C-SATS: Assessing Surgical Skills Among Urology Residency Applicants

BackgroundWe hypothesized that surgical skills assessment could aid in the selection process of medical student applicants to a surgical program. Recently, crowdsourcing has been shown to provide an accurate assessment of surgical skills at all levels of training. We compared expert and crowd assessment of surgical tasks performed by resident applicants during their interview day at the urology program at the University of California, Irvine.Materials and methodsTwenty-five resident interviewees performed four tasks: open square knot tying, laparoscopic peg transfer, robotic suturing, and skill task 8 on the LAP Mentor™ (Simbionix Ltd., Lod, Israel). Faculty experts and crowd workers (Crowd-Sourced Assessment of Technical Skills [C-SATS], Seattle, WA) assessed recorded performances using the Objective Structured Assessment of Technical Skills (OSATS), Global Evaluative Assessment of Robotic Skills (GEARS), and the Global Operative Assessment of Laparoscopic Skills (GOALS) validated assessment tools.ResultsOverall, 3938 crowd assessments were obtained for the four tasks in less than 3.5 hours, whereas the average time to receive 150 expert assessments was 22 days. Inter-rater agreement between expert and crowd assessment scores was 0.62 for open knot tying, 0.92 for laparoscopic peg transfer, and 0.86 for robotic suturing. Agreement between applicant rank on skill task 8 on the LAP Mentor assessment and crowd assessment was 0.32. The crowd match rank based solely on skills performance did not compare well with the final faculty match rank list (0.46); however, none of the bottom five crowd-rated applicants appeared in the top five expert-rated applicants and none of the top five crowd-rated applicants appeared in the bottom five expert-rated applicants.ConclusionsCrowd-source assessment of resident applicant surgical skills has good inter-rater agreement with expert physician raters but not with a computer-based objective motion metrics software assessment. Overall applicant rank was affected to some degree by the crowd performance rating

C-SATS: Assessing Surgical Skills Among Urology Residency Applicants.

BackgroundWe hypothesized that surgical skills assessment could aid in the selection process of medical student applicants to a surgical program. Recently, crowdsourcing has been shown to provide an accurate assessment of surgical skills at all levels of training. We compared expert and crowd assessment of surgical tasks performed by resident applicants during their interview day at the urology program at the University of California, Irvine.Materials and methodsTwenty-five resident interviewees performed four tasks: open square knot tying, laparoscopic peg transfer, robotic suturing, and skill task 8 on the LAP Mentor™ (Simbionix Ltd., Lod, Israel). Faculty experts and crowd workers (Crowd-Sourced Assessment of Technical Skills [C-SATS], Seattle, WA) assessed recorded performances using the Objective Structured Assessment of Technical Skills (OSATS), Global Evaluative Assessment of Robotic Skills (GEARS), and the Global Operative Assessment of Laparoscopic Skills (GOALS) validated assessment tools.ResultsOverall, 3938 crowd assessments were obtained for the four tasks in less than 3.5 hours, whereas the average time to receive 150 expert assessments was 22 days. Inter-rater agreement between expert and crowd assessment scores was 0.62 for open knot tying, 0.92 for laparoscopic peg transfer, and 0.86 for robotic suturing. Agreement between applicant rank on skill task 8 on the LAP Mentor assessment and crowd assessment was 0.32. The crowd match rank based solely on skills performance did not compare well with the final faculty match rank list (0.46); however, none of the bottom five crowd-rated applicants appeared in the top five expert-rated applicants and none of the top five crowd-rated applicants appeared in the bottom five expert-rated applicants.ConclusionsCrowd-source assessment of resident applicant surgical skills has good inter-rater agreement with expert physician raters but not with a computer-based objective motion metrics software assessment. Overall applicant rank was affected to some degree by the crowd performance rating

Endockscope: Using Mobile Technology to Create Global Point of Service Endoscopy

Background and purposeRecent advances and the widespread availability of smartphones have ushered in a new wave of innovations in healthcare. We present our initial experience with Endockscope, a new docking system that optimizes the coupling of the iPhone 4S with modern endoscopes.Materials and methodsUsing the United States Air Force resolution target, we compared the image resolution (line pairs/mm) of a flexible cystoscope coupled to the Endockscope+iPhone to the Storz high definition (HD) camera (H3-Z Versatile). We then used the Munsell ColorChecker chart to compare the color resolution with a 0° laparoscope. Furthermore, 12 expert endoscopists blindly compared and evaluated images from a porcine model using a cystoscope and ureteroscope for both systems. Finally, we also compared the cost (average of two company listed prices) and weight (lb) of the two systems.ResultsOverall, the image resolution allowed by the Endockscope was identical to the traditional HD camera (4.49 vs 4.49 lp/mm). Red (ΔE=9.26 vs 9.69) demonstrated better color resolution for iPhone, but green (ΔE=7.76 vs 10.95), and blue (ΔE=12.35 vs 14.66) revealed better color resolution with the Storz HD camera. Expert reviews of cystoscopic images acquired with the HD camera were superior in image, color, and overall quality (P=0.002, 0.042, and 0.003). In contrast, the ureteroscopic reviews yielded no statistical difference in image, color, and overall (P=1, 0.203, and 0.120) quality. The overall cost of the Endockscope+iPhone was $154 compared with$46,623 for a standard HD system. The weight of the mobile-coupled system was 0.47 lb and 1.01 lb for the Storz HD camera.ConclusionEndockscope demonstrated feasibility of coupling endoscopes to a smartphone. The lighter and inexpensive Endockscope acquired images of the same resolution and acceptable color resolution. When evaluated by expert endoscopists, the quality of the images overall were equivalent for flexible ureteroscopy and somewhat inferior, but still acceptable for flexible cystoscopy

Endockscope: Using Mobile Technology to Create Global Point of Service Endoscopy

BACKGROUND AND PURPOSE: Recent advances and the widespread availability of smartphones have ushered in a new wave of innovations in healthcare. We present our initial experience with Endockscope, a new docking system that optimizes the coupling of the iPhone 4S with modern endoscopes. MATERIALS AND METHODS: Using the United States Air Force resolution target, we compared the image resolution (line pairs/mm) of a flexible cystoscope coupled to the Endockscope+iPhone to the Storz high definition (HD) camera (H3-Z Versatile). We then used the Munsell ColorChecker chart to compare the color resolution with a 0° laparoscope. Furthermore, 12 expert endoscopists blindly compared and evaluated images from a porcine model using a cystoscope and ureteroscope for both systems. Finally, we also compared the cost (average of two company listed prices) and weight (lb) of the two systems. RESULTS: Overall, the image resolution allowed by the Endockscope was identical to the traditional HD camera (4.49 vs 4.49 lp/mm). Red (ΔE=9.26 vs 9.69) demonstrated better color resolution for iPhone, but green (ΔE=7.76 vs 10.95), and blue (ΔE=12.35 vs 14.66) revealed better color resolution with the Storz HD camera. Expert reviews of cystoscopic images acquired with the HD camera were superior in image, color, and overall quality (P=0.002, 0.042, and 0.003). In contrast, the ureteroscopic reviews yielded no statistical difference in image, color, and overall (P=1, 0.203, and 0.120) quality. The overall cost of the Endockscope+iPhone was $154 compared with$46,623 for a standard HD system. The weight of the mobile-coupled system was 0.47 lb and 1.01 lb for the Storz HD camera. CONCLUSION: Endockscope demonstrated feasibility of coupling endoscopes to a smartphone. The lighter and inexpensive Endockscope acquired images of the same resolution and acceptable color resolution. When evaluated by expert endoscopists, the quality of the images overall were equivalent for flexible ureteroscopy and somewhat inferior, but still acceptable for flexible cystoscopy

Mapping the distribution of weathered Pleistocene wadi deposits in Southern Jordan using ASTER, SPOT-5 data and laboratory spectroscopic analysis

OBJECTIVE To investigate the relationship between multiple cryoprobes was investigated to determine whether they work in an additive or synergistic fashion in an in vivo animal model because 1.47 mm (17-gauge) cryoprobes have been introduced to the armamentarium for renal cryotherapy. METHODS Laparoscopic-guided percutaneous cryoablation was performed in both renal poles of 3 pigs using 3 IceRod cryoprobes. These 12 cryolesions were compared with 12 cryolesions using a single IceRod cryoprobe. Each cycle consisted of two 10-minute freeze cycles separated by a 5-minute thaw. The iceball volume was measured using intraoperative ultrasonography. The kidneys were harvested, and cryolesion surface area was calculated. The lesions were fixed and excised to obtain a volume measurement. Statistical analysis was used to compare the single probe results multiplied by 3 to the multiple probe group for iceball volume, cryolesion surface area, and cryolesion volume. RESULTS The iceball volume for the first freeze cycle for the single cryoprobe multiplied by 3 was 8.55 cm(3) compared with 9.79 cm(3) for the multiple cryoprobe group (P = .44) and 10.01 cm(3) versus 16.58 cm(3) for the second freeze (P = .03). The cryolesion volume for the single cryoprobe multiplied by 3 was 11.29 cm(3) versus 14.75 cm(3) for the multiple cyroprobe group (P = .06). The gross cryolesion surface area for the single cryoprobe multiplied by 3 was 13.14 cm(2) versus 13.89 cm(2) for the multiple probe group (P = .52). CONCLUSION The cryolesion created by 3 simultaneously activated 1.47-mm probes appears to be larger than that of an additive effect. The lesions were significantly larger as measured by ultrasonography and nearly so (P = .06) as measured by the gross cryolesion volume. UROLOGY 79: 484.e1-484.e6, 2012. (c) 2012 Elsevier Inc. All rights reserved.Galil Medical, Inc.Galil Medical, Inc