Wanzel Kyle R, Hamstra Stanley J, Caminiti Marco F, Anastakis Dimitri J, Grober Ethan D, Reznick Richard K
Department of Surgery, Faculty of Medicine, University of Toronto, 100 College Street, Toronto, Ontario, Canada M5G 1L5.
Surgery. 2003 Nov;134(5):750-7. doi: 10.1016/s0039-6060(03)00248-4.
This study examines the influence of visual-spatial ability and manual dexterity on surgical performance across 3 levels of expertise.
Dental students, surgical residents, and staff surgeons completed standardized tests of manual dexterity and visual-spatial ability and were assessed objectively while performing the rigid fixation of an anterior mandible on bench model simulations. Outcome variables included expert assessment of technical performance and efficiency of hand motion during the procedure (recorded using electromagnetic sensors).
Visual-spatial scores correlated significantly with surgical performance scores within the group of dental students (r=.40 to.73), but this was not the case for residents or staff surgeons. For all groups, manual dexterity did not correlate with hand motion parameters. There were no differences between groups in visual-spatial ability or manual dexterity, but highly significant differences were seen in surgical performance scores (P<.001), in that surgeons outperformed residents, who in turn outperformed students.
Among novices, visual-spatial ability is associated with skilled performance on a spatially complex surgical procedure. However, advanced trainees and experts do not score any higher on carefully selected visual-spatial tests, suggesting that practice and surgical experience may supplant the influence of visual-spatial ability over time. Thus, the use of these tests for the selection of residents is not currently recommended; they may be of more use in identifying those novice trainees (ie, those with lower test scores) who might benefit most from brief supplementary instruction on specific technical tasks.
本研究考察了视觉空间能力和手部灵活性在三个专业水平层次上对外科手术操作的影响。
牙科学生、外科住院医师和外科 staff 医师完成了手部灵活性和视觉空间能力的标准化测试,并在对下颌骨前部进行刚性固定的模拟实验台上模型操作时接受客观评估。结果变量包括专家对手术操作技术表现和手术过程中手部动作效率的评估(使用电磁传感器记录)。
在牙科学生组中,视觉空间分数与手术表现分数显著相关(r = 0.40至0.73),但住院医师和外科 staff 医师组并非如此。对于所有组,手部灵活性与手部动作参数均无相关性。在视觉空间能力或手部灵活性方面,各组之间没有差异,但在手术表现分数上存在高度显著差异(P < 0.001),即外科医师的表现优于住院医师,住院医师又优于学生。
在新手当中,视觉空间能力与在空间复杂的外科手术操作中的熟练表现相关。然而,高级受训人员和专家在精心挑选的视觉空间测试中得分并没有更高,这表明随着时间推移,实践和手术经验可能会取代视觉空间能力的影响。因此,目前不建议使用这些测试来选拔住院医师;它们可能在识别那些新手受训人员(即测试分数较低的人员)方面更有用,这些新手受训人员可能从针对特定技术任务的简短补充指导中获益最多。