Sensors and Psychomotor Metrics: A Unique Opportunity to Close the Gap on Surgical Processes and Outcomes

Abstract

The surgical process remains elusive to many. This paper presents two independent empirical investigations where psychomotor skill metrics were used to quantify elements of the surgical process in a procedural context during surgical tasks in a simulated environment. The overarching goal of both investigations was to address the following hypothesis: Basic motion metrics can be used to quantify specific aspects of the surgical process including instrument autonomy, psychomotor efficiency, procedural readiness, and clinical errors. Electromagnetic motion tracking sensors were secured to surgical trainees’ (N = 64) hands for both studies, and several motion metrics were investigated as a measure of surgical skill. The first study assessed performance during a bowel repair and laparoscopic ventral hernia (LVH) repair in comparison to a suturing board task. The second study assessed performance in a VR task in comparison to placement of a subclavian central line. The findings of the first study support our subhypothesis that motion metrics have a generalizable application to surgical skill by showing significant correlations in instrument autonomy and psychomotor efficiency during the suturing task and bowel repair (idle time: r = 0.46, p < 0.05; average velocity: r = 0.57, p < 0.05) and the suturing task and LVH repair (jerk magnitude: r = 0.36, p < 0.05; bimanual dexterity: r = 0.35, p < 0.05). In the second study, performance in VR (steering and jerkiness) correlated to clinical errors (r = 0.58, p < 0.05) and insertion time (r = 0.55, p < 0.05) in placement of a subclavian central line. Both gross (dexterity) and fine motor skills (steering) were found to be important as well as efficiency (i.e., idle time, duration, velocity) when seeking to understand the quality of surgical performance. Both studies support our hypotheses that basic motion metrics can be used to quantify specific aspects of the surgical process and that the use of different technologies and metrics are important for comprehensive investigations of surgical skill.

Performance assessment using sensor technology

“…In the current literature, motion metrics are mostly reported (90%) in the context of laparoscopic surgery and virtual reality rather than open surgery (10%). The most commonly explored motion metrics are time, path length, and velocity, while other metrics, like idle time, remain underdeveloped 17 . Our team sought to further investigate and provide valid evidence for idle time as a potential assessment metric of interest.…”

“…The study design was an empirical assessment and comparison of participant procedure outcomes (standardized FPS) and performance metrics (motion, checklist). The participants ( n = 139) included residents from several Midwest surgical training programs and were part of a multi‐year study that included other simulators 17,25 . An overview of the LVH repair procedure steps is outlined in Table 2 and includes varying critical points.…”

Sex Differences in Milestones Achievement—An Issue of Learning or Assessment Bias?

“…While the use of objective and standardized assessments of resident competence may mitigate these concerns, routine use of such tools remains limited. Incorporating innovative strategies, such as video review or automated measures of psychomotor skill using motion tracking or virtual reality, into milestones assessments may help deemphasize bias based on individual trainee characteristics. Furthermore, the introduction of entrustable professional activities, which are actively being established by the American Board of Surgery, may improve the validity of resident assessment .…”

Special Issue: Leaders in Biomedical Engineering

“…Biomedical sensors are mostly used to detect patient samples or monitor organ activities in clinical settings. However, Mohamadipanah and co-workers contributed a paper to show that sensors can be applied to evaluate the skills of surgical trainees . They secured electromagnetic motion tracking sensors on trainees’ fingers and wrists for studying motion metrics.…”

“…However, Mohamadipanah and co-workers contributed a paper to show that sensors can be applied to evaluate the skills of surgical trainees. 13 They secured electromagnetic motion tracking sensors on trainees' fingers and wrists for studying motion metrics. Their study suggested that instrument autonomy is correlated to psychomotor efficiency and that performance in virtual reality is correlated to clinical errors.…”