Assessment of Competence in Surgical Skills Using Functional Magnetic Resonance Imaging: A Feasibility Study

Morris, Marie; Frodl, Thomas; D'Souza, Arun; Fagan, Andrew; Ridgway, Paul F.

doi:10.1016/j.jsurg.2014.09.007

Cited by 15 publications

(12 citation statements)

References 14 publications

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“…Some studies have investigated surgery with tasks that did require participants to make domain-related movements: For example, Bahrami et al (2011) have built an fMRI-compatible laparoscopic surgery trainer to allow non-expert participants to train surgical movements while being scanned ( Bahrami et al, 2014 ). Morris et al (2015) had participants tie knots on a jig. In both cases, however, only relatively simple movements could be performed and they were not executed in the complexity of a surgical procedure, where movements rely on visual cues.…”

Section: Discussionmentioning

confidence: 99%

“…This study is among the first to investigate the neural implementation of motor expertise in a professional, here surgical task and the first to include a considerable sample of participants with an intermediate level of expertise (a pilot-study of Morris et al, 2015 only included three intermediate participants). A particular focus was put on the MNS as it was previously found to selectively respond to movements that are part of an expert’s motor repertoire.…”

Section: Discussionmentioning

confidence: 99%

“…Very few studies included a group of intermediates in domains beyond sports and music. An interesting example that includes intermediates constitutes a pilot study by Morris et al (2015) , who investigated expertise differences in surgery in a pilot study with three undergraduate medical students (novices), three senior house officers with at least 2 years of postgraduate surgical experience (intermediates), and three surgeons with at least 5 years of postgraduate surgical experience (experts). They contrasted a finger-tapping task with a shoelace surgical knot-tying task and a task in which knot-tying had to be imagined.…”

Section: Introductionmentioning

confidence: 99%

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The Neural Implementation of Surgical Expertise Within the Mirror-Neuron System: An fMRI Study

Kok

Bruin

Geel

et al. 2018

Front. Hum. Neurosci.

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Motor expertise is an important aspect of high-level performance in professional tasks such as surgery. While recently it has been shown that brain activation as measured by functional magnetic resonance imaging (fMRI) within the mirror-neuron system (MNS) is modulated by expertise in sports and music, little is known about the neural underpinnings of professional, e.g., surgical expertise. Here, we investigated whether and (if so) how surgical expertise is implemented in the MNS in medical professionals across three levels of surgical qualification. In order to answer the more specific research question, namely, if the neural implementation of motor expertise develops in a linear or non-linear fashion, the study compares not only brain activation within the MNS related to action observation of novices and experts, but also intermediates. Ten novices (medical students), ten intermediates (residents in orthopedic surgery) and ten experts (orthopedic surgeons) watched 60 video clips (5 s each) of daily-life activities and surgical procedures each while their brain activation was measured using a 3-T fMRI scanner. An established localization procedure was followed to functionally define the MNS for each participant individually. A 2 (video type: daily-life activities, surgical procedures) × 3 (expertise level: novice, intermediate, expert) ANOVA yielded a non-significant interaction. Furthermore, separate analyses of the precentral and parietal part of the MNS also yielded non-significant interactions. However, post hoc comparisons showed that intermediates displayed marginally significantly lower brain activation in response to surgery-related videos within the MNS than novices. No other significant differences were found. We did not find evidence for the hypothesis that the brain-activation level in the MNS evoked by observing surgical videos reflects the level of surgical expertise in the professional task of (orthopedic) surgery. However, the results suggest a potential non-linear relationship between expertise level and MNS-activation level.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Neural Implementation of Surgical Expertise Within the Mirror-Neuron System: An fMRI Study

Kok

Bruin

Geel

et al. 2018

Front. Hum. Neurosci.

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“…It could be argued that fMRI can be used to assess these effects, not only on initial surgical skill acquisition and refinement but also on skill retention. One such study using fMRI identified a potential impact of ageing on ability; the authors found intermediate‐level surgical trainees to be most proficient in the objective assessment of knot‐tying ability, compared with novices and experts aged over 35 years.…”

Section: Discussionmentioning

confidence: 99%

When should surgeons retire?

Bhatt

Morris

O’Neil

et al. 2015

British Journal of Surgery

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Background: Retirement policies for surgeons differ worldwide. A range of normal human functional abilities decline as part of the ageing process. As life expectancy and their population increases, the performance ability of ageing surgeons is now a growing concern in relation to patient care. The aim was to explore the effects of ageing on surgeons' performance, and to identify current practical methods for transitioning surgeons out of practice at the appropriate time and age.Methods: A narrative review was performed in MEDLINE using the terms 'ageing' and 'surgeon'. Additional articles were hand-picked. Modified PRISMA guidelines informed the selection of articles for inclusion. Articles were included only if they explored age-related changes in brain biology and the effect of ageing on surgeons' performance. Results:The literature search yielded 1811 articles; of these, 36 articles were included in the final review. Wide variation in ability was observed across ageing individuals (both surgical and lay). Considerable variation in the effects of the surgeon's age on patient mortality and postoperative complications was noted. A lack of neuroimaging research exploring the ageing of surgeons' brains specifically, and lack of real markers available for measuring surgical performance, both hinder further investigation. Standard retirement policies in accordance with age-related surgical ability are lacking in most countries around the world. Conclusion:Competence should be assessed at an individual level, focusing on functional ability over chronological age; this should inform retirement policies for surgeons.

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“…Similarly, data on surgeons’ posture or physiological function may be obtained in both environments (99, 113). Such data include surgeons’ posture, muscle activation, electrodermal activity, temperature, heart rate, respiratory rate, blood pressure, and functional magnetic resonance images (113, 123). Although advances in wearable technologies allow easy capture of variety of data from the surgeon, their utility for OCASE-T has yet to be demonstrated.…”

Section: Sources Of Data For Ocase-tmentioning

confidence: 99%

Objective Assessment of Surgical Technical Skill and Competency in the Operating Room

Vedula

Ishii

Hager

2017

Annu. Rev. Biomed. Eng.

106

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Training skillful and competent surgeons is critical to ensure high quality of care and to minimize disparities in access to effective care. Traditional models to train surgeons are being challenged by rapid advances in technology, an intensified patient-safety culture, and a need for value-driven health systems. Simultaneously, technological developments are enabling capture and analysis of large amounts of complex surgical data. These developments are motivating a “surgical data science” approach to objective computer-aided technical skill evaluation (OCASE-T) for scalable, accurate assessment; individualized feedback; and automated coaching. We define the problem space for OCASE-T and summarize 45 publications representing recent research in this domain. We find that most studies on OCASE-T are simulation based; very few are in the operating room. The algorithms and validation methodologies used for OCASE-T are highly varied; there is no uniform consensus. Future research should emphasize competency assessment in the operating room, validation against patient outcomes, and effectiveness for surgical training.

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Assessment of Competence in Surgical Skills Using Functional Magnetic Resonance Imaging: A Feasibility Study

Cited by 15 publications

References 14 publications

The Neural Implementation of Surgical Expertise Within the Mirror-Neuron System: An fMRI Study

The Neural Implementation of Surgical Expertise Within the Mirror-Neuron System: An fMRI Study

When should surgeons retire?

Objective Assessment of Surgical Technical Skill and Competency in the Operating Room

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