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Teaching and assessment of laparoscopic skills are currently essential components of surgical training. The Fundamentals of Laparoscopic Surgery (FLS) is a widely adopted training program based on expert-derived benchmarks; technical skills are assessed and completion is a mandatory criterion for general surgery board certification in the United States.1 However, is attainment of technical proficiency synonymous with being a safe surgeon? Intraoperative errors persist and are thought to be related to errors in cognition2 as opposed to technical failure per se. The prefrontal cortex (PFC) is a brain region associated with attention and executive function serving as a scaffold to support novel task demands during effortful unrefined performance.3 Studies examining cortical correlates of technical skills acquisition have observed predictable attenuation in PFC response alongside improvement in technical performance4,5; however, this has not been adequately tested for challenging laparoscopic skills.
Shetty K, Leff DR, Orihuela-Espina F, Yang G, Darzi A. Persistent Prefrontal Engagement Despite Improvements in Laparoscopic Technical Skill. JAMA Surg. 2016;151(7):682-684. doi:10.1001/jamasurg.2016.0050