title: Visual control strategies of surgeons: a novel method of establishing the construct validity of a transurethral resection of the prostate surgical simulator.
abstract: OBJECTIVE
  To examine novice and expert differences in visual control strategies while performing a virtual reality transurethral resection of the prostate (TURP) task and to determine if these differences could provide a novel method for assessing construct validity of the simulator.
  
  
  METHODS
  A total of 11 novices (no TURP experience) and 7 experts (>200 TURPs) completed a virtual reality prostate resection task on the TURPsim (Simbionix USA Corp, Cleveland, OH) while wearing an eye tracker (ASL, Bedford, MA). Performance parameters and the surgeon's visual control strategy were measured and compared between the 2 groups.
  
  
  RESULTS
  Experts resected a greater percentage of prostate than novices (p < 0.01) and had less active diathermy time without tissue contact (p < 0.01). Experts adopted a target-locking visual strategy, employing fewer visual fixations (p < 0.05) with longer mean fixation duration (p < 0.005). With multiple learning trials, novices' performance improved and the adoption of a more expertlike gaze strategy was observed.
  
  
  CONCLUSIONS
  Significant differences between experts and novices in both performance and visual control strategy were observed. The study of visual control strategies may be a useful adjunct, alongside measurements of motor performance, providing a novel method of assessing the construct validity of surgical simulators.
authors.affiliation: Exeter Surgical Health Services Research Unit, Royal Devon & Exeter NHS Foundation Trust, Devon, United Kingdom. Electronic address: ebright9@gmail.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bright
authors.affiliation: College of Life and Environmental Sciences, University of Exeter, St Luke's Campus, Devon, United Kingdom.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Vine
authors.affiliation: Exeter Surgical Health Services Research Unit, Royal Devon & Exeter NHS Foundation Trust, Devon, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Dutton
authors.affiliation: College of Life and Environmental Sciences, University of Exeter, St Luke's Campus, Devon, United Kingdom.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Wilson
authors.affiliation: Exeter Surgical Health Services Research Unit, Royal Devon & Exeter NHS Foundation Trust, Devon, United Kingdom.
authors.forename: John S
authors.initials: JS
authors.lastname: McGrath
mesh_terms: D003198:Computer Simulation / Q000592:standards*; D006801:Humans; D008297:Male; D020728:Transurethral Resection of Prostate / Q000592:standards*; D014584:User-Computer Interface
keywords: Patient Care; Practice-Based Learning and Improvement; Professionalism; construct validity; surgical simulation; surgical training; transurethral resection of the prostate