Can playing Video Games make you a Better Surgeon?

Introduction

Firstly, let me introduce myself so you know where I’m coming from. I'm Shamshir a long time lurker of wiskey media (Screened, GB and Tested mostly) and am currently a 3rd year undergraduate student at the University of Central Lancashire in the UK. Currently I’m studying Physiology and Pharmacology with an idea to pursue graduate entry medicine. I though I might also try my hand as some writing and build up some sort of literary base to increase my chances of ever becoming a freelancer for GB. You see what got me interested in science was always its real world applications and I’m sure copious amounts of British sci-fi contributed. And it was as I was reading literature for my third year project I decided to see how video games were being used by academics. And a simple search found, to my surprise that since the year 2000 more than 14,000 peer reviewed articles have been published. Following games journalism over time we as gamers have in the past been demonised where studies suggesting the link between violence and video games get widely reported. But just from a little light skimming the amount of researching being done and the findings that are turning up is something I find incredibly interesting. Hence this article, I was naturally reticent about this idea but contacting one Mr Klepek I think if something these scientific papers are going to find and audience it will be on a site like this. So I hope this is the first of many volumes and that they are enjoyable to read.

I have been taught that when writing anything academic you need to reference everything. Now while I won’t be citing in the text it is vital to me that you, the reader, know where I am getting this stuff from. So I point you in the direction of the Journal of Surgical Education Volume 67, Issue 3 Pages 184-189. This is a review article written by Jeremy Lynch, Paul Aughwane and Toby Hammond entitled “Video Games and Surgical Ability: A Literature Review”. Before I can begin to delve into the piece you have to understand the nature of a review article and their role in modern science. Everyone writing anything anywhere will have a bias. Jeff, Brad and Vinny all of their reviews are biased to some degree. While this is not really a problem in the press as ultimately what reviews think of a game is what they think. But when doing scientific research published articles need to be as objective as possible. So all published articles in scientific journals are peer reviewed to maintain some objectivity similarly to how metacritic will average out review scores for games to get an objective score that takes into account the views of all the game press. The article by Lynch et al. is peer reviewed but is also a review article in which they taken a look at 12 pieces of original research from different sources to give us the best understanding of our current knowledge.

Why are people interested in this?

But you may be asking why on earth we would wish to pursue if games do in fact affect surgical ability. In developed countries like the UK, US and the other EU nations operating experience for trainees is being cut as they are in comparison with their forbearers made to work less. Fewer operations now occur during the night and overall there is a drive to decrease and eliminate errors made my inexperienced surgeons. Hence the interest in augmenting trainee’s video games that could make them better, as a link has been shown between video game usage and visuospatial ability. It has been seen that newer techniques skills in laparoscopic surgery are picked up faster in the younger trainees. Some have attributed this possibly due to the exposure to video games. Laparoscopic surgery is where small incisions are made into the body allow tiny cameras and tools to be inserted and used while minimising the risk of haemorrhage during surgery. When we play games we are essentially manipulating 3D objects via the input we receive via our 2D screens at home. It’s an act that requires precise use of the hand, wrist and thumbs…everyone forgets the importance of precise thumb control. If you have ever played COD online you’ll know what I mean. But if some of these skills such as the visuospatial ability as well as the alleged motor coordination and cognitive skills could be transferred. It opens up a way to increase the ability of a surgical team as well as ensure fewer mistakes are made by raising the baseline skill of surgical professionals who do not play video games. The surgical field is becoming more and more interested in surgical simulations but the drawbacks are they lack tactile feedback, are not particularly widespread and are currently too expensive. Enter video games with holy trifecta; cheap, readily available and fun. Of course they are not going to be able (currently) to teach someone complex skill sets but could they give surgeons an edge?

Time to Science

The research can be split up into 2 significant groups based on their methodology. The first is where participants filled in a questionnaire about their video game usage. This was followed by a test of their surgical ability. The second group were, and I quote “Trained on the Video Game” before their surgical skills were tested to see if had an effect. The first group made up 9 of the 12 research articles and second group the remaining 3. They were tested in various was with regards to surgical ability. If you’re a doctor I’m sure this will mean something to you but the tests for Surgical Modality were with following: da Vinci robotic simulator, ; GI, Mentor II, ; MIST-VR simulator, Minimally Invasive Surgical Trainer-Virtual Reality; Virtual Reality Sinus Surgery simulator. I personally like that in one study the researchers did not care for simulations and went whole hog, using a swine model.

Here is a summary from 3 of the research papers (ones I could get a hand on):

University of Pittsburgh, 2005

A Key Quote: “Our goal was to see if there is a correlation between skill in video games and skill in laparoscopy. Also, we hoped to demonstrate that practicing video games can improve one's laparoscopic skills.”

Who took Part: 11 medical students (nine male, two female) volunteered

How did they go about it? Well on the first day all of the students played Top Spin, XSN Sports and Project Gotham Racing on the Xbox for 30 minutes each. How good they were at these games were taken into account “both objectively and subjectively”. The students were tested on their performance with four laparoscopic tasks:

1. Object transfer
2. Tracing a figure-of-eight
3. Suture placement
4. Knot-tying

Afterwards they were randomly put into a control group and a training group. The training group would continue to play the 3 games and after 2 weeks they were all tested again.

The researchers found that the time taken to complete each of the four tasks as well as the hand–eye coordination was better in those that played the games but not significantly. There was a weaker association between how good at games the volunteers were and their laparoscopic ability. However they did find those who were better at games were better at completing the four tasks. My thoughts on this one are that like many study’s it is small in its scope. As only 11 people were involved you can gain nothing conclusive from it. But if I was a researcher reading this in 05’ it would seem to warrant more research to provide a more solid answer.

University of Rochester, 2006

A Key Quote: “This study was designed to test the ability to define and measure innate endovascular aptitude and empirically correct performance and to determine whether these are two different things.”

Who took Part: 61 subjects broken down as follows: 42% students, 8% technicians, 19% surgeons, 13% cardiologists, and 18% radiologists. 62% were novices and 30% experts based on previous experience. 56% of those involved worked in an endovascular-related occupation.

How did they go about it? Very simply all of them filled in a questionnaire about their video game usage. They were then were tested on an Endovascular simulator.

The guys at Rochester found obviously the experts did better than noobs as you would and should expect. Interestingly they found a strong correlation between the number or hours of games played per week and how long volunteers took to finish. But these completion times still fit the overall score the surgeons received with those with training passing more than those without. So it would seem games might not make you better surgeons but they sure make faster at the cutting, poking around and sowing that body up. I quite liked this study as there were plenty of graphs and stats to chew. But more importantly is that it is more significant due to the number of people involved as 61 is not a number to scoff at.

Loma Linda University, 2007

A Key Quote: “The purpose of this study was to determine whether prior video-game experience enhances the acquisition of robotic surgical skills.”

Who took Part: 10 preclinical medical students.

How did they go about it? 242 preclinical medical students were given a questionnaire detailing the frequency, duration, and peak playing time. Of these 242 the 5 with most and least exposure to video games were selected. A second questionnaire was filled that went into more detail of the 10 volunteer’s video game, sports, musical instrument, and craft and hobby exposure. After watching a training video of the da Vinci surgical robot tying knots they were tested. Each person got 3 minutes of practice time then had to tie knots for 5 minutes. An independent observer recorded the number of knots tied, missed knots, frayed sutures, broken sutures, and mechanical errors.

The scientists found that those who played video games tied the fewest knots than those who did not play. Those who played sports were found to have fewer mechanical errors and broken sutures. And those who played an instrument for more than 5 years missed fewer knots. But this is why I like reviews and the study by Rochester University because they are large and you can believe conclusions derived from the results. You would be a fool to task this proof that those who play video games are better surgeons. But what the review I have used for my research has taken a look at many of these studies and seen the commonalities. As science is self-correcting over time, when an article is published other researchers around the world will read it and if you made something it up it comes out in the wash.

The Verdict

The commonalities that Lynch has found is that from multiple studies it seems there is astatistically significant link between playing video games and increased initial performance with laparoscopic, endovascular, gastrointestinal endoscopic. But this performance from some reason id not shared with robotic techniques. And that all of the studies so far are on small sample sizes and over short periods of time in terms of training with video games. And that virtual simulations of surgery as a way of measuring ability might be inaccurate due to the fact that gamers will be more familiar with 3-D computer-rendered graphics. Lynch does make a fine point at the end; surgical skill is only one of things that make a surgeon. Good judgement, teamwork and interpersonal communication skills are also vital and well you’ll have to come back for when I write about how video games affect those. Thank you for reading and for me it’s back to Trauma Center on the wii.