We previously reported that a particular type of visual–spatial ability, mental rotation of visual forms, correlates with surgical performance in residents. In the current study, we used functional magnetic resonance imaging (fMRI) to identify patterns of cortical activation associated with mental rotation ability in those same residents.

Seventeen surgery residents underwent fMRI scan while performing a mental rotations test (MRT) and a perceptual matching task as a control (CON) for nonimagery components, such as visual attention. A contrast analysis (MRT greater than CON) revealed cortical regions engaged during mental rotation by all participants, and parametric statistical analysis identified regions having the strongest association with MRT performance.

Significant bilateral (left greater than right) activation was seen in all participants for rotation-versus-perceptual CON contrast. Better MRT performance was associated with greater activation in several cortical regions related to visual imagery and motion processing.

Surgery residents represent a unique population in which to study individual differences in visual–spatial abilities and associated neural substrates because they may relate to technical skills. These findings suggest that variation in performance on spatially complex tasks involving imagery may reflect different spatial problem-solving strategies in surgery students.