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SJ Hamstra, KR Wanzel, DJ Anastakis, ED Matsumoto, MD Cusimano; Visuospatial Abilities Relevant to Learning Psychomotor Skills in Surgery . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4795.
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Purpose: Based on interviews with surgeons and anecdotal reports, it was hypothesized that there would be a substantial relationship between visuospatial ability and performance on spatially-complex surgical procedures. However, there is no consensus as to the exact nature of these abilities that are required of surgeons. Specific areas of surgery in which visuospatial ability may affect performance include the detection of structures in noise, recovery of depth from 2-dimensional views, and pre-operative planning and visualization. We chose to focus our initial investigation on the latter area since it seemed to be immediately tractable and we also wished to take advantage of recent developments in the objective assessment of technical skills in surgery. Method: Thirty-seven junior surgical residents completed a variety of standardized visuospatial tests of varying complexity, including tests of object recognition and form completion, as well as higher-level tests, such as the Mental Rotations Test (MRT) and the Form Board Test (FBT). These subjects were then objectively assessed on their ability to perform a 2-flap Z-plasty before and after a practice session with feedback, and then a 4-flap Z-plasty. (The Z-plasty requires the transposition of skin flaps to reorient a scar, thereby reducing tension and allowing greater freedom of movement.)Results: Significant correlations were seen between only the highest-level visuospatial tests (MRT and FBT) and performance on the initial 2-flap Z-plasty (r=0.40, p<0.05). Following practice and feedback, subjects who scored in the bottom quartile on the MRT improved their 2-flap Z-plasty scores to a level comparable to subjects in the top quartile (t(17) =1.23, p=.24). Subsequent assessment on the more spatially complex four-flap Z-plasty revealed that the higher MRT group once again significantly outperformed the lower MRT group (t(17) = 2.90, p<0.01), suggesting a better ability to transfer knowledge to a more complex version of the same task. Conclusions: Performance on a novel surgical task involving complex visuospatial planning is associated with well-specified visuospatial constructs. Subjects with lower visuospatial test scores can achieve satisfactory levels of performance following practice and feedback. These results help to specify the visuospatial abilities necessary for successful performance in spatially-complex applied tasks.
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