Date of Award

Winter 2018

Document type


Degree Name

PhD (Doctor of Philosophy)

First Supervisor

Dr Dara Kavanagh

Second Supervisor

Professor Oscar Traynor


Health Service Executive Ireland


Health Sciences Education, Surgical Education, Competency Acquisition, Laparoscopy, Motivational Saliences, Serious Games


Background: The predictive validity of cognitive and non-cognitive factors in the development of surgical trainees’ competencies are not well described. Further research gaps exist regarding the impact of competitive personality traits and competitive platforms in the development of skills. We hypothesised that several trainee factors and competitive games platforms are conducive to technical and non-technical skill acquisition.

Aims: The primary goal of this dissertation was to determine in essence, true competitive factors in surgical trainee competency. In addition, we aimed to develop gamified simulation resources that motivate deliberate practice in the home environment.

Materials and Methods: This research was conducted via multiphase mixed methods approaches, involving premedical/medical students, surgical trainees and trainers. A systematic review and meta-analysis for the predictive validity of selection-criteria to surgical training were performed (chapter #3). A pre-post intervention analysis was conducted to determine the impact of open benchmarking of operative records, and identification of variables influencing operative exposure and competency (chapter #4). Cross-sectional and prospective cohort studies were undertaken to determine predictive variables in the baseline, acquisition and maintenance of laparoscopic skills (chapter #5). A single-blinded randomised controlled trial was implemented to determine the impact of a dedicated laparoscopic ‘serious game’ on the voluntary acquisition of technical skills (chapter #6). A cross-sectional analysis was utilised to assess the face, construct and concurrent validity of a decision-making serious game collaboratively developed (chapter #7). A randomised cross-over study was performed to evaluate the impact of 360° virtual reality videos on attentiveness, engagement and information retention (chapter #8).

Results: This research demonstrated the predictive validity of several pre-training factors with future in-training performances. Visuospatial aptitudes and fine-motor experiences were associated with acquisition and maintenance of minimally invasive skills. While competitive personalities provided no performance benefit with psychomotor skills, introducing competitive dynamics and serious games platforms resulted in significant benefits and evidence of validity.

Conclusions: A multiplicity of academic and non-academic factors are conducive to technical and non-technical skill progression. In addition, a rivalrous learning environment may promote improved recording behaviours, but competitive personalities were not associated with psychomotor performances. Furthermore, multiple serious games platforms demonstrated evidence of validity and may be conducive to deliberate practice in the home environment.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.

File Size

31.3 MB


A thesis submitted for the degree of Doctor of Philosophy from the Royal College of Surgeons in Ireland in 2018.

Available for download on Sunday, November 15, 2020