Taxing working memory during laparoscopic training: reducing the impact of perfectionistic concerns on skill learning

Perfectionistic concerns are common among surgeons and have been linked to reduced learning gains in the acquisition of basic instrument-handling skills for minimally invasive surgery (MIS). These concerns often trigger rumination, which distracts attention from the task at hand during practice and interferes with effective skill acquisition. According to working-memory models, occupying task-irrelevant capacity with a neutral secondary task may leave fewer resources available for rumination, thereby reducing negative self-focus. This study investigated whether adding a secondary working-memory task during MIS training alters the association between self-critical perfectionism and laparoscopic skill retention.

In this randomized experimental study, 55 laparoscopically naïve participants practiced a peg-transfer task on a custom MIS simulator and returned within 48 h for a retention test. Participants were allocated to a control condition wherein the target position for the pegs were continuously visible, or an experimental condition in which targets were visible for one second only, imposing visuospatial working-memory load. Performance was measured by completion time and instrument path length. Perfectionistic strivings and perfectionistic concerns were measured with the Big Three Perfectionism Scale. Retention was measured as the regression slope between late-practice and retention performance, wherein more negative slopes reflect better retention.

Practice performance and retention test performance did not differ between conditions. Perfectionistic strivings were not associated with skill retention in either group. In the control condition, higher perfectionistic concerns significantly predicted reduced retention of movement efficiency, though completion time was unaffected. Conversely, under working-memory load, perfectionistic concerns did not predict retention for either outcome.

Imposing a visuospatial working memory load during MIS practice did not compromise performance, and the observed pattern is consistent with reduced vulnerability to perfectionistic concerns in movement-efficiency retention. While these initial patterns are promising, future studies are required to definitively establish the effectiveness of these training constraints.