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Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists

Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists. Z Boom-Saad*, SA Langenecker † , LA Bieliauskas † , C Graver † , J O’Neill † , A Caveney † , PG Gauger* ‡ , LJ Greenfield*, and RM Minter* ‡ Departments of Surgery*, Neuropsychology † ,

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Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists

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  1. Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker†, LA Bieliauskas†, C Graver†, J O’Neill†, A Caveney†, PG Gauger*‡, LJ Greenfield*, and RM Minter*‡ Departments of Surgery*, Neuropsychology†, and Medical Education‡

  2. Background • Variation exists with respect to psychomotor and procedural learning capabilities • Preliminary work by our group demonstrated that practicing surgeons outperformed normative controls on a series of neuropsychological tests – Cambridge Neuropsychological Test Automated Battery (CANTAB)

  3. Research Question Do surgeons outperform normative controls due to experience gained during surgical training, or is this difference present at baseline in those individuals drawn to a surgical career?

  4. Methods • 308 practicing surgeons age 45-75 years performed a battery of CANTAB tests at the American College of Surgeons Meeting (2001-2004) • 21 medical students ( age 24-35 years) entering General or Plastic Surgery or Urology residency performed the same tests (2005-2006) • For analysis, subjects were divided into three age groups • 20-35 yrs (medical students, n=21, 28% ♀) • 45-60 yrs (practicing surgeons, n=139, 18% ♀) • 61-75 yrs (practicing surgeons, n=169, 1.8% ♀)

  5. Methods • Performance was compared between surgeon groups as well as to age-matched normative comparison groups • IQ of 120 was selected for normative comparison for all groups • ANOVA was used for comparing group performance and post-hoc analysis was performed using least squares difference • Significance was set at p<0.05 • Study was approved by the University of Michigan Institutional Review Board

  6. CANTAB • CANTAB battery of tests • Reaction time and efficiency of motion (RTI) • Rapid visual information processing (RVIP) • Visual memory and rapid learning index (PAL) • Uses a touchscreen so effect of prior computer experience is minimized • CANTAB provides age-matched normative control subject data against which performance can be compared

  7. Reaction Time Task (RTI) • Subject must release pad in response to a visual stimulus • Release time and time to target is measured • Measures efficiency of motion and response time

  8. Rapid Visual Information Processing (RVIP) • Test of sustained attention with a small working memory component • Measures stimulus response time and accuracy (% correct hits)

  9. Paired Associates Learning (PAL) • Test of attention and visual memory – an index of rapid learning • Measures how a subject processes visually complex information • Performance recorded as overall accuracy on task

  10. Results – Reaction Time Task RTI – Total Movement Time RTI – Total Reaction Time

  11. Results – Rapid Visual Information Processing RVIP – Stimulus response time RVIP – Percent Correct Hits

  12. Results – Paired Associates Learning (Visual Memory) PAL – Stages completed on first trial PAL – Total adjusted errors

  13. Surgeon Group versus NormsRTI – Total Movement Time

  14. Surgeon Group versus NormsRTI – Total Reaction Time

  15. Surgeon Group versus NormsRVIP – Accuracy Rate

  16. Summary • Decline in visual memory and psychomotor performance occurs with advancing age • Improved performance on the selected CANTAB tests by the surgeon groups appears to be a factor which is present at baseline and is not a result of surgical training

  17. Limitations of Study • These tests do not account for the effect of experience on procedural learning ability • Subjects did not undergo IQ testing so exact normative control comparisons could not be made • Medical student group was limited in size and to one institution – expansion of this group would strengthen the study

  18. Conclusions • Older surgeons may require additional trials for mastery of visually complex surgical procedures as compared to younger surgeons • CANTAB may be a useful construct for evaluating residents who appear to have difficulty with visual memory psychomotor performance

  19. Acknowledgements • Dr. Lazar Greenfield • Drs. Scott Langenecker and Linas Bieliauskas • Association for Surgical Education Foundation’s Center for Excellence in Surgical Education, Research, and Training (CESERT) Grant

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