Simulators to Assess Ability: Airlines use them, so why not Surgery?

Traditionally, the selection of surgical residents has been largely based on cognitive attributes (academic achievements), and subjective assessment of personality, attitude, and motivation. A new study suggests that using a robot simulator, medical students can be assessed for innate ability, to provide a further measure of their suitability as candidates for surgical positions.


Whether or not you completely buy into the technology of today, robots most certainly have a place in the operating rooms of the future. Unquestionably the best known current offering is Intuitive Surgical’s daVinci system, part of which involves surgical simulation based on virtual reality, used to train surgeons in preparation for robotic surgery.

Now researchers at the EndoCAS research and education center of University of Pisa (Italy), in collaboration with the Multidisciplinary Center of Robotic Surgery at Cisanello Hospital in Pisa, and IMSaT Center of University of Dundee (United Kingdom) have taken things a step further. For what is believed to be the first time, they have been using a da Vinci Skills Simulator to study the innate ability for surgery among medical students. The results have now been published in the journal Surgical Endoscopy and is likely to have important implications on the selection of future surgeons.

What the results showed is that a small cohort (8/121) of medical students tested, faced with 26 exercises, stood apart as having superior skills to the remainder. Indeed their performance matched that of a control group of four expert surgeons. At the other end of the spectrum, another cohort (14/121) performed significantly worse than the remaining 107. All of these results are statistically significant.

Interestingly, thinking back to the days when Air Forces used Space Invaders games as a guide to aptitude, in these tests there was no correlation between computer gaming experience and performance in these tests. This suggests that the tests were a true and indeed useful marker of innate ability.

The study abstract can be found at Surgical Endoscopy here or on Pubmed, here.

In conclusion then, it seems that virtual reality tests such as those used in this study, do provide an objective evaluation of the manipulative abilities of candidates and could be used as an additional tool to complement the selection process.

Investigator comments

Dr Andrea Moglia, from the research team states; “Training surgical residents is expensive. Hence, it is important to concentrate economic resources on those candidates who are most likely to become proficient surgeons. In the the study we demonstrated that there is a very low percentage (6.6%) of medical students with outstanding manipulative and psychomotor skills and, at the same time, there is almost a double percentage (11.6%) of students with a scarce level of these skills.”


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