Surgeons Outperform Normative Controls, but Age-Related Decay of Skills Persists Z Boom-Saad*, SA Langenecker †, LA Bieliauskas †, C Graver †, J O’Neill †, A Caveney †, PG Gauger* ‡, LJ Greenfield*, and RM Minter* ‡ Departments of Surgery*, Neuropsychology †, and Medical Education ‡

Background Variation exists with respect to psychomotor and procedural learning capabilities Preliminary work by our group demonstrated that practicing surgeons outperformed normative controls on a series of neuropsychological tests – Cambridge Neuropsychological Test Automated Battery (CANTAB)

Research Question Do surgeons outperform normative controls due to experience gained during surgical training, or is this difference present at baseline in those individuals drawn to a surgical career?

Methods 308 practicing surgeons age years performed a battery of CANTAB tests at the American College of Surgeons Meeting ( ) 21 medical students ( age years) entering General or Plastic Surgery or Urology residency performed the same tests ( ) For analysis, subjects were divided into three age groups –20-35 yrs (medical students, n=21, 28% ♀) –45-60 yrs (practicing surgeons, n=139, 18% ♀) –61-75 yrs (practicing surgeons, n=169, 1.8% ♀)

Methods Performance was compared between surgeon groups as well as to age-matched normative comparison groups IQ of 120 was selected for normative comparison for all groups ANOVA was used for comparing group performance and post-hoc analysis was performed using least squares difference Significance was set at p<0.05 Study was approved by the University of Michigan Institutional Review Board

CANTAB CANTAB battery of tests –Reaction time and efficiency of motion (RTI) –Rapid visual information processing (RVIP) –Visual memory and rapid learning index (PAL) Uses a touchscreen so effect of prior computer experience is minimized CANTAB provides age-matched normative control subject data against which performance can be compared

Reaction Time Task (RTI) Subject must release pad in response to a visual stimulus Release time and time to target is measured Measures efficiency of motion and response time

Rapid Visual Information Processing (RVIP) Test of sustained attention with a small working memory component Measures stimulus response time and accuracy (% correct hits)

Paired Associates Learning (PAL) Test of attention and visual memory – an index of rapid learning Measures how a subject processes visually complex information Performance recorded as overall accuracy on task

Results – Reaction Time Task RTI – Total Movement TimeRTI – Total Reaction Time

Results – Rapid Visual Information Processing RVIP – Percent Correct HitsRVIP – Stimulus response time

Results – Paired Associates Learning (Visual Memory) PAL – Stages completed on first trialPAL – Total adjusted errors

Surgeon Group versus Norms RTI – Total Movement Time

Surgeon Group versus Norms RTI – Total Reaction Time

Surgeon Group versus Norms RVIP – Accuracy Rate

Summary Decline in visual memory and psychomotor performance occurs with advancing age Improved performance on the selected CANTAB tests by the surgeon groups appears to be a factor which is present at baseline and is not a result of surgical training

Limitations of Study These tests do not account for the effect of experience on procedural learning ability Subjects did not undergo IQ testing so exact normative control comparisons could not be made Medical student group was limited in size and to one institution – expansion of this group would strengthen the study

Conclusions Older surgeons may require additional trials for mastery of visually complex surgical procedures as compared to younger surgeons CANTAB may be a useful construct for evaluating residents who appear to have difficulty with visual memory psychomotor performance

Acknowledgements Dr. Lazar Greenfield Drs. Scott Langenecker and Linas Bieliauskas Association for Surgical Education Foundation’s Center for Excellence in Surgical Education, Research, and Training (CESERT) Grant