Periscapular Strength Profile Changes in Collegiate Baseball Pitchers Over the Course of a Season.

Background: Repetitive application of high forces to the shoulder and scapular musculature during the pitching motion over the course of a collegiate baseball season may lead to changes in strength and increased fatigue, potentially predisposing pitching athletes to injury. The purpose of this study was to investigate periscapular strength profiles of Division I collegiate baseball players over the course of a season. Methods: This study was a retrospective data analysis of 18 Division I baseball pitchers. Isometric scapular plane abduction (scaption), external rotator, internal rotator, middle trapezius, and lower trapezius isometric strength was measured on throwing arm of each subject using a MicroFET 2 handheld dynamometer. Data were collected in a single session at the preseason, midseason, and postseason of the college baseball season, which spanned a five-month period. A repeated measures ANOVA was utilized to determine if there was a significant change in periscapular strength across the baseball season. Results: Over the three time-points, all strength values decreased for each muscle group, with decreases ranging from 3-14%. Changes in scaption strength values were statistically significant (p=0.018, partial eta squared =0.284) with an 8% reduction over the entire season, specifically with a 5% decline from mid-season to post-season. While external rotator, internal rotator, middle trapezius, and lower trapezius strength values all decreased over the course of the season (range 0.02kg to 1.8kg), these differences were not statistically significant. However, the middle trapezius strength value change (1.3kg loss) exceeded the minimal detectible change. Conclusion: Periscapular muscles in baseball pitchers diminish in strength over the course of a collegiate baseball season. Understanding strength changes over the course of a season may influence training and therapeutic interventions. Level of Evidence: 3b.

Examining the effects of amplitude-based training as a component of the plan of care in an individual with olivopontocerebellar atrophy.

BACKGROUND: Amplitude-based exercise training has been shown to be effective in the motor performance of individuals with idiopathic Parkinson's disease, with limited research investigating its effects on Parkinson plus syndromes such as olivopontocerebellar atrophy (OPCA). The purpose of this clinical case report is to examine the effects of amplitude-based training exercises on an individual with OPCA. CASE DESCRIPTION: A 68-year-old man with a 14-month history of OPCA presented to physical therapy with bradykinesia, rigidity, and postural instability. The individual participated in 34 intervention sessions. Pre- and post-test measurements were collected for the following outcome measures: Five Times Sit to Stand (FTSTS); Functional Gait Assessment (FGA); Activities-Specific Balance Confidence Scale (ABC-6); 9 Hole Peg Test (9HPT); preferred and maximal gait speed. OUTCOMES: Improvements reaching Minimum Detectable Change (MDC) or Minimal Clinically Important Difference (MCID) were recorded with a pre (Week 1) and post (Week 20) intervention: FGA score (4-point improvement (MDC95 = 4 points), preferred gait speed (0.09 meters/second improvement (MCID = 0.05 meters/second)), FTSTS (6-second improvement (MDC95 = 2.3 seconds)), and 9HPT on the dominant hand (3-second improvement (MDC95 = 2.6 seconds)). Fluctuations during the plan of care were observed for these measures, and additional outcomes did not demonstrate a worsening of function. CONCLUSION: In an individual with OPCA, amplitude-based exercise training as a component of the plan of care increased dynamic balance in walking, gait speed, and hand dexterity. However, these results need to be validated on a larger sample of individuals with OPCA through randomized controlled trials.

Variations of spinous and transverse process length in the human lumbar spine.

BACKGROUND: Some manual therapy schools of thought rely on palpation of vertebral position via bony processes prior to the application of directional manual interventions. It is feasible that malformation or asymmetry of the spinous processes (SPs) or transverse processes (TPs), if unknown, may influence the outcome of a diagnostic palpatory exam and the application of directional manual interventions. This study provides morphometric data for the lumbar spine, to assess the occurrence of length differences in lumbar SPs and TPs occurring between the right and left sides. METHODS: The lumbar processes were measured bilaterally in 16 adult cadaveric specimens, 9 females and 7 males ranging in age from 68 to 89 years. A measurable difference in SP length, defined as ≥ 0.1 cm, was found in 72.4% of the population, and for TP lengthin 90.6% of the population. A mean SP length difference of 0.2 ± 0.2 cm and a mean TP length difference of 0.4 ± 0.3 cm were observed. Process length was longer on average for males, and the magnitude of process length difference increased with age. CONCLUSION: These results indicate that a finding of a clinical positional fault of a vertebra through palpatory exam may be flawed.

The effect of an attending versus neutral observer on peg transfer and intracorporeal knot-tying laparoscopic tasks.

BACKGROUND: Surgery is an outcome-based specialty where maintaining peak performance is crucial to patient care. There are a variety of identified surgeon stressors that can have an impact on performance, but one factor unique to surgical residents is the observation by an attending surgeon. This study explored how the perceived authority of the observer had an impact on the participants' physiologic markers of stress and task completion times. METHODS: Eighteen general surgery residents performed the Fundamentals of Laparoscopic Surgery skills intracorporeal knot-tying and peg transfer tasks in a crossover study design while under the observation of an attending and a neutral observer. Heart rate variability, mean R-R interval, the time between R spikes on an EKG, minimum heart rate, maximum heart rate, average heart rate, and time to task completion were recorded. Analyses were completed via 2 × 2 analysis of variance with repeated measures. RESULTS: When observed by an attending, participants demonstrated higher minimum, average, and maximum heart rates (P = .046, = .007, and < .001, respectively) than when observed by a neutral observer. Attending observation also significantly shortened time to task completion, relative to neutral observation (P = .022). CONCLUSION: Attending observation is linked to increased objective measures of stress at the time of performance with decreased task completion times. Educational efforts to optimize the response to stress during learning may lead to better outcomes.

Twelve tips for applying Moore's Theory of Transactional Distance to optimize online teaching.

Globally, education has seen increased incorporation of online and distance approaches to teaching and learning across all fields and program levels. As a result, many educators question how best to deliver their content in this format, resulting in a significant demand for professional development resources that focus on the best practices for online teaching. These twelve tips focus on the design, delivery and refinement stages of course development and introduce health professions educators to Moore's Theory of Transactional Distance, with the end goal of identifying concrete opportunities and methods for applying Moore's Theory to their online teaching.

YouTube-based course orientation videos delivered prior to matriculation fail to alleviate medical student anxiety about anatomy.

Gross anatomy is a source of anxiety for matriculating medical students due to the large volume of information presented in a truncated timeline, and because it may be their first exposure to human cadavers. This study aimed to assess if video-based resources would affect matriculating medical students' anatomy state anxiety levels. Videos were designed to be short, YouTube-based units that served to provide orientation information about the anatomy course, dissection facilities, and available study resources to dispel anxiety around beginning their anatomy studies. To evaluate the impact of the videos, students in two consecutive matriculating years (2018 and 2019) completed the validated State-Trait Anxiety Inventory and a demographic questionnaire. The 2019 cohort (n = 118) served as the experimental group with access to the videos; while the 2018 cohort (n = 120) without video access served as a historical control. Analyses revealed that the groups were equivalent in terms of trait anxiety (P = 0.854) and anatomy state anxiety even when student video exposure was controlled (P = 0.495). Anatomy state anxiety was only significantly lower in students with prior formal anatomy exposure (P = 0.006). Further inquiry into students' prior anatomy experience identified that individuals with post-secondary dissection experience were significantly less anxious than those without formal anatomical experience (P = 0.023). These results may serve as a cautionary tale to educators; while preference for video-based instructional materials is prevalent in the literature, videos delivered on public social media platforms fail to prepare students for the psychological impact of studying human anatomy.

Fostering Early Preclinical Experiences for Developing Knowledge, Skills, and Confidence in Key Residency Competencies Through Participation in a Medical Student Research Training Program.

Periods of academic transition are challenging and require medical students to adjust to new environments and expectations. Commonly cited areas of struggle include integrating into the interprofessional health care team, communication, organization and time management, and self-regulated learning. Consciously designing opportunities early in the preclinical curriculum to help students gradually build these competencies can be achieved within existing research training programs or projects. This perspective article reflects on how the medical student research training program at the Oakland University William Beaumont School of Medicine supports student growth in these areas beginning in the first year, so that students can directly apply these skills as they progress to the clinical years and beyond.

Assessing the efficacy of tablet-based simulations for learning pseudo-surgical instrumentation.

Nurses and surgeons must identify and handle specialized instruments with high temporal and spatial precision. It is crucial that they are trained effectively. Traditional training methods include supervised practices and text-based study, which may expose patients to undue risk during practice procedures and lack motor/haptic training respectively. Tablet-based simulations have been proposed to mediate some of these limitations. We implemented a learning task that simulates surgical instrumentation nomenclature encountered by novice perioperative nurses. Learning was assessed following training in three distinct conditions: tablet-based simulations, text-based study, and real-world practice. Immediately following a 30-minute training period, instrument identification was performed with comparable accuracy and response times following tablet-based versus text-based training, with both being inferior to real-world practice. Following a week without practice, response times were equivalent between real-world and tablet-based practice. While tablet-based training does not achieve equivalent results in instrument identification accuracy as real-world practice, more practice repetitions in simulated environments may help reduce performance decline. This project has established a technological framework to assess how we can implement simulated educational environments in a maximally beneficial manner.

An early introduction to surgical skills: Validating a low-cost laparoscopic skill training program purpose built for undergraduate medical education.

BACKGROUND: Medical student exposure to laparoscopy is limited to observation despite the prevalence of minimally invasive techniques in practice. The high cost of laparoscopic simulation equipment, commonly called "box trainers", limits undergraduate exposure to skill training. METHODS: Students at a Midwestern medical school were recruited to participate in an experimental laparoscopic skill training program. One cohort (n = 17) used a DIY box trainer design freely available on MedEdPORTAL. A second cohort (n = 17) used a commercially available equivalent. Pre- and post-training attempts for four tasks were scored and the difference was calculated. The average differences for each cohort were then contrasted statistically. RESULTS: Significant performance improvements (pre- and post-training) were demonstrated regardless of group allocation. The difference in performance between the cohorts was not significant for any task (p > 0.05). CONCLUSIONS: This low-cost training program using DIY box trainers is as effective as commercially available equivalent box trainers for introducing laparoscopic skills to medical students.

Correlating Spatial Ability With Anatomy Assessment Performance: A Meta-Analysis.

Interest in spatial ability has grown over the past few decades following the emergence of correlational evidence associating spatial aptitude with educational performance in the fields of science, technology, engineering, and mathematics. The research field at large and the anatomy education literature on this topic are mixed. In an attempt to generate consensus, a meta-analysis was performed to objectively summarize the effects of spatial ability on anatomy assessment performance across multiple studies and populations. Relevant studies published within the past 50 years (1969-2019) were retrieved from eight databases. Study eligibility screening was followed by a full-text review and data extraction. Use of the Mental Rotations Test (MRT) was required for study inclusion. Out of 2,450 screened records, 15 studies were meta-analyzed. Seventy-three percent of studies (11 of 15) were from the United States and Canada, and the majority (9 of 15) studied professional students. Across 15 studies and 1,245 participants, spatial ability was weakly associated with anatomy performance (rpooled  = 0.240; CI at 95% = 0.09, 0.38; P = 0.002). Performance on spatial and relationship-based assessments (i.e., practical assessments and drawing tasks) was correlated with spatial ability, while performance on assessments utilizing non-spatial multiple-choice items was not correlated with spatial ability. A significant sex difference was also observed, wherein males outperformed females on spatial ability tasks. Given the role of spatial reasoning in learning anatomy, educators are encouraged to consider curriculum delivery modifications and a comprehensive assessment strategy so as not to disadvantage individuals with low spatial ability.

Analysis of Instrument Motion and the Impact of Residency Level and Concurrent Distraction on Laparoscopic Skills.

OBJECTIVE: Using a laparoscopic box trainer fitted with motion analysis trackers and software, we aim to identify differences between junior and senior residents performing the peg transfer task, and the impact of a distracting secondary task on performance. DESIGN: General surgery residents were asked to perform the laparoscopic peg transfer task on a trainer equipped with a motion tracker. They were also asked to perform the laparoscopic task while completing a secondary task. Extreme velocity and acceleration events of instrument movement in the 3 rotational degrees of freedom were measured during task completion. The number of extreme events, defined as velocity or acceleration exceeding 1 SD above or below their own mean, were tabulated. The performance of junior residents was compared to senior residents. SETTING: Simulation learning institute, Beaumont Hospital, Royal Oak, Michigan. PARTICIPANTS: Thirty-seven general surgery residents from Beaumont Hospital, Royal Oak. RESULTS: When completing the primary task alone, senior residents executed significantly fewer extreme motion events specific to acceleration in pitch (16.63 vs. 20.69, p = 0.04), and executed more extreme motion events specific to velocity in roll (16.14 vs. 15.11, p = 0.038), when compared to junior residents. With addition of a secondary task, senior residents had fewer extreme acceleration events specific to pitch, (14.69 vs. 22.22, p < 0.001). CONCLUSIONS: While junior and senior residents completed the peg transfer task with similar times, motion analysis identified differences in extreme motion events between the groups, even when a secondary task was added. Motion analysis may prove useful for real-time feedback during laparoscopic skill acquisition.

Low-Cost Laparoscopic Skill Training for Medical Students Using Homemade Equipment.

Introduction: Despite the increasing prevalence of minimally invasive surgery (MIS), medical students receive little training in MIS techniques like laparoscopy. Cost is perhaps the biggest obstacle, as expensive laparoscopic skill simulators (box trainers) are needed to mimic the laparoscopic environment. Low-cost, homemade box trainers have been built and described in the literature but are generally relegated to self-directed practice for surgical residents. These do-it-yourself (DIY) box trainers are uniquely capable of addressing cost as a major barrier to laparoscopic skills training for medical students but have not previously been used specifically for this purpose. Methods: Students from the Oakland University William Beaumont School of Medicine (n = 17) participated in a laparoscopic skills training course using DIY box trainers. Four basic laparoscopic tasks were taught using live demonstrations followed by directed practice. Learners were instructed to record their first and last attempts in order to enable self-assessment of their progress. Results: All learners were able to successfully complete each of the four laparoscopic tasks by the end of their respective sessions. Feedback from the learners in the form of a postsession survey indicated that the course provided an enjoyable and high-quality experience. Discussion: This resource is effective at providing medical students with a low-cost opportunity to experience laparoscopy and develop basic laparoscopic skills.

Guiding Low Spatial Ability Individuals through Visual Cueing: The Dual Importance of Where and When to Look.

Research suggests that spatial ability may predict success in complex disciplines including anatomy, where mastery requires a firm understanding of the intricate relationships occurring along the course of veins, arteries, and nerves, as they traverse through and around bones, muscles, and organs. Debate exists on the malleability of spatial ability, and some suggest that spatial ability can be enhanced through training. It is hypothesized that spatial ability can be trained in low-performing individuals through visual guidance. To address this, training was completed through a visual guidance protocol. This protocol was based on eye-movement patterns of high-performing individuals, collected via eye-tracking as they completed an Electronic Mental Rotations Test (EMRT). The effects of guidance were evaluated using 33 individuals with low mental rotation ability, in a counterbalanced crossover design. Individuals were placed in one of two treatment groups (late or early guidance) and completed both a guided, and an unguided EMRT. A third group (no guidance/control) completed two unguided EMRTs. All groups demonstrated an increase in EMRT scores on their second test (P < 0.001); however, an interaction was observed between treatment and test iteration (P = 0.024). The effect of guidance on scores was contingent on when the guidance was applied. When guidance was applied early, scores were significantly greater than expected (P = 0.028). These findings suggest that by guiding individuals with low mental rotation ability "where" to look early in training, better search approaches may be adopted, yielding improvements in spatial reasoning scores. It is proposed that visual guidance may be applied in spatial fields, such as STEMM (science, technology, engineering, mathematics and medicine), surgery, and anatomy to improve student's interpretation of visual content. Anat Sci Educ. © 2018 American Association of Anatomists.

Time limits in testing: An analysis of eye movements and visual attention in spatial problem solving.

Individuals with an aptitude for interpreting spatial information (high mental rotation ability: HMRA) typically master anatomy with more ease, and more quickly, than those with low mental rotation ability (LMRA). This article explores how visual attention differs with time limits on spatial reasoning tests. Participants were assorted to two groups based on their mental rotation ability scores and their eye movements were collected during these tests. Analysis of salience during testing revealed similarities between MRA groups in untimed conditions but significant differences between the groups in the timed one. Question-by-question analyses demonstrate that HMRA individuals were more consistent across the two timing conditions (κ = 0.25), than the LMRA (κ = 0.013). It is clear that the groups respond to time limits differently and their apprehension of images during spatial problem solving differs significantly. Without time restrictions, salience analysis suggests LMRA individuals attended to similar aspects of the images as HMRA and their test scores rose concomitantly. Under timed conditions however, LMRA diverge from HMRA attention patterns, adopting inflexible approaches to visual search and attaining lower test scores. With this in mind, anatomical educators may wish to revisit some evaluations and teaching approaches in their own practice. Although examinations need to evaluate understanding of anatomical relationships, the addition of time limits may induce an unforeseen interaction of spatial reasoning and anatomical knowledge. Anat Sci Educ 10: 528-537. © 2017 American Association of Anatomists.

Different perspectives: Spatial ability influences where individuals look on a timed spatial test.

Learning in anatomy can be both spatially and visually complex. Pedagogical investigations have begun exploration as to how spatial ability may mitigate learning. Emerging hypotheses suggests individuals with higher spatial reasoning may attend to images differently than those who are lacking. To elucidate attentional patterns associated with different spatial ability, eye movements were measured in individuals completing a timed electronic mental rotation test (EMRT). The EMRT was based on the line drawings of Shepherd and Metzler. Individuals deduced whether image pairs were rotations (same) or mirror images (different). It was hypothesized that individuals with high spatial ability (HSA) would demonstrate shorter average fixation durations during problem solving and attend to different features of the EMRT than low spatial ability (LSA) counterparts. Moreover, question response accuracy would be associated with fewer fixations and shorter average response times, regardless of spatial reasoning ability. Average fixation duration in the HSA group was shorter than LSA (F(1,8) = 7.99; P = 0.022). Importantly, HSA and LSA individuals looked to different regions of the EMRT images (Fisher Exact Test: 12.47; P = 0.018); attending to the same locations only 34% of the time. Correctly answered questions were characterized by fewer fixations per question (F(1, 8) = 18.12; P = 0.003) and shorter average response times (F(1, 8) = 23.89; P = 0.001). The results indicate that spatial ability may influence visual attention to salient areas of images and this may be key to problem solving processes for low spatial individuals. Anat Sci Educ 10: 224-234. © 2016 American Association of Anatomists.

Changing the Learning Curve in Novice Laparoscopists: Incorporating Direct Visualization into the Simulation Training Program.

OBJECTIVE: A major challenge in laparoscopic surgery is the lack of depth perception. With the development and continued improvement of 3D video technology, the potential benefit of restoring 3D vision to laparoscopy has received substantial attention from the surgical community. Despite this, procedures conducted under 2D vision remain the standard of care, and trainees must become proficient in 2D laparoscopy. This study aims to determine whether incorporating 3D vision into a 2D laparoscopic simulation curriculum accelerates skill acquisition in novices. DESIGN: Postgraduate year-1 surgical specialty residents (n = 15) at the Schulich School of Medicine and Dentistry, at Western University were randomized into 1 of 2 groups. The control group practiced the Fundamentals of Laparoscopic Surgery peg-transfer task to proficiency exclusively under standard 2D laparoscopy conditions. The experimental group first practiced peg transfer under 3D direct visualization, with direct visualization of the working field. Upon reaching proficiency, this group underwent a perceptual switch, changing to standard 2D laparoscopy conditions, and once again trained to proficiency. RESULTS: Incorporating 3D direct visualization before training under standard 2D conditions significantly (p < 0.0.5) reduced the total training time to proficiency by 10.9 minutes or 32.4%. There was no difference in total number of repetitions to proficiency. Data were also used to generate learning curves for each respective training protocol. CONCLUSIONS: An adaptive learning approach, which incorporates 3D direct visualization into a 2D laparoscopic simulation curriculum, accelerates skill acquisition. This is in contrast to previous work, possibly owing to the proficiency-based methodology employed, and has implications for resource savings in surgical training.

The eye of the beholder: Can patterns in eye movement reveal aptitudes for spatial reasoning?

Mental rotation ability (MRA) is linked to academic success in the spatially complex Science, Technology, Engineering, Medicine, and Mathematics (STEMM) disciplines, and anatomical sciences. Mental rotation literature suggests that MRA may manifest in the movement of the eyes. Quantification of eye movement data may serve to distinguish MRA across individuals, and serve as a consideration when designing visualizations for instruction. It is hypothesized that high-MRA individuals will demonstrate fewer eye fixations, conduct shorter average fixation durations (AFD), and demonstrate shorter response times, than low-MRA individuals. Additionally, individuals with different levels of MRA will attend to different features of the block-figures presented in the electronic mental rotations test (EMRT). All participants (n = 23) completed the EMRT while metrics of eye movement were collected. The test required participants view pairs of three-dimensional (3D) shapes, and identify if the pair is rotated but identical, or two different structures. Temporal analysis revealed no significant correlations between response time, average fixation durations, or number of fixations and mental rotation ability. Further analysis of within-participant variability yielded a significant correlation for response time variability, but no correlation between AFD variability and variability in the number of fixations. Additional analysis of salience revealed that during problem solving, individuals of differing MRA attended to different features of the block images; suggesting that eye movements directed at salient features may contribute to differences in mental rotations ability, and may ultimately serve to predict success in anatomy. Anat Sci Educ 9: 357-366. © 2015 American Association of Anatomists.

Head to head: The role of academic competition in undergraduate anatomical education.

Competition is a key element in many educational games and is often adopted by educators in an effort to motivate and excite their students. Yet, the use of academic competition in educational institutions remains the subject of much debate. Opponents argue that academic competition causes an increase in student anxiety and divides their attention. However, if the contexts of academic competition are defined, could the inclusion of a game-like competition in a university course be a viable and beneficial method of engaging students? Students (n = 67) were recruited from an undergraduate human anatomy course at Western University. Using a crossover design, students were exposed to a competitive tournament either at the time of their first term test or second term test. The anatomical knowledge of participating students was assessed prior to the start of the study using a baseline anatomy test. Following treatment with an online competitive anatomy tournament, student's term test grades and final course grades were analyzed. Both the second term test scores (F(2,64) = 3.743, P = 0.029) and overall course grades (F(2,64) = 3.356, P = 0.041) were found to be significantly different (P < 0.05) for individuals in the competitive group when compared to their non-competing peers. As suggested by the literature where organized competition in the classroom correlates to improved academic performance, this study uncovered significant results pertaining to increased academic performance resulting from participating in tournament-based competition. In light of these positive results, further exploration of the effects of academic competition on student performance across age brackets and disciplines is warranted.

Spatial visualization ability and laparoscopic skills in novice learners: evaluating stereoscopic versus monoscopic visualizations.

Elevated spatial visualization ability (Vz) is thought to influence surgical skill acquisition and performance. Current research suggests that stereo visualization technology and its association with skill performance may confer perceptual advantages. This is of particular interest in laparoscopic skill training, where stereo visualization may confer learning advantages to novices of variant Vz. This study explored laparoscopic skill performance scores in novices with variable spatial ability utilizing stereoscopic and traditional monoscopic visualization paradigms. Utilizing the McGill Inanimate System for Teaching and Evaluating Laparoscopic Skills (MISTELS) scoring protocol it was hypothesized that individuals with high spatial visualization ability (HVz) would achieve higher overall and individual MISTELS task scores as compared to low spatial visualization ability (LVz) counterparts. Further, we also hypothesized that a difference would exist between HVz and LVz individual scores based on the viewing modality employed. No significant difference was observed between HVz and LVz individuals for MISTELS tasks scores, overall or individually under both viewing modalities, despite higher average MISTELS scores for HVz individuals. The lack of difference between scores obtained under the stereo modality suggested that the additional depth that is conferred by the stereoscopic visualization may act to enhance performance for individuals with LVz, potentially equilibrating their performance with their HVz peers. Further experimentation is required to better ascertain the effects of stereo visualization in individuals of high and low Vz, though it appears stereoscopic visualizations could serve as a prosthetic to enhance skill performance.

Application of stereoscopic visualization on surgical skill acquisition in novices.

OBJECTIVE: The use of stereoscopic imaging can provide additional depth cues that may increase trainee performance on surgical tasks, but it has yet to be evaluated using a validated surgical skill system. This study examines the influence of monoscopic vs stereoscopic visualization in novice trainees performing the McGill Inanimate System for Training and Evaluation of Laparoscopic Skill (MISTELS) tasks, a validated laparoscopic skill-evaluation system, predicting a difference in performance based on visualization modality. DESIGN: A total of 31 first- and second-year medical students at the University of Western Ontario were selected, each performed the MISTELS battery of tasks (circle cutting, peg transfer, ligated loop Placement, intracorporeal knot tying, and extracorporeal knot tying) using either monoscopic or stereoscopic visualization displays. Performance was evaluated in accordance with the MISTELS protocol. Participant visual spatial ability and manual dexterity skills were also analyzed and compared with performance. p values less than 0.05 were considered significant. RESULTS: For ligated loop placement, extracorporeal knot tying, and intracorporeal knot tying, no significant difference was found between monoscopic and stereoscopic visualization on task performance (p > 0.05). Monoscopic visualization was shown to produce significantly better performance in the peg transfer task alone (p = 0.001). Qualitatively, 57.1% of participants believed their performance was aided by stereoscopic visualization and 68.8% believed that future learners would benefit from its implementation into surgical education. Most participants rated the peg transfer task to be the least difficult task (60%) and rated the intracorporeal knot-tying task to be the most difficult (65.9%). CONCLUSIONS: These results suggest that the intrinsic difficulty of the MISTELS tasks may exceed a novice user's skill. No benefit with additional 3-dimensional cues in naïve surgical trainees was found. Additional visual cues in stereoscopic visualization may only serve to increase cognitive load and potentially decrease skill acquisition and learning.