Use of Risk Model for Assessment of Residents’ Perception of Complexity of Surgical Steps: Example of Modular Component Steps of Lumbar Spinal Fusion Surgery

Raskin, Jeffrey S.; Liu, Jesse J.; Holste, Katherine; Brown, Sarah; Hardaway, Fran; Pang, Priscilla; Raslan, Ahmed M.

doi:10.1093/ons/opx072

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…7 However, residents rate unfamiliarity with the navigation system as a major impediment to using the system, suggesting that the utility of navigation may increase with increased training exposure. 28,35,41,42 The cost-effectiveness of navigation is still debated when taking into consideration the potential for increased operating time due to setup, registration, acquisition, and execution time. 43 However, this increase in surgical time is often mitigated with sufficient experience.…”

Section: Discussionmentioning

confidence: 99%

The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation

Gardeck¹,

Yang

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVEResidency work-hour restrictions necessitate efficient, reproducible training. Simulation training for spinal instrumentation placement shows significant benefit to learners’ subjective and objective proficiency. Cadaveric laboratories are most effective but have high cost and low availability. The authors’ goal was to create a low-cost, efficient, reproducible spinal instrumentation placement simulation curriculum for neurosurgery and orthopedic surgery residents using synthetic models and 3D computer-assisted navigation, assessing subjective and objective proficiency with placement of thoracolumbar pedicle screws.METHODSFifteen neurosurgery and orthopedic surgery residents participated in a standardized curriculum with lecture followed by two separate sessions of thoracolumbar pedicle screw placement in a synthetic spine model utilizing 3D computer-assisted navigation. Data were collected on premodule experience, time and accuracy of screw placement, and both subjective and objective ratings of proficiency.RESULTSFifteen of 15 residents demonstrated improvement in subjective (Physician Performance Diagnostic Inventory Scale [PPDIS]) and 14 in objective (Objective Structured Assessment of Technical Skills [OSATS]) measures of proficiency in navigated screw placement with utilization of this curriculum (p < 0.001 for both), regardless of the number of cases of previous experience using thoracolumbar spinal instrumentation. Fourteen of 15 residents demonstrated decreased time per screw placement from session 1 to session 2 (p = 0.006). There was no significant difference in pedicle screw accuracy between session 1 and session 2.CONCLUSIONSA standardized curriculum using synthetic simulation training for navigated thoracolumbar pedicle screw placement results in significantly improved resident subjective and objective proficiency. Development of a nationwide competency curriculum using simulation training for spinal instrumentation placement should be considered for safe, efficient resident training.

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Section: Discussionmentioning

confidence: 99%

The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation

Gardeck¹,

Yang

et al. 2021

Journal of Neurosurgery: Spine

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“…The complexity of surgery makes it an ideal educational paradigm to apply these systems. [35] Teaching in surgery is largely reliant on the apprenticeship model whereby the knowledge of a skill (know-how) is assumed to be learned through observation and graduated active responsibility in the operating room. [36] Therefore, a significant part of knowledge and skill acquisition also occurs through experiential learning.…”

Section: Benefits Of the Virtual Operative Assistantmentioning

confidence: 99%

The Virtual Operative Assistant: An explainable artificial intelligence tool for simulation-based training in surgery and medicine

Mirchi¹,

Bissonnette²,

Yilmaz³

et al. 2020

PLoS ONE

137

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Simulation-based training is increasingly being used for assessment and training of psychomotor skills involved in medicine. The application of artificial intelligence and machine learning technologies has provided new methodologies to utilize large amounts of data for educational purposes. A significant criticism of the use of artificial intelligence in education has been a lack of transparency in the algorithms' decision-making processes. This study aims to 1) introduce a new framework using explainable artificial intelligence for simulationbased training in surgery, and 2) validate the framework by creating the Virtual Operative Assistant, an automated educational feedback platform. Twenty-eight skilled participants (14 staff neurosurgeons, 4 fellows, 10 PGY 4-6 residents) and 22 novice participants (10 PGY 1-3 residents, 12 medical students) took part in this study. Participants performed a virtual reality subpial brain tumor resection task on the NeuroVR simulator using a simulated ultrasonic aspirator and bipolar. Metrics of performance were developed, and leave-one-out cross validation was employed to train and validate a support vector machine in Matlab. The classifier was combined with a unique educational system to build the Virtual Operative Assistant which provides users with automated feedback on their metric performance with regards to expert proficiency performance benchmarks. The Virtual Operative Assistant successfully classified skilled and novice participants using 4 metrics with an accuracy, specificity and sensitivity of 92, 82 and 100%, respectively. A 2-step feedback system was developed to provide participants with an immediate visual representation of their standing related to expert proficiency performance benchmarks. The educational system outlined establishes a basis for the potential role of integrating artificial intelligence and virtual reality simulation into surgical educational teaching. The potential of linking expertise classification, objective feedback based on proficiency benchmarks, and instructor input creates a novel educational tool by integrating these three components into a formative educational paradigm.

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“…Increasingly it is being recognized in the surgical community that a high degree of variability in teaching, hand‐offs, and patient care may negatively affect the care of the patient by the surgical trainee, and has been cited as an adverse contributor to education 1 . To date, standardization practices have been implemented and studied with regard to patient care hand‐offs, assessment of competency, and teaching skills of attending doctors on the wards 2,3 . Nevertheless, the act of teaching in the operating room remains an elusively difficult subject to teach; indeed, while some trainees flourish, others flounder in the immense variability that exists within the surgical technique.…”

Section: Figurementioning

confidence: 99%

Making standardization in microsurgical education palatable

Lakhiani

Cheng

2020

Journal of Surgical Oncology

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Use of Risk Model for Assessment of Residents’ Perception of Complexity of Surgical Steps: Example of Modular Component Steps of Lumbar Spinal Fusion Surgery

Cited by 7 publications

References 12 publications

The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation

The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation

The Virtual Operative Assistant: An explainable artificial intelligence tool for simulation-based training in surgery and medicine

Making standardization in microsurgical education palatable

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