title: Individual differences in field independence influence the ability to determine accurate needle angles.
abstract: OBJECTIVE
  "Field dependence" is used in cognitive psychology to describe an individual's tendency to be visually distracted by the surrounding environment. Notwithstanding the role of field dependence in contexts in which spatial judgment is important, such as piloting an aircraft, to date, studies linking field dependence to surgical skills have been limited. We evaluated whether field dependence correlates with an ability to anticipate appropriate needle angles in a simulated setting.
  
  
  METHODS
  Trainees underwent field dependence testing and then participated in a surgical skills exercise. Correlations between field dependence and surgical skill were computed. Specifically, cardiothoracic surgery residents (n=11) took a battery of cognitive examinations to assess general reasoning and visuospatial judgment. Two written tests, the Rod and Frame test and the Judgment of Line Orientation test, measured the degree of field dependence. The subjects then underwent surgical skills testing. Using a standard needle driver, the participants placed curved needles into a cylindrical silicone mitral valve model with 10 premarked needle entry and exit sites. The components assessed included the ability to load a needle on driver at the appropriate angle.
  
  
  RESULTS
  The test results showed a parametric distribution, with internal cognitive testing controls demonstrating valid testing techniques and methods. Performance on the cognitive tests measuring spatial judgment and field dependence correlated significantly with skill at determining the appropriate needle angle load in an inverse fashion (Judgment of Line Orientation test, r=0.61, P<.05; Rod and Frame test, r=-0.52, P=.05), suggesting that residents who were not distracted by surrounding objects performed better. Performance on the cognitive examinations did not correlate with resident training level.
  
  
  CONCLUSIONS
  Although our study was of a small cohort, the findings suggest that individuals described as field independent (not easily distracted by external visual cues) might possess improved ability to determine appropriate needle angle loads compared with field-dependent individuals. Additional studies examining the role field dependence might play in the acquisition and execution of surgical tasks are warranted.
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif, and the Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif.
authors.forename: Ahmad Y
authors.initials: AY
authors.lastname: Sheikh
authors.affiliation: University of Dundee, Dundee, United Kingdom.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Keehner
authors.affiliation: University of Dundee, Dundee, United Kingdom.
authors.forename: Audrey
authors.initials: A
authors.lastname: Walker
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif, and the Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Chang
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif, and the Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Burdon
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif, and the Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. Electronic address: jfann@stanford.edu.
authors.forename: James I
authors.initials: JI
authors.lastname: Fann
mesh_terms: D001288:Attention; D006348:Cardiac Surgical Procedures / Q000193:education* / Q000295:instrumentation; D002983:Clinical Competence; D003071:Cognition; D003463:Cues; D004502:Education, Medical, Continuing / Q000379:methods*; D004777:Environment; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007600:Judgment; D059032:Learning Curve; D008297:Male; D008943:Mitral Valve / Q000033:anatomy & histology / Q000601:surgery*; D008953:Models, Anatomic; D009339:Needles; D009483:Neuropsychological Tests; D013028:Space Perception; D013536:Suture Techniques / Q000295:instrumentation; D013647:Task Performance and Analysis; D013663:Teaching / Q000379:methods*; D014796:Visual Perception