Training Effects of Visual Stroboscopic Impairment on Surgical Performance: A Randomized-Controlled Trial

Dmitry Zavlin, MD^1,2, Vishwanath Chegireddy, MD¹, John J Nguyen-Lee, MD³, Linden Shih, BS¹, Anna M Nia, MS⁴, Jeffrey D Friedman, MD, FACS¹, Anthony Echo, MD¹. ¹Institute for Reconstructive Surgery, Houston Methodist Hospital, ²Department of Surgery, Easton Hospital, ³Department of Surgery, Houston Methodist Hospital, ⁴School of Medicine, University of Texas Medical Branch

BACKGROUND: There have been numerous advances to accelerate and improve quality of surgical training to meet the growing US demand of graduating surgeons. In this randomized-controlled study, the authors investigated the learning effects of limited visual input with stroboscopic glasses on surgical proficiency in untrained novice surgeons.

METHODS: Medical students were randomized into either the experimental group wearing stroboscopic eyewear (n=11) or the reference group (n=11). For five weeks, the subjects were scored during standardized surgical tasks from the ACS/APDS Resident Skills Curriculum: knot tying, simple interrupted sutures, and a running stitch. In addition, we preoperatively employed the State-Trait Anxiety Inventory and postoperatively, the NASA Task Load Index.

RESULTS: The demographic characteristics of our study participants were uniformly distributed: each group had 7 males and 4 females. Average ages were 23.6 and 24.2 years (p=0.471). The anxiety was low during all five sessions and indifferent between both groups. At the end of the study, no changes were observed in the stroboscopic group for the knot tying task (p=0.619). However, for the simple interrupted and the running stitch, the students with stroboscopic glasses performed significantly better (p=0.001 and p=0.024, respectively). The stroboscopic students also had significantly lower workload scores (p=0.001).

CONCLUSION: Regular training with stroboscopic glasses has a significant positive effect on the technical skills of novice surgical trainees with regards to more complex tasks such as multiple simple interrupted suturing or running suture. Intermittently impaired vision is beneficial in the early education of surgical students and residents.