title: Multitask training promotes automaticity of a fundamental laparoscopic skill without compromising the rate of skill learning.
abstract: A defining characteristic of expertise is automated performance of skills, which frees attentional capacity to better cope with some common intraoperative stressors. There is a paucity of research on how best to foster automated performance by surgical trainees. This study examined the use of a multitask training approach to promote automated, robust laparoscopic skills.
  
  
  
  Eighty-one medical students completed training of a fundamental laparoscopic task in either a traditional single-task training condition or a novel multitask training condition. Following training, participants' laparoscopic performance was tested in a retention test, two stress transfer tests (distraction and time pressure) and a secondary task test, which was included to evaluate automaticity of performance. The laparoscopic task was also performed as part of a formal clinical examination (OSCE).
  
  
  
  The training groups did not differ in the number of trials required to reach task proficiency (p = .72), retention of skill (ps > .45), or performance in the clinical examination (p = .14); however, the groups did differ with respect to the secondary task (p = .016). The movement efficiency (number of hand movements) of single-task trainees, but not multitask trainees, was negatively affected during the secondary task test. The two stress transfer tests had no discernable impact on the performance of either training group.
  
  
  
  Multitask training was not detrimental to the rate of learning of a fundamental laparoscopic skill and added value by providing resilience in the face of a secondary task load, indicative of skill automaticity. Further work is needed to determine the extent of the clinical utility afforded by multitask training.
authors.affiliation: Carnegie Faculty, Leeds Beckett University, Leeds, UK. J.Poolton@leedsbeckett.ac.uk.|Institute of Human Performance, University of Hong Kong, Pokfulam, Hong Kong. J.Poolton@leedsbeckett.ac.uk.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Poolton
authors.affiliation: Institute of Human Performance, University of Hong Kong, Pokfulam, Hong Kong.|Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.|Faculty of Education, University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Frank F
authors.initials: FF
authors.lastname: Zhu
authors.affiliation: Te Oranga School of Human Development and Movement Studies, University of Waikato, Hamilton, New Zealand.
authors.forename: Neha
authors.initials: N
authors.lastname: Malhotra
authors.affiliation: Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Gilberto K K
authors.initials: GK
authors.lastname: Leung
authors.affiliation: Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Joe K M
authors.initials: JK
authors.lastname: Fan
authors.affiliation: Institute of Human Performance, University of Hong Kong, Pokfulam, Hong Kong.|Te Oranga School of Human Development and Movement Studies, University of Waikato, Hamilton, New Zealand.
authors.forename: Rich S W
authors.initials: RS
authors.lastname: Masters
mesh_terms: D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D012153:Retention, Psychology; D013337:Students, Medical; D055815:Young Adult
keywords: Automaticity; Intraoperative stressors; Multitasking; Surgical education; Surgical skills training