Visual-spatial ability, learning modality and surgical knot tying

Abstract

Introduction: The ability to mentally rotate an object in 3 dimensions has been shown with an individual's score on the Vandenberg and Kuse Mental Rotations Test. The was to determine whether this Mental Rotations Test could be used to predict performance complex surgical skill - the tying of a 1-handed surgical reef knot. In addition, we learning a spatially complex surgical skill could be achieved more effectively via a computer-based selfdirected learning approach than with a didactic lecture-based teaching method.

Methods: preclerkship medical students at the University of Western Ontario were randomized into computer-based self-directed learning group and a didactic lecture-style learning group. administration of the Mental Rotations Test, the students were taught how to tie a reef knot via the learning modality assigned to their respective group.

Results: Students Mental Rotations Test scores were able to tie more surgical knots in the allocated time Students learning how to tie the surgical knot via the computer-based self-directed showed improvement on their knot tying abilities more rapidly than their didactically trained colleagues.

Conclusion: The ability to mentally rotate an object in 3 dimensions played an important initial learning of a spatially complex surgical technical skill. Our data demonstrated learning was as effective and more practical than traditional lecture-based learning.

FIG. 1. Sample item from the Mental Rotations Test. This is a sample item appearing on the redrawn Vandenberg and Kuse Mental Rotations Test Version A by Peters and colleagues. ⁶ The medical students were asked to identify which of the 4 items depicted on the right match the reference object on the left. (Reprinted with permission from Peters et al. ⁶ ©1995 Elsevier.)

FIG. 2. Suture tying board provided by Ethicon Incorporated. Preclerkship medical students were instructed on how to tie a surgical knot across the 2 opposing rubber bands.

FIG. 3. Total number of knots tied versus Mental Rotations Test score. A regression plot illustrating the total number of 1-handed surgical reef knots tied during three 10-minute training/repetition sequences versus the Vandenberg and Kuse Mental Rotations Test scores of preclerkship medical students in both the computer-based self-directed learning group (grey) and the didactically trained group (black). The log-transformed Pearson correlations were r = 0.42, p < 0.05; r = 0.45, p < 0.01) for the computer-based and didactic groups, respectively. Fifty-one points are shown as a result of 9 individuals having equivalent Mental Rotations Test scores and total number of knots tied.

FIG. 4. Average number of knots tied per training/repetition sequence. A comparison of the average number of knots tied by preclerkship medical students within each of three 10-minute training/repetition sequences between the computer-based self-directed learning group and the didactically trained group. Error bars correspond to the standard error of the mean shown.

FIG. 5. Improvement in the number of knots tied between the first and second training/repetition sequence. A comparison of the improvement (in average number of knots tied by preclerkship medical students) between the first and second training/repetition sequence in both the computer-based self-directed learning group and the didactically trained group. A significant ( p < 0.04) difference was observed. Error bars correspond to the standard error of the mean shown.