Surgical Skill: Trick or Trait?

Objective: Among other indispensible qualities, a competent surgeon needs to be technically skilled. With the advent of minimally invasive procedures, technical demands on surgeons also increase. Will it be possible for all individuals to meet these technical demands through motivated practice or is there a trait such as "aptitude" that determines ultimate surgical skill?

Design: Baseline laparoscopic psychomotor aptitude (on a box trainer), visual-spatial aptitude (Schlauch figures test), and interest in surgery (10-point Likert scale) were measured in our study group. Afterward, study participants attended a 3-hour hands-on laparoscopy training, followed by 2 additional weeks of voluntary practice for those who were motivated to do so. After these 2 weeks, participants were retested using the laparoscopic box trainer.

Setting: All research was performed in the Center for Surgical Technologies, Leuven.

Participants: A total of 68 fifth-year medical students without prior experience in laparoscopy from the University of Leuven.

Results: Multiple additive regression analysis showed significant effect for psychomotor aptitude (26%), interest in surgery (9%), and voluntary practice (18%) on final box trainer performance. No correlation was found between aptitude and interest in surgery (p = 0.27). No correlation was found between aptitude and amount of voluntary practice. High-aptitude students more frequently applied for surgical disciplines in their final career choice (50% vs 18%, p = 0.01).

Conclusions: This study shows that aptitude and motivated practice equally influence final box trainer performance. Students with lower aptitude do not automatically train more. Although the interest in surgery was initially not related to psychomotor aptitude, eventually students with high aptitude apply more frequently for a surgical career.