Different cognitive styles can affect performance in laparoscopic surgery skill training



The lack of depth cues and haptic feedback makes minimally invasive surgery a cognitive challenge. It is therefore important to know which individuals are expected to perform well in minimally invasive surgery. In cognitive psychology, methods are available with which one can measure different cognitive thinking styles. It is well known that these cognitive styles correlate with many different tasks. We investigated whether this method can also predict performance on a box trainer (Lübeck Toolbox®), a device for training laparoscopic surgery. If so, the method might help to select and train those people who will most likely develop high skills in minimally invasive surgery.


Thirty medical students and thirty non-medical students performed five laparoscopic surgical tasks on a box trainer. We measured the time required and the errors participants made on each task. Their cognitive style was measured with a method from cognitive psychology that distinguishes between people who think visually, spatially, or verbally. Furthermore, all students completed a subset of a standard intelligence test (Wechsler Adult Intelligence Scale) and three subtests of the German Medical University Admission Test (TMS).


Participants with spatial thinking styles performed best on the box trainer. Visual and verbal cognitive styles impeded box trainer performance. Performance on the box trainer could also be predicted by the TMS and IQ scores.


The study shows for the first time that a standard method from cognitive psychology can be used to distinguish between different cognitive styles in surgical education and that these different cognitive styles affect performance on a box trainer. Since the correlation between box trainer performance and surgical proficiency is well documented, the method might be an efficient way to reduce errors and to elevate patient safety in laparoscopic surgery.

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This research was supported by the Deutsche Forschungsgemeinschaft [DFG Grant KN 465/6-2 to Markus Knauff]. The authors thank all participants for taking part in this study.

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Correspondence to Armin Paul Mathias.

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Armin Mathias, Peter Vogel, and Markus Knauff have no conflicts of interest or financial ties to disclose.

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Mathias, A.P., Vogel, P. & Knauff, M. Different cognitive styles can affect performance in laparoscopic surgery skill training. Surg Endosc 34, 4866–4873 (2020). https://doi.org/10.1007/s00464-019-07267-y

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  • Box trainer
  • Spatial cognition
  • Cognitive styles
  • Medical assessment
  • Laparoscopic surgery