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Jack Kuhns and Dayna R. Touron

The study of aging and cognitive skill learning is concerned with age-related changes and differences in how we gather, store, and use information and abilities. As life expectancy continues to rise, resulting in greater numbers and proportions of older individuals in the population, understanding the development and retention of skills across the lifespan is increasingly important. Older adults’ task performance in cognitive skill learning is often equal to that of young adults, albeit not as efficient, where older adults often require more time to complete training. Investigations of age differences in fundamental cognitive processes of attention, memory, or executive functioning generally reveal declines in older adults. These are related to a slowing of cognitive processing. Slowing in cognitive processing results in longer time necessary to complete tasks which can interfere with the fidelity of older adults’ cognitive processes in time-limited scenarios. Despite this, older adults maintain comparable rates of learning with young adults, albeit with some reduced efficiency in more complex tasks. The effectiveness of older adults’ learning is also impacted by a lesser tendency to recognize and adopt efficient learning strategies, as well as less flexibility in strategy use relative to younger adults. In learning tasks that involve a transition from using a complex initial strategy to relying on memory retrieval, older adults show a volitional avoidance of memory that is related to lower memory confidence and an impoverished mental model of the task. Declines in learning are not entirely problematic from a functional perspective, however, as older adults can often rely upon their extensive knowledge to compensate for certain deficiencies, particularly in everyday tasks. Indeed, domains where older adults have maintained expertise are somewhat insulated from other age-related declines.


Aidan Moran, Nick Sevdalis, and Lauren Wallace

At first glance, there are certain similarities between performance in surgery and that in competitive sports. Clearly, both require exceptional gross and fine motor ability and effective concentration skills, and both are routinely performed in dynamic environments, often under time constraints. On closer inspection, however, crucial differences emerge between these skilled domains. For example, surgery does not involve directly antagonistic opponents competing for victory. Nevertheless, analogies between surgery and sport have contributed to an upsurge of research interest in the psychological processes that underlie expertise in surgical performance. Of these processes, perhaps the most frequently investigated in recent years is that of motor imagery (MI) or the cognitive simulation skill that enables us to rehearse actions in our imagination without engaging in the physical movements involved. Research on motor imagery training (MIT; also called motor imagery practice, MIP) has important theoretical and practical implications. Specifically, at a theoretical level, hundreds of experimental studies in psychology have demonstrated the efficacy of MIT/MIP in improving skill learning and skilled performance in a variety of fields such as sport and music. The most widely accepted explanation of these effects comes from “simulation theory,” which postulates that executed and imagined actions share some common neural circuits and cognitive mechanisms. Put simply, imagining a skill activates some of the brain areas and neural circuits that are involved in its actual execution. Accordingly, systematic engagement in MI appears to “prime” the brain for optimal skilled performance. At the practical level, as surgical instruction has moved largely from an apprenticeship model (the so-called see one, do one, teach one approach) to one based on simulation technology and practice (e.g., the use of virtual reality equipment), there has been a corresponding growth of interest in the potential of cognitive training techniques (e.g., MIT/MIP) to improve and augment surgical skills and performance. Although these cognitive training techniques suffer both from certain conceptual confusion (e.g., with regard to the clarity of key terms) and inadequate empirical validation, they offer considerable promise in the quest for a cost-effective supplementary training tool in surgical education. Against this background, it is important for researchers and practitioners alike to explore the cognitive psychological factors (such as motor imagery) that underlie surgical skill learning and performance.