title: Significance of metacognitive skills in laparoscopic surgery assessed by essential task simulation.
abstract: BACKGROUND
  Metacognition is the knowledge about one's own methods of perceiving, remembering, thinking, and acting. This study determined the significance of metacognitive skills in laparoscopic surgery with the aim of applying the findings in a laparoscopic surgery training program.
  
  
  METHODS
  Eighteen medical students with no experience in laparoscopic surgery (novice group) and eight expert surgeons who had each performed >100 laparoscopic surgeries (expert group) were enrolled. The examinees in each group performed an evaluation task using a virtual reality simulator and answered questions about the task.
  
  
  RESULTS
  The longest performance times, longest path lengths, and most frequent tissue damage occurred at 135° in the novice group and at 180° in the expert group. The greatest recognition of task difficulties, impatience, and irritation occurred at 135° in the novice group and at 180° in the expert group. There were statistically significant correlation coefficients between the instrument path length and task difficulty (metacognition) at 135° (R = 0.74, p = 0.03) and 180° (R = 0.79, p = 0.02) in the expert group, but there were no significant correlations in the novice group.
  
  
  CONCLUSIONS
  We elucidated the significance of metacognitive skills in laparoscopic surgery. A training program should include recognition feedback systems.
authors.affiliation: Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University , Kyushu , Japan.
authors.forename: Munenori
authors.initials: M
authors.lastname: Uemura
authors.forename: Morimasa
authors.initials: M
authors.lastname: Tomikawa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nagao
authors.forename: Natsumi
authors.initials: N
authors.lastname: Yamashita
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kumashiro
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsutsumi
authors.forename: Kenoki
authors.initials: K
authors.lastname: Ohuchida
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ieiri
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ohdaira
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashizume
mesh_terms: D002983:Clinical Competence; D003071:Cognition; D003198:Computer Simulation; D004501:Education, Medical / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D013337:Students, Medical / Q000523:psychology; D013647:Task Performance and Analysis; D013997:Time Factors; D014584:User-Computer Interface
keywords: Clinical skills; laparoscopic surgery; metacognitive skills; training; virtual reality simulator