The medical pause in simulation training

The medical pause, stopping current performance for a short time for additional cognitive activities, can potentially advance patient safety and learning in medicine. Yet, to date, we do not have a theoretical understanding of why pausing skills should be taught as a professional skill, nor empirical evidence of how pausing affects performance and learning. To address this gap, this thesis investigates the effects of pausing in medical training theoretically and empirically. For the empirical investigation, a computer-based simulation was used for the task environment, and eye-tracking and log data to assess performance

Motor learning induced neuroplasticity in minimally invasive surgery

Technical skills in surgery have become more complex and challenging to acquire since the introduction of technological aids, particularly in the arena of Minimally Invasive Surgery. Additional challenges posed by reforms to surgical careers and increased public scrutiny, have propelled identification of methods to assess and acquire MIS technical skills. Although validated objective assessments have been developed to assess motor skills requisite for MIS, they poorly understand the development of expertise. Motor skills learning, is indirectly observable, an internal process leading to relative permanent changes in the central nervous system. Advances in functional neuroimaging permit direct interrogation of evolving patterns of brain function associated with motor learning due to the property of neuroplasticity and has been used on surgeons to identify the neural correlates for technical skills acquisition and the impact of new technology. However significant gaps exist in understanding neuroplasticity underlying learning complex bimanual MIS skills. In this thesis the available evidence on applying functional neuroimaging towards assessment and enhancing operative performance in the field of surgery has been synthesized. The purpose of this thesis was to evaluate frontal lobe neuroplasticity associated with learning a complex bimanual MIS skill using functional near-infrared spectroscopy an indirect neuroimaging technique. Laparoscopic suturing and knot-tying a technically challenging bimanual skill is selected to demonstrate learning related reorganisation of cortical behaviour within the frontal lobe by shifts in activation from the prefrontal cortex (PFC) subserving attention to primary and secondary motor centres (premotor cortex, supplementary motor area and primary motor cortex) in which motor sequences are encoded and executed. In the cross-sectional study, participants of varying expertise demonstrate frontal lobe neuroplasticity commensurate with motor learning. The longitudinal study involves tracking evolution in cortical behaviour of novices in response to receipt of eight hours distributed training over a fortnight. Despite novices achieving expert like performance and stabilisation on the technical task, this study demonstrates that novices displayed persistent PFC activity. This study establishes for complex bimanual tasks, that improvements in technical performance do not accompany a reduced reliance in attention to support performance. Finally, least-squares support vector machine is used to classify expertise based on frontal lobe functional connectivity. Findings of this thesis demonstrate the value of interrogating cortical behaviour towards assessing MIS skills development and credentialing.Open Acces

Cognitive load assessment in computer based video training for the purposes of one-hand knot tying

The purpose of practice is to enable learning and this can be indirectly observed through performance. The current study employed the dual task methodology to assess the effectiveness of computer based video training during the practice of the one-hand knot tying among novice learners. Sixteen students were randomly assigned to one of two groups: practice and non-practice groups. A pre-recorded instructional video was presented to all participants. The practice group completed 10 trials of the one-hand knot tying on a bench top simulator, while the non-practice group did not. All returned a week later for a transfer task. Subjective ratings of mental effort and reaction time were indices of cognitive load. Time on task served as an indication of task performance. Results showed the practice group had reduced cognitive load and shorter performance times compared to the no practice counterparts. These findings imply that self-directed practice alongside Computer based video training (CBVT) is an effective tool in teaching technical clinical skills

Measures of Performance and Proficiency in Robotic-Assisted Surgery : A Systematic Review

The first author received a research grant from RCS England and Health Education England in November 2021 until present to complete the study.Peer reviewedPostprin

Assessing the Effectiveness of an Interval Estimation and a Visual-Spatial Secondary Task as Measures of Mental Workload During Laparoscopy

The goal of the present study was to compare two secondary workload tasks, specifically a time interval estimation and visual-spatial task, to determine which of these is most appropriate for the assessment of laparoscopic mental workload. Participants performed a peg transfer task in two conditions: a normal camera angle and a 90° camera angle intended to increase mental workload. Based on multiple resource theory, it was predicted the visual-spatial task would be more sensitive to the workload manipulation than the time estimation task because it draws upon the specific, as opposed to more general, attentional resources required by laparoscopy. Primary task results demonstrated that manipulation of camera angle did change workload levels. Secondary task results showed that the visual-spatial task possessed greater sensitivity and diagnosticity than the interval estimation task. However, interval estimation demonstrated a global sensitivity to workload changes. The findings suggest that a visual-spatial secondary task is an effective method to assess workload experienced during laparoscopy

Visual Perception and Cognition in Image-Guided Intervention

Surgical image visualization and interaction systems can dramatically affect the efficacy and efficiency of surgical training, planning, and interventions. This is even more profound in the case of minimally-invasive surgery where restricted access to the operative field in conjunction with limited field of view necessitate a visualization medium to provide patient-specific information at any given moment. Unfortunately, little research has been devoted to studying human factors associated with medical image displays and the need for a robust, intuitive visualization and interaction interfaces has remained largely unfulfilled to this day. Failure to engineer efficient medical solutions and design intuitive visualization interfaces is argued to be one of the major barriers to the meaningful transfer of innovative technology to the operating room. This thesis was, therefore, motivated by the need to study various cognitive and perceptual aspects of human factors in surgical image visualization systems, to increase the efficiency and effectiveness of medical interfaces, and ultimately to improve patient outcomes. To this end, we chose four different minimally-invasive interventions in the realm of surgical training, planning, training for planning, and navigation: The first chapter involves the use of stereoendoscopes to reduce morbidity in endoscopic third ventriculostomy. The results of this study suggest that, compared with conventional endoscopes, the detection of the basilar artery on the surface of the third ventricle can be facilitated with the use of stereoendoscopes, increasing the safety of targeting in third ventriculostomy procedures. In the second chapter, a contour enhancement technique is described to improve preoperative planning of arteriovenous malformation interventions. The proposed method, particularly when combined with stereopsis, is shown to increase the speed and accuracy of understanding the spatial relationship between vascular structures. In the third chapter, an augmented-reality system is proposed to facilitate the training of planning brain tumour resection. The results of our user study indicate that the proposed system improves subjects\u27 performance, particularly novices\u27, in formulating the optimal point of entry and surgical path independent of the sensorimotor tasks performed. In the last chapter, the role of fully-immersive simulation environments on the surgeons\u27 non-technical skills to perform vertebroplasty procedure is investigated. Our results suggest that while training surgeons may increase their technical skills, the introduction of crisis scenarios significantly disturbs the performance, emphasizing the need of realistic simulation environments as part of training curriculum