Frontal theta brain activity varies as a function of surgical experience and task error

Objective Investigations into surgical expertise have almost exclusively focused on overt behavioral characteristics with little consideration of the underlying neural processes. Recent advances in neuroimaging technologies, for example, wireless, wearable scalp-recorded electroencephalography (EEG), allow an insight into the neural processes governing performance. We used scalp-recorded EEG to examine whether surgical expertise and task performance could be differentiated according to an oscillatory brain activity signal known as frontal theta—a putative biomarker for cognitive control processes.

Design, setting, and participants Behavioral and EEG data were acquired from dental surgery trainees with 1 year (n=25) and 4 years of experience (n=20) while they performed low and high difficulty drilling tasks on a virtual reality surgical simulator. EEG power in the 4–7 Hz range in frontal electrodes (indexing frontal theta) was examined as a function of experience, task difficulty and error rate.

Results Frontal theta power was greater for novices relative to experts (p=0.001), but did not vary according to task difficulty (p=0.15) and there was no Experience × Difficulty interaction (p=0.87). Brain–behavior correlations revealed a significant negative relationship between frontal theta and error in the experienced group for the difficult task (r=−0.594, p=0.0058), but no such relationship emerged for novices.

Conclusion We find frontal theta power differentiates between surgical experiences but correlates only with error rates for experienced surgeons while performing difficult tasks. These results provide a novel perspective on the relationship between expertise and surgical performance.