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Invited Critique
February 1, 2007

The Impact of Video Games on Training Surgeons in the 21st Century—Invited Critique

Arch Surg. 2007;142(2):186. doi:10.1001/archsurg.142.2.186

The idea that video game playing improves laparoscopic skills is appealing. Now kids and guilty parents do not have to argue about the electronic babysitter—this is an investment in the children's future! This is a seductive idea that has enormous potential for distortion by the media and public. The most important statement in this article is found near the end: “indiscriminate video game play is not a panacea.” We still have to watch our children's video gaming carefully—the number of hours, the types of games, and so on. And will it really improve laparoscopic skills? There are several problems with this article. First, the small sample size leaves significant potential for bias. Second, the authors suggest that we should include video game play for laparoscopic skill training, but their data suggest that past playing is what improves laparoscopic skills. They did not determine the formative years during which video game playing will improve laparoscopic skills. If those skills are best developed from the age of 8 to 15 years, then video game play during residency is fruitless. The authors also suggest that video game playing decreases errors during Top Gun, which could improve patient safety. There is no analysis of the seriousness of those errors. We all know that many errors do not result in patient harm. This study does not indicate that good Top Gun scores decrease deaths or increase patient safety. Equally important, high Top Gun scores do not correlate with competency, and we do not know if video game playing leads to competency in laparoscopic skills. One could argue that a competent laparoscopic surgeon with lower Top Gun scores who has superb judgment, great interpersonal skill, and outstanding communication skills is a better physician than a competent laparoscopic surgeon with high Top Gun scores who has no interpersonal or communication skills because of spending so much time isolated playing video games. The lesson to be learned from this article is actually quite focused. We should consider using video games as another tool to help surgeons reach competency. Perhaps those surgeons with a demonstrated skill in video gaming or with significant past playing could use video games to help learn laparoscopic skills, while those surgeons with little to no skill in video gaming should use other learning modalities to become competent laparoscopic surgeons. Although it seems intuitive that video game skills can translate to improved laparoscopic skills, further studies are needed before we include video game play as an adjunct for skill training in laparoscopic surgery or before we relax our concerns about video game playing among children.

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