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

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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