Gaze training enhances laparoscopic technical skill acquisition and multi-tasking performance: a randomized, controlled study

Abstract

BackgroundThe operating room environment is replete with stressors and distractions that increase the attention demands of what are already complex psychomotor procedures. Contemporary research in other fields (e.g., sport) has revealed that gaze training interventions may support the development of robust movement skills. This current study was designed to examine the utility of gaze training for technical laparoscopic skills and to test performance under multitasking conditions.MethodsThirty medical trainees with no laparoscopic experience were divided randomly into one of three treatment groups: gaze trained (GAZE), movement trained (MOVE), and discovery learning/control (DISCOVERY). Participants were fitted with a Mobile Eye gaze registration system, which measures eye-line of gaze at 25 Hz. Training consisted of ten repetitions of the “eye-hand coordination” task from the LAP Mentor VR laparoscopic surgical simulator while receiving instruction and video feedback (specific to each treatment condition). After training, all participants completed a control test (designed to assess learning) and a multitasking transfer test, in which they completed the procedure while performing a concurrent tone counting task.ResultsNot only did the GAZE group learn more quickly than the MOVE and DISCOVERY groups (faster completion times in the control test), but the performance difference was even more pronounced when multitasking. Differences in gaze control (target locking fixations), rather than tool movement measures (tool path length), underpinned this performance advantage for GAZE training.ConclusionsThese results suggest that although the GAZE intervention focused on training gaze behavior only, there were indirect benefits for movement behaviors and performance efficiency. Additionally, focusing on a single external target when learning, rather than on complex movement patterns, may have freed-up attentional resources that could be applied to concurrent cognitive tasks.

Gaze training improves the retention and transfer of laparoscopic technical skills in novices

“…Participants were assigned to one of two treatment groups as discussed below. Previous research has revealed significant differences in performance under pressure between gaze training and discovery learning interventions with group sizes of 10 (t(19) = 4.86, p \ .001, Cohen's d = 2.17) [6]. We are therefore confident that the larger group sizes in the current study have sufficient power to show significant effects across delayed retention and transfer tasks.…”

“…Participants were assigned to one of two training groups: gaze training (GT) and discovery learning (DL) adapted from previous gaze-training research [6,7]. The GT group (n = 18) were shown a video of an expert's gaze control during completion of the ball pick and drop task.…”

“…This more efficient gaze control strategy has been shown to underpin superior laparoscopic performance: Not only in cross sectional comparisons between experts and novices, but also in training studies. Novices taught to model expert-like gaze strategies acquired laparoscopic skills more quickly than counterparts taught to model expert-like tool movements or to learn by discovery (no instructions) [6,7].…”

“…The limited research to date that has examined the effectiveness of gaze training has shown that it provides benefits in terms of resilience to such stress, compared to more traditional approaches [6,7]. It has been proposed that the focus on controlling only one component of the skill-accurate gaze-reduces the attentional demands for novices, allowing them to learn the skill more quickly and have resources available to deal with stressful scenarios [6,7,[10][11][12]. However, two other important criteria for effective training are the degree to which learning remains stable beyond the training period (retention), and the degree to which the skills learned actually translate to more complex skills (transfer) [1,13,14].…”

“…Although previous research has established benefits in terms of expedited skill acquisition and robustness under pressure [6,7], the current study seeks to test if gaze training stands the test of time (via a delayed retention test) and transfers to a more complex task. We derived the following hypotheses in relation to the expected benefits of gaze training compared to an appropriate control.…”