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Published in: Surgical Endoscopy 9/2016

Open Access 01-09-2016

Multitask training promotes automaticity of a fundamental laparoscopic skill without compromising the rate of skill learning

Authors: Jamie M. Poolton, Frank F. Zhu, Neha Malhotra, Gilberto K. K. Leung, Joe K. M. Fan, Rich S. W. Masters

Published in: Surgical Endoscopy | Issue 9/2016

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Abstract

Background

A defining characteristic of expertise is automated performance of skills, which frees attentional capacity to better cope with some common intraoperative stressors. There is a paucity of research on how best to foster automated performance by surgical trainees. This study examined the use of a multitask training approach to promote automated, robust laparoscopic skills.

Methods

Eighty-one medical students completed training of a fundamental laparoscopic task in either a traditional single-task training condition or a novel multitask training condition. Following training, participants’ laparoscopic performance was tested in a retention test, two stress transfer tests (distraction and time pressure) and a secondary task test, which was included to evaluate automaticity of performance. The laparoscopic task was also performed as part of a formal clinical examination (OSCE).

Results

The training groups did not differ in the number of trials required to reach task proficiency (p = .72), retention of skill (ps > .45), or performance in the clinical examination (p = .14); however, the groups did differ with respect to the secondary task (p = .016). The movement efficiency (number of hand movements) of single-task trainees, but not multitask trainees, was negatively affected during the secondary task test. The two stress transfer tests had no discernable impact on the performance of either training group.

Conclusion

Multitask training was not detrimental to the rate of learning of a fundamental laparoscopic skill and added value by providing resilience in the face of a secondary task load, indicative of skill automaticity. Further work is needed to determine the extent of the clinical utility afforded by multitask training.
Footnotes
1
Consistent with recent research [23], the number of trials required by participants in the single-task training condition to reach proficiency was a significant predictor (F(1, 39) = 15.73, p < .001, with an R 2 of .287) of task completion time in the OSCE, implying that laparoscopic ability had a significant bearing on the retention of laparoscopic performance under clinical examination conditions. Interestingly, this was not the case following multitask training, suggesting that a secondary benefit of the training intervention is that it suppresses individual differences. The implication for surgical education is that an individual’s motor competency does not have to be a prerequisite for (self-) selection onto a surgical practice pathway if multitask training is put into practice.
 
2
The tone-counting accuracy of participants in the single-task training condition (Mdn = 97.50 %) and the multitask training condition (Mdn = 98.00 %) was not significantly different (U = 827.50, z = 0.08, p = 0.94, r < 0.01).
 
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Metadata
Title
Multitask training promotes automaticity of a fundamental laparoscopic skill without compromising the rate of skill learning
Authors
Jamie M. Poolton
Frank F. Zhu
Neha Malhotra
Gilberto K. K. Leung
Joe K. M. Fan
Rich S. W. Masters
Publication date
01-09-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4713-9

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