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

Objective: There have been numerous advances to accelerate and improve quality and dexterous proficiency of surgical training to meet the growing US demand of graduating surgeons. The authors aimed to investigate the learning effects of such limited visual input on the surgical proficiency in untrained novice surgeons. Design: A prospective randomized-controlled study was created with 11 participants in the study and 11 in the control group. Setting: An inanimate surgical simulation lab of a tertiary academic institution (Houston Methodist Hospital, Houston, Texas). Participants: Adult medical students in the experimental group were wearing stroboscopic eyewear while performing the same tasks as students in the control group with normal vision. For 5 weeks, the subjects were scored during 3 standardized surgical tasks from the American College of Surgeons and the Association of Program Directors in Surgery Resident Skills Curriculum: knot tying, simple interrupted sutures, and a running stitch. Pretrial, we employed the State-Trait Anxiety Inventory and post-trial, the NASA Task Load Index. Results: The demographic characteristics of our study participants were uniformly distributed between the 2 cohorts: 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 5 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 NASA workload scores (p = 0.001). Conclusions: Regular training with stroboscopic glasses that limit visual input 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 students and surgical residents.