1.Tomas Ros*, 2. Merrick J Moseley, 3. Philip A Bloom, 4. Larry Benjamin, 5. Lesley A Parkinson and John H Gruzelier.

BMC Neuroscience BioMedCentral Research article Open Access

Optimising microsurgical skills with EEG neurofeedback

1.Tomas Ros*, 2. Merrick J Moseley, 3. Philip A Bloom, 4. Larry Benjamin,
5. Lesley A Parkinson and John H Gruzelier

1 Department of Psychology, Goldsmiths, University of London, London, UK.
2 Department of Optometry and Visual Science, City University, London, UK.
3 Western Eye Hospital, London, UK.
4 Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK and
5 Brainhealth, The Diagnostic Clinic, London, UK.

Email: Tomas Ros* – t.ros@gold.ac.uk; Merrick J Moseley – m.j.moseley@city.ac.uk; Philip A Bloom – philipbloom@zoo.co.uk;
Larry Benjamin – larry.benjamin@btopenworld.com; Lesley A Parkinson – lesleyparkinsoncp@hotmail.com;
John H Gruzelier – j.gruzelier@gold.ac.uk

* Corresponding author

Published: 24 July 2009 Received: 23 February 2009
Accepted: 24 July 2009

BMC Neuroscience 2009, 10:87 doi: 10.1186/1471-2202-10-87

This article is available from: http://www.biomedcentral.com/1471-2202/10/87

© 2009 Ros et al; licensee BioMed Central Ltd.

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By enabling individuals to self-regulate their brainwave activity in the field of optimal performance in healthy individuals, neurofeedback has been found to improve cognitive and artistic performance. Here we assessed whether two distinct EEG neurofeedback protocols could develop surgical skill, given the important role this skill plays in medicine.


National Health Service trainee ophthalmic microsurgeons (N = 20) were randomly assigned to either Sensory Motor Rhythm-Theta (SMR) or Alpha-Theta (AT) groups, a randomised subset of which were also part of a wait-list ‘no-treatment’ control group (N = 8).

Neurofeedback groups received eight 30-minute sessions of EEG training.

Pre-post assessment included a skills lab surgical procedure with timed measures and expert ratings from video-recordings by consultant surgeons, together with state/trait anxiety self-reports.

SMR training demonstrated advantages absent in the control group, with improvements in surgical skill according to:

1) the expert ratings: overall technique (d = 0.6, p < 0.03) and suture task (d = 0.9, p < 0.02) (judges’ intra class correlation coefficient = 0.85); and)

2) with overall time on task (d = 0.5, p = 0.02), while everyday anxiety (trait) decreased (d = 0.5, p < 0.02).

Importantly the decrease in surgical task time was strongly associated with SMR EEG training changes (p < 0.01), especially with continued reduction of theta (4–7 Hz) power.

Alpha Theta training produced marginal improvements in technique and overall performance time, which were accompanied by a standard error indicative of large individual differences.

Notwithstanding, successful within session elevation of the theta-alpha ratio correlated positively with improvements in overall technique (r = 0.64, p = 0.047).


SMR-Theta neurofeedback training provided significant improvement in surgical technique whilst considerably reducing time on task by 26%. There was also evidence that AT training marginally reduced total surgery time, despite suboptimal training efficacies. Overall, the data set provides encouraging evidence of optimised learning of a complex medical specialty via neurofeedback training.

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