Eye Metrics as an Objective Assessment of Surgical Skill

Abstract

We demonstrate, in simulated and live-operating environments, that eye metrics can reliably distinguish nonexpert from expert surgeons. As current medical educators rely on subjective measures of surgical skill, eye metrics may serve as the basis for objective assessment in surgical education and credentialing in the future. Further development of this potential educational tool is warranted to assess its ability to both reliably classify larger groups of surgeons and follow progression of surgical skill during postgraduate training.

Pupillometry as a Tool to Study Expertise in Medicine

“…This is a potential issue for any cross-sectional study. A study by Richstone et al (2010) suggests that it is in fact experience/expertise that is responsible for the pupillometric changes between groups, as opposed to another confounder. As part of their study, they examined one non-expert surgeon three times over the course of 18 months both in simulated and live surgical environments.…”

“…This index of cognitive activity has been utilized in the objective assessment of surgical skill where pupil size (along with other eye and pupillary metrics) was used to objectively classify non-expert from expert surgeons in environments that were uncontrolled for luminance including a simulator as well as a live operating room (Richstone et al, 2010).…”

Pupil responses during discrete goal-directed movements

“…Marshall [20] reported the Index of Cognitive Activity (ICA) that is capable of capturing subtle cognitive changes from pupil metrics, and was used to predict the expertise of surgeons, together with other eye metrics [25]. However, details of the pupil response to motor tasks were not reported.…”

What is simulation for?

“…Although simulation is now an established educational technique, the lack of consensus on its purpose is evident in the number of different outcomes used in studies of its efficacy [1][2][3][4][5]. In order to understand the place of simulation in education and training, we need to understand clearly what the problem is and why (and perhaps if) simulation is the answer.…”