Performance between surgically and medically inclined medical students in simulated laparoscopy

The rise of minimally invasive techniques such as robotic, laparoscopic, and natural orifice transluminal endoscopic surgery (NOTES) has transformed surgical practice, necessitating highly sophisticated advanced technical abilities from developing surgeons.

Psychomotor aptitude, alongside visuospatial acuity and depth perception is one of the main fundamental abilities required to master surgical techniques [1]. Recognising this, institutions like the Royal College of Surgeons in Ireland have incorporated psychomotor testing into surgical selection processes [2]. However, discordance has long existed regarding this and there has been a paucity of research about the utility of psychomotor aptitude testing in the pre‐residency stage, especially in undergraduate medical students.

Rising interest in surgical specialties has coincided with challenges in surgical education, including limited training time, resident work‐hour restrictions, and the complexity of modern procedures. These challenges underscore the importance of better aligning students with suitable specialties early to reduce costs and attrition. For senior year medical students (SYMS), identifying correlations between psychomotor aptitude and specialty aspirations may help inform both personal career decisions and institutional training approaches. The demand for high‐quality, efficient surgical education, combined with the need for better methods of identifying skilled candidates, forms the basis for this research.

This study examined whether laparoscopic simulator performance correlates with specialty inclination among SYMS and explores whether early aptitude‐based assessment has a role in guiding future surgical candidates.

This was a cross‐sectional study comparing between surgically and medically inclined medical students. Undergraduate medical schools in Singapore span from Year 1 to 5, with SYMS being defined as those in Year 3–5 of medical school when clinical clerkships begin.

Recruitment was offered to all SYMS at Singapore's largest university undergoing their compulsory surgery rotation through social media platforms. A total of 37 SYMS volunteers participated in the study. Inclusion criteria were SYMS aged 21–35 years, with a stated residency interest and no visual or motor impairments. All participants also had not undergone prior formal laparoscopic training. Participants were paired before receiving instructions to complete tasks at a urological dry laboratory training centre. A total of eight sessions were carried out across the 3 months.

The laparoscopic tasks included (i) peg transfer, (ii) circle gauze cutting, and (iii) intracorporeal suturing. All tasks were performed to the requirements of the European Basic Laparoscopic Urological Skills programme implemented and validated by the European Association of Urology [3]. Results were recorded according to the Asian Urological Surgery Training and Education Group Fundamentals of Laparoscopic Skills (FLS) scoring card [4].

After completing the tasks, participants completed an on‐line survey (Appendix S1) capturing demographic data and subjective feedback on the simulation experience. We collected 37 responss. Results were not statistically significant sparing the number of times of electronic device usage in a day, which varies largely independently. Residency aspirations were dichotomised into ‘surgical’ or ‘medical’ categories.

Comparative analyses were performed comparing between surgically and medically inclined medical students. Chi‐squared tests (or Fisher's exact test, wherever applicable) and Independent t‐tests were used to compare between categorical and continuous variables respectively. All P values were two‐tailed, and a P < 0.05 was taken to be statistically significant. Categorical variables are reported as number (percentage) or median (interquartile range [IQR]), while continuous variables are reported as mean (sd). Experiential feedback was analysed in terms of median (IQR) of Likert scales, comparing between both groups for significance. All data were de‐identified and analysed using the Statistical Package for the Social Sciences (SPSS®), version 29.0.1.0 (IBM Corp., Armonk, NY, USA).

This study was carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki). Approval was granted by the Ethics Committee/ Institutional Review Board of the NHG Research Online Administration and Management (ROAM), Reference 2021/00924.

A total of 37 SYMS (16 males [43.2%]; mean [sd] age 22.8 [1.08] years; penultimate year 73%) were recruited. Students were categorised into two groups dependent on specialty aspirations: (i) surgically inclined Group 1 (24 [64.9%]) and (ii) medically inclined Group 2 (13 [35.1%]). Regarding postgraduate residency selection, 13 (37.1%) of SYMS listed Urology as one of their top specialty aspirations. Baseline characteristics were similar between the two groups (Table S1).

Quantitative measures showed no significant differences in time to complete laparoscopic simulator tasks (Table S1), indicating no correlation between improved technical ability and specialty interest. However, surgically inclined students had longer mean timings for specific tasks, while medically inclined students dropped more pegs during transfer (P = 0.014). The majority (68%) of Group 1 students dropped no pegs, compared to only 36% in Group 2. The difference in peg drop rates may reflect early differences in psychomotor aptitude or task focus among surgically inclined students, though random variation or chance cannot be excluded.

Qualitative feedback indicated no statistical significance in difference across both groups regarding ease of use of laparoscopic simulator in terms of visual fidelity and hand movement, as well as perceived difficulty levels. All students reported a positive experience, with 94.6% supporting future sessions and 97.3% endorsing laparoscopic training in medical school for long‐term benefits, highlighting the potential value of curriculum integration.

This study found no significant differences in psychomotor performance or subjective feedback between surgically and medically inclined SYMS, suggesting that psychomotor aptitude may not correlate with specialty preference and are not reliable indicators of surgical skill or passion. These findings differ from the Mitchell et al. 2019 study [5], which found that second‐year medical students interested in procedural careers completed laparoscopic tasks faster, suggesting a correlation between specialty interest and psychomotor aptitude. In contrast, our study involving clinically exposed SYMS found no such association. This discrepancy may reflect differences in training stages where early interest may fade, or skill gaps narrow with clinical exposure. The higher proportion of urology interest in our cohort (37.1% vs 16.9–18.8%) could reflect local exposure or sampling variation.

Psychomotor aptitude testing may support progress tracking and tailored guidance by identifying students who need more support [6]. However, it should not be used in isolation for residency selection. Factors such as personality, decision‐making, and learning attitude [7] should also be considered; especially with the belief that differences in baseline abilities will no longer matter during constant repetition of residency training to improve real‐world surgical proficiency [8].

Introducing laparoscopic simulation earlier in medical school could foster interest in procedural fields, increase confidence, and enhance familiarity with surgical tools. Although simulation‐based training involves upfront investment, it may reduce attrition and improve specialty match rates, potentially offsetting costs long‐term. Early aptitude assessment may help align students with suitable specialties, improving training outcomes and resource allocation. While promising, its role in undergraduate medical education warrants further evaluation.

The study's strengths include involving laparoscopically naïve SYMS from both surgical and medical backgrounds. However, limitations include a small sample size, single‐session testing, possible selection bias due to self‐volunteered recruitment, and lack of formal data on participants’ prior laparoscopic experience, meaning some may have had informal exposure not accounted for. Future studies could explore more comprehensive software‐generated psychometric testing methods, include different platforms like robotic surgery, and focus on longitudinal studies with relation to real‐world surgical proficiency.

While psychomotor aptitude may not directly correlate with surgical specialty preference, early exposure to laparoscopic simulations offers promising benefits for medical education. By fostering interest in procedural specialties and enhancing technical confidence, early incorporation of laparoscopic training can play a crucial role in shaping future surgeons. While further research is needed, integrating such models into curricula could optimise residency selection, reduce training costs, and improve the alignment between student interests and career paths.

Disclosure of Interests

In accordance with the ICMJE Declarations of Interests, the authors received no funding or contracts and have no financial or non‐financial conflicts to declare.

Supporting information

Appendix S1. Laparoscopic check‐out survey.

Table S1. Students who met the inclusion criteria were eligible for inclusion.