The next level : video gaming, cognition and motivation in surgical simulator training

Abstract

Image guided surgery uses small incisions or existing entry ports of the body in order to decrease surgical trauma which will hopefully lead to less infections, complications and number of days needed in the hospital. It is associated with great difficulties and a steep learning curve due to several reasons such as inverted movements and 2D representation of the operating area. In order to excel in minimal invasive surgery a large amount of training is required which has spurred the rise of virtual reality (VR) surgical simulators offering a safe training environment with the possibility of customized scenarios and quantifiable feedback.

Another advantage with VR simulators is easily conducted research due to objective assessment of performance and standardized task content and scenarios. Previous research has identified visual-spatial ability, the ability to mentally rotate and manipulate objects as well as visual working memory, the ability to hold visual information during a delay and recall that information, to be important for simulator training and performance. Video gaming experience has also been identified as an important background factor.

This thesis consists of work derived from four studies that all take advantage of VR simulators as a tool for investigating which individual factors are needed for performance and training of minimal invasive surgery and whether or not they can be altered.

In the first study the hypothesis was that the importance of visual-spatial ability (VSA) and visual working memory (VWM) would differ with different simulator task content. 25 subjects were tested for VSA, VWM and performance in three different simulators. A multivariate analysis showed that the importance differed; one task seemed to be more visually loaded than the others.

That result was followed up in study II that examined whether it was possible to actually improve simulator performance by video game training and if the transfer effect differed according to simulator and video game task content. 30 subjects were matched and randomized into training with a 2D chess game or a 3D first person shooter game for five weeks, pre and post training subjects were tested with two different simulators. A control group consisting of 10 subjects was also tested. There was a transfer effect, surprisingly also from the 2D game.

Suspicions about a general cognitive workload lead to the aim in study III that investigated whether simulator performance would predict written examinations results. 158 subjects were tested in a simulator and a written examination in basic surgery.

There was a performanceexamination correlation in female but not male subjects, which lead to study IV that investigated the role of motivation for surgical performance. In study IV, 30 subjects were tested for motivation while training in a surgical simulator. Motivation as defined by the selfdetermination theory correlated only in male subjects to performance when highly motivated medical students were examined. It appeared to be less important for performance than visual spatial ability. Training in surgical simulators enhanced subjects’ interest in choosing surgery as a future work field.

The thesis identifies the importance of certain background factors and suggests alternate means of minimal invasive training that will meet the requirements of tomorrow´s surgeons, taking surgical training to the next level.