Schueneman A L, Pickleman J, Freeark R J
Surgery. 1985 Sep;98(3):506-15.
Ability patterns and surgical proficiency were examined in matched groups of general surgery residents selected on the basis of age, gender, or hand preference from a population of 141 residents who had completed neuropsychologic tests of visuospatial, psychomotor, and stress tolerance abilities and had been rated on 12 aspects of technical skill exhibited during 1480 operative procedures. Older residents (ages 28 to 42 years) exhibited less motor speed (p less than 0.05) and coordination (p less than 0.005) and more caution in avoiding psychomotor errors (p less than 0.05) than did their younger counterparts. No differences were found for visuospatial abilities, stress tolerance, or rated surgical skill. These findings indicate that although age does appear to adversely affect pure motor skills, these are not important components of operative proficiency. Female residents exhibited superior (p less than 0.05) academic achievement (MCAT, Verbal and National Boards Part II) as compared with their male counterparts. They also excelled on a signal detection task requiring identification of visual patterns. However, the women scored less well (p less than 0.05) than men on a visuomotor task demonstrated to be a significant predictor of operative skill. Greater cautiousness in avoiding errors may be a contributing factor to their reduced efficiency on this task. In comparison to male controls, female residents received consistently lower surgical skills ratings, particularly on items measuring confidence and task organization. Left-handed residents were more reactive to stress (p less than 0.03), more cautious (p less than 0.04), and more proficient on a neuropsychologic test of tactile-spatial abilities (p less than 0.03) than right-handed counterparts. Although these traits correlated positively (p less than 0.05) with rated operative skill within the left-handed group, the group received consistently lower ratings than did right-handed residents. The inconvenience of assisting left-handed residents may overshadow attending surgeons' perceptions of their innate abilities. These findings demonstrate significant, neuropsychologically based differences among surgery residents that pose unique challenges to persons responsible for their selection and training.
在141名完成了视觉空间、心理运动和应激耐受力神经心理测试，并在1480例手术过程中展现出的12项技术技能方面得到评分的住院医师群体中，按照年龄、性别或用手偏好挑选出匹配的普通外科住院医师组，对其能力模式和手术熟练程度进行了研究。年龄较大的住院医师（28至42岁）与年轻住院医师相比，表现出较低的运动速度（p<0.05）和协调性（p<0.005），并且在避免心理运动错误方面更加谨慎（p<0.05）。在视觉空间能力、应激耐受力或评定的手术技能方面未发现差异。这些发现表明，尽管年龄似乎确实会对单纯的运动技能产生不利影响，但这些并非手术熟练程度的重要组成部分。与男性住院医师相比，女性住院医师在学业成绩（医学院入学考试、语言部分和国家医师资格考试第二部分）方面表现更优（p<0.05）。她们在一项需要识别视觉模式的信号检测任务中也表现出色。然而，在一项被证明是手术技能重要预测指标的视觉运动任务中，女性的得分低于男性（p<0.05）。在避免错误方面更加谨慎可能是她们在这项任务中效率降低的一个促成因素。与男性对照组相比，女性住院医师在手术技能评定中得分一直较低，尤其是在衡量信心和任务组织的项目上。与右利手住院医师相比，左利手住院医师对应激反应更强烈（p<0.03），更谨慎（p<0.04），并且在触觉空间能力的神经心理测试中表现更熟练（p<0.03）。尽管这些特质在左利手组内与评定的手术技能呈正相关（p<0.05），但该组的评分一直低于右利手住院医师。协助左利手住院医师的不便之处可能会掩盖主刀医生对他们先天能力的看法。这些发现表明，外科住院医师之间存在基于神经心理学的显著差异，这给负责他们选拔和培训的人员带来了独特的挑战。
