Developing a Virtual Basic Laparoscopic Skill Trainer (VBLaST)

描述（由申请人提供）：虚拟腹腔镜基本技能培训器（VBLaST）的开发与验证在外科教育史上，腹腔镜手术基础（FLS）是由美国胃肠内窥镜外科学会（SAGES）最初开发的，随后由包括美国外科医生学会（ACS）在内的联合委员会开发的，一个全面的项目来教授和评估腹腔镜手术独特的认知和精神运动方面，目前正在全国范围内接受腹腔镜外科医生的培训和资格认证。作为医学界越来越接受FLS的一个例子，从2009年开始，美国外科医生委员会规定，参加外科委员会考试必须通过FLS认证考试。虽然FLS的认知评估是基于75道选择题，但手工技能评估采用了一种监督考试，其中包括在一个内置摄像头的便携式骨盆训练盒中执行的五项任务：双手转移钉、精确的图案切割、使用结扎环和用体内和体外打结进行缝合。尽管FLS的的日益流行,有几个主要的问题这个盒子教练范式:(1)评估是主观的,(2)没有反馈在学习除了当一位经验丰富的教练,(3)大量的合格监考期间必须进行测试,(4)培训材料必须不断更换,和(5)考生必须前往一个27个地区测试中心或圣贤年会或ACS临床国会。为了克服这些问题并使更广泛的传播，我们建议开发和验证虚拟基本腹腔镜技能培训器（VBLaST），使FLS中的任务可以在pc和笔记本电脑上使用廉价的触觉（触摸）接口设备（如Phantom(R) OmniTM）执行。为了开发VBLaST，必须开发一套新的技术，包括快速但高度逼真的基于物理的虚拟交互范例和统计机器学习技术，以开发“虚拟导师”，为受训者提供实时自动反馈。将对波士顿地区医院（如BIDMC、塔夫茨医疗中心、剑桥健康联盟、哈佛大学、MGH、Brigham & Women’s、Lahey Clinic）的学生、住院医生、研究员和执业外科医生进行一套全面的研究，以测试VBLaST作为培训工具的有效性，并确定其在将获得的技能转移到手术室方面的有效性。一旦验证，VBLaST将在降低培训成本和培训时间方面产生指数级影响，同时提高患者的安全性和效果。一个在基于物理的交互式医疗模拟、腹腔镜手术和外科教育以及人为因素工程方面具有集体专业知识的多学科团队已经组建起来，以实现以下具体目标：SA1)开发一个逼真的虚拟基本腹腔镜技能培训师（VBLaST）平台，以执行FLS培训工具箱中提供的所有任务。SA2)建立VBLaST作为培训工具的有效性。SA3)评估VBLaST作为培训工具的有效性。SA4)为VBLaST开发基于web的界面。

DESCRIPTION (provided by applicant): Development and Validation of a Virtual Basic Laparoscopic Skill Trainer (VBLaST) For the first time in the history of surgical education, a comprehensive program to teach and evaluate the cognitive and psychomotor aspects unique to laparoscopic surgery - the Fundamentals of Laparoscopic Surgery (FLS) developed originally by the Society of American Gastrointestinal Endoscopic Surgery (SAGES) and subsequently by a joint committee which includes the American College of Surgeons (ACS) - is being embraced nationally for training and credentialing laparoscopic surgeons. As an example of its growing acceptance by the medical community, starting in 2009, the American Board of Surgeons has mandated that passing the FLS certifying examination will be required for taking the board examination in surgery. While the cognitive assessment in FLS is based on 75 multiple-choice questions, a proctored examination is used for the manual skills assessment which includes five tasks to be performed in a portable pelvic trainer box with built-in video camera: bimanual peg transfer, precise pattern cutting, use of ligating loops and suturing with intracorporeal and extracorporeal knot tying. In spite of the growing popularity of the FLS, there are several major problems with this box trainer paradigm: (1) the assessment is subjective, (2) there is no feedback during learning except when an experienced trainer is present, (3) a large number of qualified proctors must be engaged during test taking, (4) the training material must be constantly replaced, and (5) the test-takers must travel to one of the 27 Regional Test Centers or the Annual SAGES meeting or the ACS Clinical Congress. To overcome these problems and to enable greater dissemination, we propose to develop and validate a Virtual Basic Laparoscopic Skill Trainer (VBLaST) whereby tasks available in the FLS may be performed on PCs and laptops with inexpensive haptic (touch) interface devices, such as the Phantom(R) OmniTM. To develop the VBLaST a novel set of technologies must be developed including rapid, but highly realistic physics-based virtual interaction paradigms and statistical machine learning techniques to develop a "virtual mentor" which will provide real time automated feedback to the trainees. A comprehensive set of studies involving students, residents, fellows and practicing surgeons at Boston area hospitals (e.g., BIDMC, Tufts Medical Center, Cambridge Health Alliance, Harvard, MGH, Brigham & Women's, Lahey Clinic) will be undertaken to test the validity of the VBLaST as a training tool and establish its usefulness in transferring the acquired skills to the operating room. Once validated, the VBLaST will have exponential impact in reducing training costs and training time while improving patient safety and outcomes, A multidisciplinary team with collective expertise in physics-based interactive medical simulation, laparoscopic surgery and surgical education, and human factors engineering has been assembled to achieve the following Specific Aims: SA1) To develop a realistic virtual basic laparoscopic skill trainer (VBLaST) platform to perform all the tasks available in the FLS training tool box. SA2) To establish the validity of the VBLaST as a training tool. SA3) To evaluate the usefulness of the VBLaST as a training tool. SA4) To develop a web-based interface for the VBLaST. PUBLIC HEALTH RELEVANCE: The goal of this research is to develop a comprehensive computer-based technology that will allow surgical trainees to practice their surgical skills and to take standardized tests on computer-based models. Surgical procedures and techniques, learnt and perfected in this risk-free manner before application to patients, will translate to fewer operating room errors, reduced patient morbidity and improved patient outcomes resulting in faster healing, shorter hospital stay and reduced post surgical complications and treatment costs.