Use of prefrontal cortex activity as a measure of learning curve in surgical novices: results of a single blind randomis
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and Other Interventional Techniques
2019 EAES ORAL
Use of prefrontal cortex activity as a measure of learning curve in surgical novices: results of a single blind randomised controlled trial Howard C. H. Khoe1 · Jun Wei Low1 · Sujith Wijerathne2 · Lui Su Ann2 · Hrishikesh Salgaonkar2 · Davide Lomanto2 · JongKwan Choi3 · JiYeong Baek3 · Wilson W. Tam4 · Ho Pei5 · Roger C. M. Ho6,7,8,9 Received: 9 July 2019 / Accepted: 24 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Neurobiological feedback in surgical training could translate to better educational outcomes such as measures of learning curve. This work examined the variation in brain activation of medical students when performing laparoscopic tasks before and after a training workshop, using functional near-infrared spectroscopy (fNIRS). Methods and procedures This single blind randomised controlled trial examined the prefrontal cortex activity (PFCA) differences in two groups of novice medical students during the acquisition of four laparoscopic tasks. Both groups were shown a basic tutorial video, with the “Trained-group” receiving an additional standardised one-to-one training on the tasks. The PFCA was measured pre- and post-intervention using a portable fNIRS device and reported as mean total oxygenated hemoglobin (HbOµm). Primary outcome of the study is the difference in HbOµm between post- and pre-intervention readings for each of the four laparoscopic tasks. The pre- and post-intervention laparoscopic tasks were recorded and assessed by two blinded individual assessors for objective scores of the performance. Results 16 Trained and 16 Untrained, right-handed medical students with an equal sex distribution and comparable age distribution were recruited. Trained group had an attenuated left PFCA in the “Precision cutting” (p = 0.007) task compared to the Untrained group. Subgroup analysis by sex revealed attenuation in left PFCA in Trained females compared to Untrained females across two laparoscopic tasks: “Peg transfer” (p = 0.005) and “Precision cutting” (p = 0.003). No significant PFCA attenuation was found in male students who underwent training compared to Untrained males. Conclusion A standardised laparoscopic training workshop promoted greater PFCA attenuation in female medical students compared to males. This suggests that female and male students respond differently to the same instructional approach. Implications include a greater focus on one-to-one surgical training for female students and use of PFCA attenuation as a form of neurobiological feedback in surgical training. Keywords Functional near-infrared spectroscopy (fNIRS) · Laparoscopic skill · Prefrontal cortex · Cortical activation · Sex differences · Medical education With technological advances, minimally invasive surgery has since become the preferred surgical approach due to reduced surgical trauma by using smaller incisions. Unlike open surgical approaches, laparoscopic surgery is considered technically difficult due to
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