title: Gaze training enhances laparoscopic technical skill acquisition and multi-tasking performance: a randomized, controlled study.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  Thirty 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.
  
  
  RESULTS
  Not 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.
  
  
  CONCLUSIONS
  These 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.
authors.affiliation: College of Life and Environmental Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK. Mark.Wilson@exeter.ac.uk
authors.forename: Mark R
authors.initials: MR
authors.lastname: Wilson
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Vine
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bright
authors.forename: Rich S W
authors.initials: RS
authors.lastname: Masters
authors.forename: David
authors.initials: D
authors.lastname: Defriend
authors.forename: John S
authors.initials: JS
authors.lastname: McGrath
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002983:Clinical Competence / Q000592:standards*; D004501:Education, Medical / Q000379:methods*; D005260:Female; D005403:Fixation, Ocular / Q000502:physiology*; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D007858:Learning / Q000502:physiology; D008297:Male; D011597:Psychomotor Performance / Q000502:physiology*; D013663:Teaching / Q000379:methods*; D055815:Young Adult