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Looking into Learning: Visuospatial and Psychomotor Predictors of Ultrasound-Guided Procedural Performance
  1. Hugh M. Smith, MD, PhD*,
  2. Sandra L. Kopp, MD*,
  3. Rebecca L. Johnson, MD*,
  4. Timothy R. Long, MD*,
  5. Jane H. Cerhan, PhD and
  6. James R. Hebl, MD*
  1. From the Departments of *Anesthesiology and
  2. Psychology, Mayo Clinic College of Medicine, Rochester, MN.
  1. Address correspondence to: Hugh M. Smith, MD, PhD, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: smith.hugh2{at}


Background and Objectives Despite widespread use of ultrasound in regional anesthesia, little understanding of the psychomotor and visuospatial skills required to achieve and maintain procedural proficiency exists. Despite its procedural nature, anesthesiology lags behind other fields in assessing technical aptitude among practitioners and trainees. The goals of this study were to measure relevant visuospatial and psychomotor aptitudes of anesthesia residents-in-training and to evaluate the relationship between these skill sets and the performance of ultrasound-guided regional anesthesia.

Methods Forty residents from the Mayo Clinic Department of Anesthesiology were enrolled, and 39 (PGY-1 through PGY-4) voluntarily completed a demographic survey, 4 psychomotor and 4 visuospatial aptitude assessments, and an ultrasound-based performance assessment.

Results The Block Design Test, a subtest of the Wechsler Adult Intelligent Scale - III, correlated with ultrasound guided skill performance (correlation coefficient, 0.47; P < 0.002). By contrast, psychomotor aptitude assessments did not correlate with ultrasound task performance. Psychomotor skill performance was significantly reduced by indirect hand-eye coordination visual feedback (projected image) compared with direct hand-eye coordination (P < 0.001). A learning effect was observed between the first and second ultrasound skill task attempts and was independent of hand dominance.

Discussion This study reveals that visuospatial aptitude is a better predictor of ultrasound-based procedural performance than psychomotor ability. The type of real-time visual feedback (indirect versus direct) used for hand-eye coordination significantly impacts procedural performance and has implications for anesthesia and other procedural specialties. The learning effect noted during initial ultrasound skill trials suggests visuospatial assimilation and underscores the importance of early ultrasound instruction.

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  • Support for this work was provided by the Mayo Clinic Department of Anesthesiology, Rochester, Minnesota.

  • The authors declare no conflicts of interest.