LEARNING SURGICAL TECHNICAL SKILLS

Training issues raised by the recent introduction of laparoscopic surg ical techniques led to this analysis of motor-skill learning principle s as they apply specifically to the learning of technical surgical ski lls. The most accepted theories of motor-skill learning are presented, not as opposing views, but as complementary constructs. The behaviour ist school of thought's main contribution is the executive routine or knowledge of the steps of a procedure. Schmidt's schema theory and Mac Kay's node theory suggest that perceptual information may play an impo rtant role in the quality of the performance. The conclusions reached from neuropsychologic testing experiments on surgeons are that visuosp atial perceptual skills (the ability to represent mentally the physica l environment and the movement to be performed) are the major determin ants of surgical technical performance. Learners should make use of le arning strategies that improve mental representation of a skill and th e corresponding anatomy. Specific strategies discussed include imagery , mental practice and a systematic review of performance that focuses on the perceptual feedback received by the learner.