"Quiet Eye" Can Help A Surgeon's Patients And Golf Game

Surgeons now have a really good excuse to be out on the golf course.  Researchers have shown that the same training technique that will improve their putting can also improve their operating skills.  Dr Samuel Vine and Dr Mark Wilson, from Sport and Health Sciences at the University of Exeter, tested both elite golfers and surgical residents in two separate experiments using the gaze control technique known as the “Quiet Eye.”

First, they divided 22 elite golfers, (handicaps less than 6), into two groups after their baseline putting performance was measured.  The control group received no additional training while the experimental group participated in Quiet Eye (QE) training, a method first developed by Dr. Joan Vickers of the University of Calgary.  They were instructed to follow these steps:

1. Assume your stance and align the club so your gaze is on the back of the ball.
2. After setting up over the ball, fix your gaze on the hole. Fixations toward the hole should be made no more than 3 times.
3. The final fixation should be a QE on the back of the ball. The onset of the QE should occur before the stroke begins and last for 2 to 3 seconds.
4. No gaze should be directed to the clubhead during the backswing or foreswing.
5. The QE should remain on the green for 200 to 300 ms after the club contacts the ball.

While several earlier studies have shown the effectiveness of using QE in lab-based putting experiments, Vine and Wilson wanted to add two additional tests.  Would the golfers not only putt better in the lab, but also retain that performance under induced stress and in real world, golf course conditions?

The stress was added by telling the golfers that they were playing for a $50 prize as well as having their final scores posted at their home golf courses.  Even though the two groups showed no difference at the pre-training baseline testing, the QE group had significantly better putting scores than the control group in all three scenarios, including a decrease of two putts per round.

So, QE will help a surgeon on the green but what about in the operating room?  Knowing the positive results that athletes have seen, Vine and Wilson wondered if gaze control could help other professions, especially medicine.  Working in collaboration with the University of Hong Kong, the Royal Devon and Exeter NHS Foundation Trust and the Horizon training centre Torbay, the University of Exeter team brought thirty medical students together to find out....
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The Coach's Curse - Mental Mistakes

"Donadoni rues Italian 'mistakes' against Dutch"

"Mental errors cost Demons in regional quarterfinal"

"Mental mistakes doom Rays in loss to Cardinals"


Every day, there is always a new variety of stories linked to the phrase, "mental mistakes".  Either the writer recaps a game, calling out the mistakes or a coach or player claims that mistakes were made. It has become sort of a throwaway phrase, "...we made a lot of mental mistakes out there today, that we need to avoid if we want to get to the playoffs..." The million dollar question then is HOW to reduce these mental mistakes. And, to answer that, we need to define WHAT is a mental mistake?

In a previous post, I introduced the "Sports Cognition Framework", which is a trio of elements needed for success in sports. These three elements are:

- decision-making ability (knowing what to do)

- motor skill competence (being physically able to do it)

- po
sitive mental state (being motivated and confident to do it)

Most of the time, a mental mistake is thought of as a breakdown of decision-making ability. The center fielder throws to the wrong base, the tight end runs the wrong route, or the defender forgets to mark his man, etc. These scenarios describe poor decisions or even memory lapses during the stress of the game. They are not necessarily the lack of skill to execute a play or the lack of confidence or motivation to want to do the right thing. It is a recognition, in hindsight, that the best option was not chosen. In addition to glaring nega
tive plays, there are also missed opportunities on the field (i.e. taking a contested shot on goal, instead of passing to the open teammate).

So, back to the payoff question: HOW do we reduce mental mistakes and poor decisions? Just as we practice physical skills to improve our ability to throw, catch, shoot, run, etc., we need to practice making decisions using a a training system that directly exposes the athlete to these scenarios. Dr. Joan Vickers, who we met during our discussion of the Quiet Eye, has created a new system which she calls the "Decision-Training Model", and is the focus of the second half of her book, "Perception, Cognition, and Decision Training". As opposed to traditional training methods that separate skill training from tactical decision making training, the Decision-Training model (D-T) forces the athlete to couple her skill learning with the appropriate tactical awareness of when to use it.

So, instead of an "easy-first" breakdown of a skill, and then build it up step by step, D-T begins with a "hard-first" approach putting the "technique within tactics" demanding a higher cognitive effort right up front. The theory behind D-T is that the coach is not on the field with the player during competition, so the player must learn to rely on their own blended combination of skill and game awareness. Research from Vickers and others shows that D-T provides a more lasting retention of knowledge, while more traditional bottom-up training with heavy coach feedback delivers a stronger short-term performance gain, but that success in practice does not often translate later in games. Practice and training need to mirror game situations as often and as completely as the real thing.

There are three major steps to Decision-Training (p. 167):

1. Identify a decision the athlete has to make in a game, using one of the seven cognitive skills (anticipation, attention, focus/concentration, pattern recognition, memory, problem solving and decision making)

2. Create a drill(s) that trains that decision using one of the seven cognitive triggers (object cues, location cues, Quiet Eye, reaction-time cues, memory cues, kinesthetic cues, self-coaching cues)

3. Use one or more of the seven decision tools in the design of the drill (variable practice, random practice, bandwidth feedback, questioning, video feedback, hard-first instruction, external focus of instruction)

This post was just to serve as an introduction to D-T. Dr. Vickers and her team at University of Calgary offer full courses for coaches to learn D-T and apply it in their sport. Combined with the visual cues of the playing environment provided by the Quiet Eye gaze control, D-T seems to offer a better tactical training option for coaches and athletes. Coming up, we will continue the discussion of decision-making in sports with a look at some other current research. Please give me your thoughts on D-T and the whole topic of mental mistakes!

See The Ball, Be The Ball - Vision and Sports

The whistle blows and Shaq goes to the line again after being fouled on purpose for the fourth time. And, again, we watch as he takes that awkward stance, looks at the basket and then clanks one of the back of the rim. We wonder how hard this can be... just aim and shoot! Isn't it that simple? Well, not exactly. In our introduction to this series I mentioned the research of Dr. Joan Vickers and her concept of the "Quiet Eye". In her book, Perception, Cognition and Decision Training, she describes this visual targeting pathway:

"...the visual pathway begins when information is registered on the eye's retina by the focal and ambient systems, then travels to the back of the head along the optic nerve and radiates to the occipital cortex, where visual information is registered as billions of features. These then race in parallel fashion both to the top of the head to the parietal cortex (dorsal) and along the sides of the head to the temporal (ventral) areas. There is an integration of information in the somatosensory cortex as the information goes to the frontal cortex, where the goals and intentions reside and plans are formulated for the specific event that is occurring. The flow of information then goes to the premotor and motor cortex at the top of the head before going down the spinal cord to the effectors." P.26

This same process repeats constantly during any athletic event and it is the most critical determinant of the outcome of the game. Just think about the types of visual work that needs to be done by an athlete (as defined by Dr. Vickers):

1. Targeting Tasks - being able to fixate on a target, fixed or moving, to be able to throw, kick or send an object towards it. (i.e. Shooting or passing a baseball, football, basketball, soccer ball, hockey puck, etc.)

2. Interceptive Timing Tasks - being able to recognize, track and finally control an object as it comes at you (aka "catching")

3. Tactical Decision Making Tasks - being able to take in an environmental scan of the field/court and recognize patterns of all the moving objects (i.e. a quarterback scanning his receivers and choosing the best option for a pass).

All of these scenarios require the athlete to focus or "gaze" on the right points in the environment and ignore the rest of the scene. Dr. Vickers' work has been to observe athletes of different skill levels, expert and non-expert, and define the "best practices" of visual control so that the non-expert athletes can be coached to better performance. Her research lab uses "eye-trackers" (see photo) to monitor the focus and gaze of the athlete's pupils as they perform their skills.

For example, she has found that expert baseball hitters focus on the release point of the ball exclusively, rather than random fixations on the pitcher's arm, head, jersey, etc. She found that expert golf putters focus on a specific point on the cup, then a specific point on the back of the ball and remain fixated on the point on the ball after the ball has left the putter blade.

Novices allow their gaze to wander from the ball to the hole, without a very specific focal point on either the cup or the ball. The term "Quiet Eye" comes from these observations that expert performers have consciously chosen points in their space to focus on rather than allowing their eyes to wander and fixate on multiple points (i.e. a "noisy" eye).

So, why does the Quiet Eye work? When we fixate on key points in our field of vision, how does this help our neuromuscular systems perform better? The subconscious part of our brain may be recognizing a pattern that we have seen and experienced before and directing our movements based on this information. Some have called this "muscle memory", meaning our brain has learned through repetition and practice how to throw a ball to a moving receiver at that distance and speed, and so, when presented with a similar scenario, knows what to do. Think about when you shoot a jump shot and sometimes you get that sensation, as soon as it leaves your hand, that the ball is going in. Your brain may be telling you that, based on past experience, when you've executed the same aim and same muscle movement then the ball has gone in.

This takes us back to the discussion we had in our previous post on baseball fielding regarding theories of perception-action combinations. The Information Processing model claims that we perceive the environment first through our senses, primarily our vision. Then, we access our memory to find the rules, suggestions and knowledge that we have gained from past experiences and these memories guide our action in the moment.

The Ecological Psychology model removes the memory access step and claims that our perception of the environment leads directly to our actions, as there is not enough time to access our lessons. If that is true, then how does the Quiet Eye help us? It seems the Quiet Eye is what we need to connect the current scenario (standing on the free throw line looking at the basket) with our lessons learned from the past (how we made this shot hundreds of times before). Research continues on this question and I'm sure we'll come back to this in future posts.

Next time, I will take a look at Dr. Vickers' "Decision Training Model", which builds on the Quiet Eye theory to train athletes to improve their tactical in-game decision making. We will look at the athletes who are known as having good "vision of the field" and how to raise everyone's game to that level.