed a control test (designed to assess learning) and a multitasking transfer test, in which they completed the procedure while performing a concurrent tone counting task.ResultsNot only did the GAZE group learn more quickly than the MOVE and DISCOVERY groups (faster completion times in the control test), but the performance difference was even more pronounced when multitasking. Differences in gaze control (target locking fixations), rather than tool movement measures (tool path length), underpinned this performance advantage for GAZE training.ConclusionsThese results suggest that although the GAZE intervention focused on training gaze behavior only, there were indirect benefits for movement behaviors and performance efficiency. Additionally, focusing on a single external target when learning, rather than on complex movement patterns, may have freed-up attentional resources that could be applied to concurrent cognitive tasks.

show abstract

“…By reducing the likelihood of reinvestment, implicit motor learning has been shown to result in performance that is robust under psychological pressure [20, 21], physiological fatigue [43, 44], multitasking [45, 46], and time pressure [47]. Implicit motor learning has been suggested as an alternative theoretical framework [48] for training surgical skills. Preliminary work that has pioneered implicit motor learning in surgery has shown some promise in this avenue [49, 50].…”

Section: Discussionmentioning

confidence: 99%

Conscious monitoring and control (reinvestment) in surgical performance under pressure

et al. 2012

View full text Add to dashboard Cite

BackgroundResearch on intraoperative stressors has focused on external factors without considering individual differences in the ability to cope with stress. One individual difference that is implicated in adverse effects of stress on performance is “reinvestment,” the propensity for conscious monitoring and control of movements. The aim of this study was to examine the impact of reinvestment on laparoscopic performance under time pressure.MethodsThirty-one medical students (surgery rotation) were divided into high- and low-reinvestment groups. Participants were first trained to proficiency on a peg transfer task and then tested on the same task in a control and time pressure condition. Outcome measures included generic performance and process measures. Stress levels were assessed using heart rate and the State Trait Anxiety Inventory (STAI).ResultsHigh and low reinvestors demonstrated increased anxiety levels from control to time pressure conditions as indicated by their STAI scores, although no differences in heart rate were found. Low reinvestors performed significantly faster when under time pressure, whereas high reinvestors showed no change in performance times. Low reinvestors tended to display greater performance efficiency (shorter path lengths, fewer hand movements) than high reinvestors.ConclusionTrained medical students with a high individual propensity to consciously monitor and control their movements (high reinvestors) displayed less capability (than low reinvestors) to meet the demands imposed by time pressure during a laparoscopic task. The finding implies that the propensity for reinvestment may have a moderating effect on laparoscopic performance under time pressure.

show abstract

Implicit Learning of Movement Skills for Surgery

Cited by 25 publications

References 50 publications

Multitask training promotes automaticity of a fundamental laparoscopic skill without compromising the rate of skill learning

Multitask training promotes automaticity of a fundamental laparoscopic skill without compromising the rate of skill learning

Gaze training enhances laparoscopic technical skill acquisition and multi-tasking performance: a randomized, controlled study

Conscious monitoring and control (reinvestment) in surgical performance under pressure

Contact Info

Product

Resources

About