Motion tracking to support surgical skill feedback and evaluation

Introduction & Aims Performance evaluation of technical surgical skill is done by direct observation by expert surgeons. This is time intensive, costly, and requires training of assessors. Motion tracking could complement direct observation to provide immediate feedback during training and to support objective performance assessment. A recent study by Ahmed et al. (2017) showed that expert feedback combined with validated metrics resulted in greater performance improvement for novices. However, current motion tracking methods are expensive, non-portable, or very sensitive to disturbances from the environment. We hypothesize that combining technologies solves these limitations. The goal of the current study was to design a wireless, low-cost motion tracking system to support 1) real-time individual performance feedback and 2) objective assessment of technical surgical skills. Description An iterative, research-based design process with rapid prototyping was followed. First, we performed a needs assessment with a literature review and survey to a broad range of surgeons to identify relevant motion parameters. Second, various prototypes using an Inertial Measurement Unit (IMU) and a Leap motion sensor were tested in an authentic surgical environment for 1) robustness and 2) accuracy. Outcomes Twelve surgeons (experience range = 2 - 27 years) from five different hospitals and a range of surgical specialties completed the survey and rated ‘precision of movement’ and ‘minimizing unnecessary movements’ as most important motion parameters of surgical skill. Furthermore, unnecessary or excessive movements and secondary tissue damage were reported as most common errors. The final prototype can be seen in Figure 1. The IMU is embedded in a sleeve and detects fine motor skills such as small hand movements, tremors, and strokes. The Leap Motion sensors complement this with infrared tracking of the hand in 3D space and time. The devices proved robust under changing lighting and gowning conditions. Accuracy of motion tracking was however influenced by instrument use. Discussion Our device offers the possibility for immediate performance feedback aiding trainees’ self-assessment during training. By discriminating good from poor performers in training early on, training can be adapted to an individual trainee’s needs and facilitate deliberate practice. Future research includes expert benchmarking and parameter selection. Motion tracking analysis complements subjective assessment that is prone to bias and reduces assessors’ workload. Novelty of methodology Motion tracking to support surgical skill assessment is not yet common practice. The device offers a robust, affordable, and wearable alternative to current motion tracking devices

Development and Evaluation of a Proficiency-based and Simulation-based Surgical Skills Training for Technical Medicine Students

Objective: Surgical graduate training to achieve practice-ready students is needed, yet is often lacking. This study developed and evaluated a proficiency-based, simulation-based course for basic surgical skills at graduate level. Learning outcomes were measured at the level of knowledge and skills and evaluated with a post-course questionnaire after students’ clinical rotations.Methods: The surgical skills course was anchored to surgical patient flow and covered topics and skills related to pre-, intra-, and post-operative care, including case-based medical reasoning, patient safety, infection management, operating theatre etiquette, scrubbing and donning, instrument handling, local anaesthesia, excision of tissue, and suturing. Students were assessed on knowledge and procedural skills.Results: 155 graduate Technical Medicine students from academic years 2015-2016 and 2016-2017 entered this 10-week, 3 ECTS credits graduate Surgical Skills course. Pass rates of the knowledge test were 78%, and 87% for the procedural skill assessment. Graduate students reached proficiency level in a simulation-based basic surgical skills course. Students stated to go with confidence to the operating room and felt competent in performing four basic surgical skills.Conclusion: Based on this study, we recommend that proficiency-based training using simulation should be standard in surgical curricula before students are allowed to practice on patients

Tango to traffic : a field study into consequences of noisy urban conditions for acoustic courtship interactions in birds

The acoustic courtship display of a male and a female great tit show all the characteristics of a passionate dance. This thesis examines the impact of anthropogenic noise on the acoustic communication between males and females and the relationship with reproduction.LEI Universiteit LeidenAnimal science

Gluconeogenesis, liver energy metabolism and weight loss in lung cancer : dynamic studies using stable isotope tracers and 31P magnetic resonance spectroscopy

Weight loss is a major problem in many types of cancer and is associated with reduced quality of life and a poor prognosis. Weight loss can also interfere with potentially curable treatment [41,561. Many uncertainties remain about the mechanisms underlying weight loss in patients with cancer. This thesis describes a series of studies aimed at defining alterations in metabolic processes that are potentially related with weight loss in lung cancer patients. Although in literature the terms 'cachexia' (~ a syndrome of weight loss and rnalnutrition) and 'weight loss' are often used interchangeably, in this thesis weight loss will be preferentially used. In this chapter, current knowledge on weight loss in cancer and its relation with metabolic alterations are reviewed and the aim of this thesis is presented