Reframing motor skill organisation: Dynamics, mechanisms, and impact in surgical settings

Complex motor behaviour, such as bimanual coordination, plays an important role in daily-life activities and specialist skills, relying on a highly refined motor system that interacts with cognitive, emotional and motivational processes. In this review, we propose that handedness, dexterity and expertise are key complementary modulators of motor skill organisation, steering neural and behavioural interactions, with an optimal performance emerging from a synergy between predispositions and acquired abilities. We further demonstrate the implications for surgical practice, where outcomes emerge within high-performance environments. In these settings, motor behaviour follows core principles of motor skill organisation, although its expression strongly relies on cognitive demands due to multiple factors such as procedural and environmental complexity, multitasking, and high-precision requirements. Accounting for these constraints is a critical determinant of how the brain optimises behaviour and mindset during surgical performance. Through extensive training, experts develop adaptive control that promotes an advanced level of motor skill organisation, enabling them to translate their skill, knowledge and experience into superior outcomes. Advancing our understanding of how complex specialist motor skills are performed, acquired and refined is essential for strengthening theoretical models of motor control and learning, enhancing training opportunities, and informing objective assessment criteria and curriculum development.