Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA...
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Transcript of Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA...
![Page 1: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/1.jpg)
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‡
![Page 2: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/2.jpg)
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)
![Page 3: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/3.jpg)
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?
![Page 4: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/4.jpg)
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% ♀)
![Page 5: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/5.jpg)
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
![Page 6: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/6.jpg)
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
![Page 7: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/7.jpg)
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
![Page 8: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/8.jpg)
Rapid Visual Information Processing (RVIP)
• Test of sustained attention with a small working memory component
• Measures stimulus response time and accuracy (% correct hits)
![Page 9: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/9.jpg)
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
![Page 10: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/10.jpg)
Results – Reaction Time Task
Subject age range
Res
pon
se ti
me
(sec
onds
)0
50
100
150
200
250
300
350
400
450
20-35 years 45-60 years 61-75 years
*p<0.05
Subject age range
Mov
emen
t tim
e (s
econ
ds)
0
100
200
300
400
500
600
20-35 years 45-60 years 61-75 years
*p<0.05
RTI – Total Movement Time RTI – Total Reaction Time
![Page 11: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/11.jpg)
Results – Rapid Visual Information Processing
Subject age range
Acc
urac
y ra
te -
% c
orre
ct h
its0
20
40
60
80
100
20-35 years 45-60 years 61-75 years
*p<0.05
Subject age range
Res
pon
se ti
me
(sec
onds
)
0
100
200
300
400
500
600
20-35 years 45-60 years 61-75 years
*p<0.05
RVIP – Percent Correct HitsRVIP – Stimulus response time
![Page 12: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/12.jpg)
Results – Paired Associates Learning (Visual Memory)
Subject age range
Sta
ges
com
plet
ed
first
tria
l (#)
0
1
2
3
4
5
20-35 years 45-60 years 61-75 years
*p<0.05
PAL – Stages completed on first trial PAL – Total adjusted errors
Subject age range
To
tal a
dju
sted
err
ors
(#)
0
10
20
30
40
20-35 years 45-60 years 61-75 years
*p<0.05
![Page 13: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/13.jpg)
Surgeon Group versus NormsRTI – Total Movement Time
Subject age range
Mov
emen
t tim
e (s
econ
ds)
0
100
200
300
400
500
600
700
800Surgeon groupNormative controls
20-35 years 45-60 years 61-75 years
* **
![Page 14: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/14.jpg)
Surgeon Group versus NormsRTI – Total Reaction Time
Subject age range
Res
pon
se ti
me
(se
cond
s)
0
100
200
300
400
500Surgeon groupNormative controls
20-35 years 45-60 years 61-75 years
* *
![Page 15: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/15.jpg)
Surgeon Group versus NormsRVIP – Accuracy Rate
Subject age range
Acc
urac
y ra
te -
% c
orre
ct h
its
0102030405060708090
100Surgeon groupNormative controls
20-35 years 45-60 years 61-75 years
**
![Page 16: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/16.jpg)
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
![Page 17: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/17.jpg)
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
![Page 18: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/18.jpg)
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
![Page 19: Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill.](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e3f5503460f94b30604/html5/thumbnails/19.jpg)
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