SutureCoach: Examining Vascular Suturing Skills Assessment, Training, and Transfer of Training via Objective Metrics

项目摘要 外科医生的技能对患者的成功预后至关重要。最近的一项里程碑式的研究报告说，外科医生的 技能评分与手术后的临床结果显著相关。一些研究表明， 记录了因不熟练的手术操作而导致潜在医疗并发症的医疗差错。 医疗差错现在是美国第三大死亡原因，减少医疗差错的一个方法是专注于有效和 培训临床医生手术技能的有效方法。 为了应对培养下一代血管外科医生所面临的挑战， 血管外科委员会与其他血管外科教育工作者一起开发了一套开放的核心技能 血管外科被称为血管外科基础(FVS)，由五项技能组成-打结，放射状 缝合、吻合(端到端、端到侧)、结扎和止血技术--在工作台上进行 使用合成材料的模型，用于衡量居民的表现。这些练习都是模拟的 在腹腔镜技能基础课程之后，用于对执行以下操作的普通外科医生进行认证 腹腔镜。然而，FVS课程有几个局限性：基本的结果指标，缺乏 为技能培训提供强有力的反馈，并将模拟器和手术室(OR)的性能关联起来。 在过去的几年里，我们的团队与《血管基础》的创作者们合作 外科课程，以创建一个测量血管缝合技能的仪表化模拟器。关于我们的指标 模拟器平台测量熟练的血管缝合的关键方面：针的移动、撕裂力、针的驱动 动作和手部动作。这些指标提供了一组丰富的特定于事件、多模式和实时的指标 用于评估血管缝合。初步验证表明，模拟器指标可以区分 住院医师和主治医师之间的缝合技巧，包括在模拟腔内(深度)缝合。 该项目的目标是为血管外科社区提供量化技能的培训工具 血管缝合方面的表现，加速培训，并将培训转移到手术室的相关指标。我们的 三个项目目标是：目标1：在模拟器上测试血管缝合技术指标的假设 在大型数据集上区分专家和新手的技能水平；目标2：测试以下假设 将模拟器上的培训与基于度量的反馈结合起来将提高模拟器上的技能；目标3：测试 假设(1)模拟器上的训练转移到FVS吻合任务，以及(2)在FVS吻合任务上的任务表现 模拟器与术中表现密切相关。 1

Project Summary The skill of a surgeon is critical to successful patient outcomes. A recent landmark study reported that surgeons' skill ratings were significantly correlated with clinical outcomes after surgery. A number of studies have documented medical errors that led to potential medical complications caused by unskilled surgical maneuvers. One way to reduce medical errors, now the third leading cause of death in the US, is to focus on effective and efficient methods to train surgical skills of clinicians. To respond to the challenges being faced with training the next generation of vascular surgeons, the Vascular Surgery Board along with other vascular surgery educators have developed a set of core skills for open vascular surgery called the Fundamentals of Vascular Surgery(FVS) consisting of five skills—knot tying, radial suturing, anastomosis (end-to-end, end-to-side), ligation and hemostatic techniques—performed on bench models with synthetic materials towards measuring resident performance. These set of exercises are modeled after the Fundamentals of Laparoscopic Skills curriculum, used for credentialing general surgeons who perform laparoscopy. There are several limitations of the FVS curriculum, however: rudimentary outcome metrics, lack of robust feedback for skills training and correlating simulator and Operating Room (OR) performance. Over the past several years, our team has collaborated with the creators of the Fundamentals of Vascular Surgery curriculum to create an instrumented simulator that measures vascular suturing skill. Metrics on our simulator platform measure key aspects of skilled vascular suturing: needle movement, tear forces, needle driver motion and hand movement. These metrics provide a rich set of event-specific, multi-modal and real-time metrics for assessment of vascular suturing. Initial validation demonstrates that the simulator metrics can differentiate between resident and attending suturing skill including suturing in a simulated cavity (at depth). The goal of this project is to provide the vascular surgery community with training tools that quantify skilled performance on vascular suturing, accelerate training and correlate metrics for transfer of training to the OR. Our three project aims are: Aim 1: Test the hypothesis that metrics for vascular suturing skill on the simulator differentiate between expert and novice skill level on a large data set; Aim 2: Test the hypothesis that vascular suturing training on the simulator with metrics-based feedback will improve skill on the simulator; Aim 3: Test the hypothesis that (1) training on simulator transfers to the FVS anastomosis task and (2) task performance on the simulator is correlated with intraoperative performance. 1