Surgical Endoscopy

, Volume 25, Issue 4, pp 1037–1042 | Cite as

Sex is not everything: the role of gender in early performance of a fundamental laparoscopic skill

  • Nicoleta O. Kolozsvari
  • Amin Andalib
  • Pepa Kaneva
  • Jiguo Cao
  • Melina C. Vassiliou
  • Gerald M. Fried
  • Liane S. Feldman
Article

Abstract

Background

Existing literature on the acquisition of surgical skills suggests that women generally perform worse than men. This literature is limited by looking at an arbitrary number of trials and not adjusting for potential confounders. The objective of this study was to evaluate the impact of gender on the learning curve for a fundamental laparoscopic task.

Methods

Thirty-two medical students performed the FLS peg transfer task and their scores were plotted to generate a learning curve. Nonlinear regression was used to estimate learning plateau and learning rate. Variables that may affect performance were assessed using a questionnaire. Innate visual-spatial abilities were evaluated using tests for spatial orientation, spatial scanning, and perceptual abilities. Score on first peg transfer attempt, learning plateau, and learning rate were compared for men and women using Student’s t test. Innate abilities were correlated to simulator performance using Pearson’s coefficient. Multivariate linear regression was used to investigate the effect of gender on early laparoscopic performance after adjusting for factors found significant on univariate analysis. Statistical significance was defined as P < 0.05.

Results

Nineteen men and 13 women participated in the study; 30 were right-handed, 12 reported high interest in surgery, and 26 had video game experience. There were no differences between men and women in initial peg transfer score, learning plateau, or learning rate. Initial peg transfer score and learning rate were higher in subjects who reported having a high interest in surgery (P = 0.02, P = 0.03). Initial score also correlated with perceptual ability score (P = 0.03). In multivariate analysis, only surgical interest remained a significant predictor of score on first peg transfer (P = 0.03) and learning rate (P = 0.02), while gender had no significant relationship to early performance.

Conclusions

Gender did not affect the learning curve for a fundamental laparoscopic task, while interest in surgery and perceptual abilities did influence early performance.

Keywords

FLS Laparoscopy Learning curve Gender Visual-spatial ability Interest in surgery 

Notes

Acknowledgments

We thank the McGill medical and dental students who participated in this study. The Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation receives an unrestricted educational grant from Covidien. Dr. Kolozsvari receives salary support from the McGill Surgeon Scientist program.

Disclosures

Drs. N. O. Kolozsvari, A. Andalib, J. Cao, M. C. Vassiliou, G. M. Fried, and L. S. Feldman and Ms. P. Kaneva have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J (2003) Impact of hand dominance, gender, and experience with computer games on performance in virtual reality laparoscopy. Surg Endosc 17:1082–1085PubMedCrossRefGoogle Scholar
  2. 2.
    Schueneman AL, Pickleman J, Freeark RJ (1985) Age, gender, lateral dominance, and prediction of operative skill among general surgery residents. Surgery 98:506–515PubMedGoogle Scholar
  3. 3.
    Madan AK, Harper JL, Frantzides CT, Tichansky DS (2008) Nonsurgical skills do not predict baseline scores in inanimate box or virtual-reality trainers. Surg Endosc 22:1686–1689PubMedCrossRefGoogle Scholar
  4. 4.
    Elneel FH, Carter F, Tang B, Cuschieri A (2008) Extent of innate dexterity and ambidexterity across handedness and gender: implications for training in laparoscopic surgery. Surg Endosc 22:31–37PubMedCrossRefGoogle Scholar
  5. 5.
    Stabile BE (2008) The surgeon: a changing profile. Arch Surg 143:827–831PubMedCrossRefGoogle Scholar
  6. 6.
    Gibbons R, Baker R, Skinner D (1986) Field articulation testing: a predictor of technical skills in surgical residents. J Surg Res 41:53–57PubMedCrossRefGoogle Scholar
  7. 7.
    Murdoch J, Bainbridge L, Fisher S, Webster M (1994) Can a simple test of visual-motor skill predict the performance of microsurgeons? J R Coll Surg Edinb 39:150–152PubMedGoogle Scholar
  8. 8.
    Risucci D, Geiss A, Gellman L, Pinard B, Rosser J (2001) Surgeon-specific factors in the acquisition of laparoscopic surgical skills. Am J Surg 173:326–329Google Scholar
  9. 9.
    Schueneman A, Pickleman J, Hesslein R, Freeark R (1984) Neuropsychologic predictors of operative skill among general surgery residents. Surgery 96:288–295PubMedGoogle Scholar
  10. 10.
    Macmillan AIM, Cuschieri A (1999) Assessment of innate ability and skills for endoscopic manipulations by the advanced Dundeed Endoscopic Psychomotor Tester: predictive and concurrent validity. Am J Surg 177:274–277PubMedCrossRefGoogle Scholar
  11. 11.
    Cook JA, Ramsay CR, Fayers P (2007) Using the literature to quantify the learning curve: a case study. Int J Tech Assess 23(2):255–260Google Scholar
  12. 12.
    Heathcote A, Brown S, Mewhort DJK (2000) The power law repealed: the case for an exponential law of practice. Psychon Bull Rev 7:185–207PubMedCrossRefGoogle Scholar
  13. 13.
    Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT (2001) Statistical assessment of the learning curves of health technologies. Health Technol Assess 5:1–79PubMedGoogle Scholar
  14. 14.
    Feldman LS, Cao J, Andalib A, Fraser S, Fried GM (2009) A method to characterize the learning curve for performance of a fundamental laparoscopic simulator task: defining “learning plateau” and “learning rate”. Surgery 46(2):381–386CrossRefGoogle Scholar
  15. 15.
    Fried GM, Feldman LS, Vassiliou MC, Fraser SA, Stanbridge D, Ghitulescu G, Andrew CG (2004) Proving the value of simulation in laparoscopic surgery. Ann Surg 240:518–525; discussion 525-518PubMedCrossRefGoogle Scholar
  16. 16.
    Fried GM (2008) FLS assessment of competency using simulated laparoscopic tasks. J Gastrointest Surg 12:210–212PubMedCrossRefGoogle Scholar
  17. 17.
    Vassiliou MC, Ghitulescu GA, Feldman LS, Stanbridge D, Leffondre K, Sigman HH, Fried GM (2006) The MISTELS program to measure technical skill in laparoscopic surgery: evidence for reliability. Surg Endosc 20:744–747PubMedCrossRefGoogle Scholar
  18. 18.
    Fraser SA, Klassen DR, Feldman LS, Ghitulescu GA, Stanbridge D, Fried GM (2003) Evaluating laparoscopic skills: setting the pass/fail score for the MISTELS system. Surg Endosc 17:964–967PubMedCrossRefGoogle Scholar
  19. 19.
    Society of American Gastrointestinal and Endoscopic Surgeons (2003–2008) Fundamentals of laparoscopic surgery: technical skills proficiency-based training curriculum. Available at http://www.flsprogram.org/index.php. Accessed 1 November 2009
  20. 20.
    Scott DJ, Ritter EM, Tesfay ST, Pimentel EA, Nagji A, Fried GM (2008) Certification pass rate of 100% for fundamentals of laparoscopic surgery skills after proficiency-based training. Surg Endosc 22:1887–1893PubMedCrossRefGoogle Scholar
  21. 21.
    Arora H, Uribe J, Ralph W, Zeltsan M, Cuellar H, Gallagher AG, Fried MP (2005) Assessment of construct validity of the endoscopic surgery simulator. Arch Otolaryngol Head Neck Surg 131:217–221PubMedCrossRefGoogle Scholar
  22. 22.
    Gallagher A, Cowie R, Crothers I, Jordan-Black J, Satava R (2003) PicSOr: an objective test of perceptual skill that predicts laparoscopic technical skill in three initial studies of laparoscopic performance. Surg Endosc 17:1468–1471PubMedCrossRefGoogle Scholar
  23. 23.
    Madan AK, Frantzides CT, Park WC, Tebbit CL, Kumari NV, O’Leary PJ (2005) Predicting baseline laparoscopic surgery skills. Surg Endosc 19:101–104PubMedCrossRefGoogle Scholar
  24. 24.
    Stefanidis D, Korndorffer JR Jr, Black FW, Dunne JB, Sierra R, Touchard CL, Rice DA, Markert RJ, Kastl PR, Scott DJ (2006) Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training. Surgery 140(2):252–262PubMedCrossRefGoogle Scholar
  25. 25.
    Rosenberg BH, Landsittel D, Averch TD (2005) Can video games be used to predict or improve laparoscopic skills? J Endourol 19(3):372–376PubMedCrossRefGoogle Scholar
  26. 26.
    Pintrich PR (1999) The role of motivation in promoting and sustaining self-regulated learning. Int J Educ Res 31:459–470CrossRefGoogle Scholar
  27. 27.
    Dev PC (1997) Intrinsic motivation and academic achievement. Rem Spec Educ 18(1):12–19CrossRefGoogle Scholar
  28. 28.
    Wanzel KR, Ward M, Reznick RK (2002) Teaching the surgical craft: from selection to certification. Curr Probl Surg 39:573–660PubMedCrossRefGoogle Scholar
  29. 29.
    Wanzel KR, Hamstra SJ, Anastakis DJ, Matsumoto ED, Cusimano MD (2002) Effect of visual-spatial ability on learning of spatially-complex surgical skills. Lancet 359:230–231PubMedCrossRefGoogle Scholar
  30. 30.
    Wanzel KR, Hamstra SJ, Caminiti MF, Anastakis DJ, Grober ED, Reznick RK (2003) Visual-spatial ability correlates with efficiency of hand motion and successful surgical performance. Surgery 134(5):750–757PubMedCrossRefGoogle Scholar
  31. 31.
    Risucci D, Geiss A, Gellman L, Pinard B, Rosser J (2000) Experience and visual perception in resident acquisition of laparoscopic skills. Curr Surg 57(4):368–372PubMedCrossRefGoogle Scholar
  32. 32.
    Gettman MT, Kondraske GV, Traxer O, Ogan K, Napper C, Jones DB, Pearle MS, Cadeddu JA (2003) Assessment of basic human performance resources predicts operative perdormance of laparoscopic surgery. J Am Coll Surg 197(3):489–496PubMedCrossRefGoogle Scholar
  33. 33.
    Keehner MM, Tendick F, Meng MV, Anwar HP, Hegarty M, Stoller M, Duh Q-Y (2004) Spatial ability, experience, and skill in laparoscopic surgery. Am J Surg 188:71–75PubMedCrossRefGoogle Scholar
  34. 34.
    Green CS, Bavelier D (2003) Action video game modifies visual selective attention. Nature 423:534–537PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Nicoleta O. Kolozsvari
    • 1
  • Amin Andalib
    • 1
  • Pepa Kaneva
    • 1
  • Jiguo Cao
    • 2
  • Melina C. Vassiliou
    • 1
  • Gerald M. Fried
    • 1
  • Liane S. Feldman
    • 1
  1. 1.Steinberg-Bernstein Centre for Minimally Invasive Surgery and InnovationMcGill UniversityMontrealCanada
  2. 2.Department of Statistics and Actuarial ScienceSimon Fraser UniversityBurnabyCanada

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