Use of sensors to quantify procedural idle time: Validity evidence for a new mastery metric

Abstract

Background: Pancreatoduodenectomies at high risk for clinically relevant pancreatic fistula are uncommon, yet intimidating, situations. In such scenarios, the impact of individual surgeon experience on outcomes is poorly understood. Methods: The fistula risk score was applied to identify high-risk patients (fistula risk score 7e10) from 7,706 pancreatoduodenectomies performed at 18 international institutions (2003e2020). For each case, surgeon pancreatoduodenectomy career volume and years of practice were linked to intraoperative fistula mitigation strategy adoption and outcomes. Consequently, best operative approaches for clinically relevant pancreatic fistula prevention and best performer profiles were identified through multivariable analysis models. Results: Eight hundred and thirty high-risk pancreatoduodenectomies, performed by 64 surgeons, displayed an overall clinically relevant pancreatic fistula rate of 33.7%. Clinically relevant pancreatic fistula Author Contributions: Conception/design (F Casciani, MT Trudeau, CM Vollmer); data acquisition (all authors); data interpretation (all authors) critical revisions (all authors); final approval (all authors).All individuals claiming authorship meet all of the following 3 conditions: (1) Authors made substantial contributions to conception and design, and/or acquisition of data, and/or analysis and interpretation of data; (2) Authors participated in drafting the article or revising it critically for important intellectual content; and (3) Authors gave final approval of the version to be published.

Evaluating the Use of an Aerosol Box During Simulated Intubations

“…There were no standardized breaks between intubations. Attempts without the box (1-5) always preceded attempts with the box (6)(7)(8)(9)(10).…”

Performance assessment using sensor technology

“…One of the most powerful aspects of our multimodal methodology is that it can be adapted to capture the performance criteria in various medical procedures. To this end, we have collected data from procedures spanning multiple surgical specialties, such as general, cardiothoracic, microsurgery, and gynecology 3,19,28,29 . One of the most important factors that facilitate productive data collection and collaboration is working with principal investigators who have already developed simulators or educational curricula for surgical education in their own fields.…”

“…The actual airway mold for both scenarios remained the same. Participants were also verbally instructed that they may experience more difficulty with the burnt airway 19 …”

“…Idle plots during a burnt airway intubation display top tier performer with less idle time than a lower‐tier performer 19 [Color figure can be viewed at wileyonlinelibrary.com] ​ …”

The what? How? And Who? Of video based assessment

“…26 Advanced engineering technologies such as sensors and motion tracking have been synchronized with video and used to digitize and quantify specific features of expert and novice procedural strategies. 27,28 Differences in operative performance and strategy can be readily identified and linked to specific video segments. 29 In the urologic surgery literature, Hung et al have demonstrated proof of concept that automated measures such as kinematic data from robotic systems can correlate with outcomes and can differentiate even expert from "super-expert" surgeons performing robotic prostatectomy.…”