Multitask training promotes automaticity of a fundamental laparoscopic skill without compromising the rate of skill learning.

A defining characteristic of expertise is automated performance of skills, which frees attentional capacity to better cope with some common intraoperative stressors. There is a paucity of research on how best to foster automated performance by surgical trainees. This study examined the use of a multitask training approach to promote automated, robust laparoscopic skills.Eighty-one medical students completed training of a fundamental laparoscopic task in either a traditional single-task training condition or a novel multitask training condition. Following training, participants' laparoscopic performance was tested in a retention test, two stress transfer tests (distraction and time pressure) and a secondary task test, which was included to evaluate automaticity of performance. The laparoscopic task was also performed as part of a formal clinical examination (OSCE).The training groups did not differ in the number of trials required to reach task proficiency (p = .72), retention of skill (ps > .45), or performance in the clinical examination (p = .14); however, the groups did differ with respect to the secondary task (p = .016). The movement efficiency (number of hand movements) of single-task trainees, but not multitask trainees, was negatively affected during the secondary task test. The two stress transfer tests had no discernable impact on the performance of either training group.Multitask training was not detrimental to the rate of learning of a fundamental laparoscopic skill and added value by providing resilience in the face of a secondary task load, indicative of skill automaticity. Further work is needed to determine the extent of the clinical utility afforded by multitask training

The Road to Certainty and Back

The author relates his intellectual journey from eye-testing clinician to experimental vision scientist. Starting with the quest for underpinning in physics and physiology of vague clinical propositions and of psychology's acceptance of thresholds as "fuzzy-edged," and a long career pursuing a reductionist agenda in empirical vision science, his journey led to the realization that the full understanding of human vision cannot proceed without factoring in an observer's awareness, with its attendant uncertainty and open-endedness. He finds support in the loss of completeness, finality, and certainty revealed in fundamental twentieth-century formulations of mathematics and physics. Just as biology prospered with the introduction of the emergent, nonreductionist concepts of evolution, vision science has to become comfortable accepting data and receiving guidance from human observers' conscious visual experience