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.
Similar content being viewed by others
References
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 17:1082–1085
Schueneman AL, Pickleman J, Freeark RJ (1985) Age, gender, lateral dominance, and prediction of operative skill among general surgery residents. Surgery 98:506–515
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 22:1686–1689
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 22:31–37
Stabile BE (2008) The surgeon: a changing profile. Arch Surg 143:827–831
Gibbons R, Baker R, Skinner D (1986) Field articulation testing: a predictor of technical skills in surgical residents. J Surg Res 41:53–57
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 39:150–152
Risucci D, Geiss A, Gellman L, Pinard B, Rosser J (2001) Surgeon-specific factors in the acquisition of laparoscopic surgical skills. Am J Surg 173:326–329
Schueneman A, Pickleman J, Hesslein R, Freeark R (1984) Neuropsychologic predictors of operative skill among general surgery residents. Surgery 96:288–295
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 177:274–277
Cook JA, Ramsay CR, Fayers P (2007) Using the literature to quantify the learning curve: a case study. Int J Tech Assess 23(2):255–260
Heathcote A, Brown S, Mewhort DJK (2000) The power law repealed: the case for an exponential law of practice. Psychon Bull Rev 7:185–207
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 5:1–79
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):381–386
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 525-518
Fried GM (2008) FLS assessment of competency using simulated laparoscopic tasks. J Gastrointest Surg 12:210–212
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 20:744–747
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 17:964–967
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
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 22:1887–1893
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 131:217–221
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 17:1468–1471
Madan AK, Frantzides CT, Park WC, Tebbit CL, Kumari NV, O’Leary PJ (2005) Predicting baseline laparoscopic surgery skills. Surg Endosc 19:101–104
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):252–262
Rosenberg BH, Landsittel D, Averch TD (2005) Can video games be used to predict or improve laparoscopic skills? J Endourol 19(3):372–376
Pintrich PR (1999) The role of motivation in promoting and sustaining self-regulated learning. Int J Educ Res 31:459–470
Dev PC (1997) Intrinsic motivation and academic achievement. Rem Spec Educ 18(1):12–19
Wanzel KR, Ward M, Reznick RK (2002) Teaching the surgical craft: from selection to certification. Curr Probl Surg 39:573–660
Wanzel KR, Hamstra SJ, Anastakis DJ, Matsumoto ED, Cusimano MD (2002) Effect of visual-spatial ability on learning of spatially-complex surgical skills. Lancet 359:230–231
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):750–757
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):368–372
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):489–496
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 188:71–75
Green CS, Bavelier D (2003) Action video game modifies visual selective attention. Nature 423:534–537
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kolozsvari, N.O., Andalib, A., Kaneva, P. et al. Sex is not everything: the role of gender in early performance of a fundamental laparoscopic skill. Surg Endosc 25, 1037–1042 (2011). https://doi.org/10.1007/s00464-010-1311-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-1311-8