Quiet eye training improves surgical knot tying more than traditional technical training: a randomized controlled study

Am J Surg. 2014 Aug;208(2):171-7. doi: 10.1016/j.amjsurg.2013.12.042. Epub 2014 Apr 25.


Background: We examined the effectiveness of technical training (TT) and quiet eye training (QE) on the performance of one-handed square knot tying in surgical residents.

Methods: Twenty surgical residents were randomly assigned to the 2 groups and completed pretest, training, retention, and transfer tests. Participants wore a mobile eye tracker that simultaneously recorded their gaze and hand movements. Dependent variables were knot tying performance (%), QE duration (%), number of fixations, total movement time (s), and hand movement phase time (s).

Results: The QE training group had significantly higher performance scores, a longer QE duration, fewer fixations, faster total knot tying times, and faster movement phase times compared with the TT group. The QE group maintained performance in the transfer test, whereas the TT group significantly decreased performance from retention to transfer.

Conclusions: QE training significantly improved learning, retention, and transfer of surgical knot tying compared with a traditional technical approach. Both performance effectiveness (performance outcome) and movement efficiency (hand movement times) were improved using QE modeling, instruction, and feedback.

Keywords: Attention; Expertise; Gaze; Knots; Surgery; Training.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Clinical Competence*
  • Female
  • Fixation, Ocular / physiology*
  • General Surgery / education*
  • Hand / physiology
  • Humans
  • Internship and Residency*
  • Male
  • Movement / physiology
  • Psychomotor Performance / physiology*
  • Retention, Psychology
  • Suture Techniques / education*
  • Teaching / methods
  • Young Adult