Element 2 was Top Gun itself, which was conducted over 1
days. The Top Gun basic skills and intracorporeal suturing courses involve preparatory laparoscopic drills and interrupted suturing on porcine bowel. The preparatory drills emphasize nondominant hand dexterity, 2-handed choreography, 2-dimensional depth perception compensation, and targeting. The first drill is the Cobra Rope Drill, requiring participants to unwind and pass a string using 2 standardized laparoscopic graspers, targeting specific colored sections of the string. The second drill is the Terrible Triangle Drill, which involves lifting and moving 5 triangular objects from one designated point to another by placing a needle through a metal loop atop each triangle, using an instrument with the nondominant hand. The third drill is the Cup Drop Drill, during which participants move beans from a designated area into a cup with a 1-cm aperture using a standard laparoscopic grasper in the nondominant hand. Last, interrupted sutures are placed into porcine intestine. This complex task is executed using a standardized technique algorithm. The time to complete each task is recorded, and an electronic proctor registers and tabulates errors committed by inaccurate instrument movements. These variables serve as a measure of performance. The course has been previously described in detail.
Element 3 consisted of playing 3 over-the-counter video games. Subjects were taken in groups of 3 for 25 minutes of video game play. All participants completed all 3 elements. Of the 33 subjects, 8 completed the video game tasks after having participated in Top Gun between 12 and 24 months previously. These 8 participants were not selected and were not members of the original study group. All other participants completed all elements at the same time. Participants were given a standard set of instructions and a brief demonstration and then asked to begin play.
Three representative games were selected from 100 of the most popular video games. Each game was chosen based on its applicability to the development of specific skills required for completion of Top Gun. The skills tested by these games included fine motor control, visual attention processing, spatial distribution, reaction time, eye-hand coordination, targeting, nondominant hand emphasis, and 2-dimensional depth perception compensation. Games were also selected based on their ease of measurement and lack of bonus scores, which could skew data away from the mean, thus creating a nonrepresentative bimodal distribution of scores. Therefore, 2 games were scored purely as total time to complete, while the third measured total targets hit. Sex neutrality and game novelty were also selection criteria. None of the subjects had ever played any of the 3 video games used for this study.
The first video game was Super Monkey Ball 2 (Sega of America Inc, San Francisco, Calif) for Nintendo Gamecube (Nintendo Co Ltd, Tokyo, Japan). The player pilots a spherical ball around a dynamic undulating course while targeting specific items. Performance was scored by total time to complete the course. If the course was not completed in 300 seconds, a value of 300 seconds was assigned.
The second video game was Star Wars Racer Revenge (LucasArts Entertainment Company, San Rafael, Calif) for Sony PlayStation 2 (Sony Computer Entertainment, Inc, Tokyo), in which players navigated a serpentine canyon track, competing against 5 other computer-controlled racers. The score was total time to complete a single lap. All games were viewed on either a 51-cm television monitor or a 46-cm flat screen monitor (Trinitron; Sony Corporation, Tokyo), such as those used in laparoscopic surgery.
The third video game selected was Silent Scope (Konami Co, Tokyo) for Microsoft Xbox (Microsoft Corp, Redmond, Wash), which required the player to shoot as many screen targets as possible in 2 minutes 30 seconds. The score was the total number of targets hit.
