Malhotra Neha, Poolton Jamie M, Wilson Mark R, Leung Gilberto, Zhu Frank, Fan Joe K M, Masters Rich S W
Institute of Human Performance, The University of Hong Kong, Hong Kong, China.
Institute of Human Performance, The University of Hong Kong, Hong Kong, China; School of Sport, Carnegie Faculty, Leeds Beckett University, United Kingdom.
J Surg Educ. 2015 Jul-Aug;72(4):662-9. doi: 10.1016/j.jsurg.2014.12.011. Epub 2015 Apr 7.
Surgical educators have encouraged the investigation of individual differences in aptitude and personality in surgical performance. An individual personality difference that has been shown to influence laparoscopic performance under time pressure is movement specific reinvestment. Movement specific reinvestment has 2 dimensions, movement self-consciousness (MS-C) (i.e., the propensity to consciously monitor movements) and conscious motor processing (CMP) (i.e., the propensity to consciously control movements), which have been shown to differentially influence laparoscopic performance in practice but have yet to be investigated in the context of psychological stress (e.g., the objective structured clinical examination [OSCE]).
This study investigated the role of individual differences in propensity for MS-C and CMP in practice of a fundamental laparoscopic skill and in laparoscopic performance during the OSCE. Furthermore, this study examined whether individual differences during practice of a fundamental laparoscopic skill were predictive of laparoscopic performance during the OSCE.
Overall, 77 final-year undergraduate medical students completed the movement specific reinvestment scale, an assessment tool that quantifies the propensity for MS-C and CMP. Participants were trained to proficiency on a fundamental laparoscopic skill. The number of trials to reach proficiency was measured, and completion times were recorded during early practice, later practice, and the OSCE.
There was a trend for CMP to be negatively associated with the number of trials to reach proficiency (p = 0.064). A higher propensity for CMP was associated with fewer trials to reach proficiency (β = -0.70, p = 0.023). CMP and MS-C did not significantly predict completion times in the OSCE (p > 0.05). Completion times in early practice (β = 0.05, p = 0.016) and later practice (β = 0.47, p < 0.001) and number of trials to reach proficiency (β = 0.23, p = 0.003) significantly predicted completion times in the OSCE.
It appears that a higher propensity for CMP predicts faster rates of learning of a fundamental laparoscopic skill. Furthermore, laparoscopic performance during practice is indicative of laparoscopic performance in the challenging conditions of the OSCE. The lack of association between the 2 dimensions of movement specific reinvestment and performance during the OSCE is explained using the theory of reinvestment as a framework. Overall, consideration of personality differences and individual differences in ability during practice could help inform the development of individualized surgical training programs.
外科教育工作者鼓励对外科手术操作中能力和个性的个体差异进行研究。运动特定再投资是一种已被证明会在时间压力下影响腹腔镜手术操作的个体个性差异。运动特定再投资有两个维度，即运动自我意识（MS-C）（即有意识地监测动作的倾向）和有意识运动加工（CMP）（即有意识地控制动作的倾向），这两个维度在实际操作中已被证明会对腹腔镜手术操作产生不同影响，但尚未在心理压力环境下（如客观结构化临床考试[OSCE]）进行研究。
本研究调查了MS-C和CMP倾向的个体差异在一项基本腹腔镜技能操作以及OSCE期间腹腔镜手术表现中的作用。此外，本研究还考察了一项基本腹腔镜技能操作过程中的个体差异是否能预测OSCE期间的腹腔镜手术表现。
总体而言，77名本科医学专业最后一年的学生完成了运动特定再投资量表，这是一种量化MS-C和CMP倾向的评估工具。参与者接受一项基本腹腔镜技能的培训直至熟练掌握。记录达到熟练所需的试验次数，并在早期练习、后期练习和OSCE期间记录完成时间。
CMP与达到熟练所需的试验次数呈负相关趋势（p = 0.064）。CMP倾向较高与达到熟练所需的试验次数较少相关（β = -0.70，p = 0.023）。CMP和MS-C在OSCE中对完成时间没有显著预测作用（p > 0.05）。早期练习（β = 0.05，p = 0.016）、后期练习（β = 0.47，p < 0.001）的完成时间以及达到熟练所需的试验次数（β = 0.23，p = 0.003）对OSCE中的完成时间有显著预测作用。
似乎CMP倾向较高预示着一项基本腹腔镜技能的学习速度更快。此外，练习期间的腹腔镜手术表现预示着在OSCE具有挑战性的条件下的腹腔镜手术表现。以再投资理论为框架解释了运动特定再投资的两个维度与OSCE期间表现之间缺乏关联的原因。总体而言，在练习期间考虑个性差异和能力的个体差异有助于为个性化外科培训计划的制定提供参考。
