In fact, you could make the argument that only with the widespread release of truly 3-D games did potential surgeons get exposed to laparoscopy-like entertainment, which pushes the start date further forward from 1995. Still, at some point there will be a significant population of surgeons who played a lot of Spyro the Dragon and Psychonauts. It would be instructive to find out if that extra time people spent studying instead of playing Ape Escape translates into better outcomes.

There is, of course, a practical reason to ask about the utility of laparoscopic video simulators, and that is to find out whether it makes sense for surgery departments to invest a lot of money in expensive equipment rather than just getting their residents more laparoscopic cases. But that doesn't address the underlying issue of whether simulator performance is in any way correlated to actual outcomes. The real question is not whether games are a worthwhile mainstream occupation or a giant waste of time, but how to get surgical residents better training so they don't kill people. Those hoping for more ammunition in the culture wars are out of luck.

The attractive part of this research for gamers is that maybe someone will secretly validate all of our time playing the Call of Duty series because it makes us better at being surgeons or investment bankers or jet fighter pilots. I have to say that - given the number of times gaming has been derided in my presence, sometimes in the O.R. - that it might be amusing for someone to conclusively prove that it makes for better surgeons. Or gets us lots of hot chicks. (I think you can disprove that last point empirically without rigorous statistical analysis.)

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In the end, I'm growing weary of these relentless attempts to justify ex post facto my leisure time. Reflecting on my residency so far, gaming's ultimate appeal is that the complete attention it requires precludes interaction with the rest of the world (unlike watching TV or eating). The ability to completely disconnect from all the awful things that may have happened in the hospital, from all the emotional energy expended in patient care, to instead walk around a post-apocalyptic wasteland with a dog companion, is one of my most jealously guarded pleasures. I don't care if it makes me a better surgeon; I am just glad it keeps me sane. The "better surgeon" part I can work on.

Although it is not his actual name, Rich Retractor, MD, PhD, is a surgical resident at a large U.S. academic medical center.

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