Factors influencing surgical performance and learning progress in minimally invasive surgery - results of an interdisciplinary muticenter study.

BACKGROUND: Advancing surgical techniques require a high level of adaptation and learning skills on the part of surgeons. We need selection procedures and decision support systems for the recruitment of medical students and young surgeons. We aimed to investigate factors influencing the surgical performance and learning abilities of surgeons and medical students.

MATERIAL AND METHODS: The training scores of persons attending 16 standardized training courses (at three training centers) of the German Working Group for Gynecological Endoscopy (AGE e.V.) from 2017 to 2020, individual characteristics, and the results of psychomotor tests of three-dimensional imagination and hand-eye coordination were correlated. Similar analyses were performed for medical students in their final clinical year from 2019 to 2020. The training concept was evaluated in a prospective, multicenter, interdisciplinary, multinational setting.

RESULTS: In all, 180 of 206 physicians (response rate 87.4%) and 261 medical students (response rate 100%) completed the multi-stage training concept successfully. Of personal characteristics, the strongest correlation was noted for good surgical performance and learning success, and the absolute number of performed laparoscopic surgeries (r=0.28-0.45, P<0.001/r=0.1-0.28, P<0.05). A high score on the spatial visualization ability test was also correlated with good surgical performance (r=0.18-0.27, P<0.01). Among medical students with no surgical experience, however, age was negatively correlated with surgical performance, i.e. the higher the age, the lower the surgical performance (r=0.13/r=0.22, P<0.05/P<0.001).

CONCLUSION: Individual factors (e.g. surgical experience, self-assessment, spatial visualization ability, eye-hand coordination, age) influence surgical performance and learning. Further research will be needed to create better decision support systems and selection procedures for prospective physicians. The possibilities of surgical training should be improved, promoted, and made accessible to a maximum number of surgical trainees because individual learning curves can be overcome even by less talented surgeons. Training options should be institutionalized for those attending medical school.