Developing a Virtual Basic Laparoscopic Skill Trainer (VBLaST)

描述（申请人提供）：虚拟基本腹腔镜技能训练器（VBLaST）的开发和验证在外科教育史上，一个全面的计划，教导和评估腹腔镜手术独特的认知和心理方面-腹腔镜手术的基础（FLS）最初由美国胃肠内窥镜手术学会（SAGES）开发随后由一个包括美国外科医生学会（ACS）在内的联合委员会批准，在全国范围内对腹腔镜外科医生进行培训和认证。作为医学界日益接受的一个例子，从2009年开始，美国外科医生委员会规定，参加外科医生委员会考试必须通过FLS认证考试。虽然FLS中的认知评估基于75个多项选择题，但人工技能评估使用了监督考试，其中包括在带有内置摄像机的便携式骨盆训练箱中执行的五项任务：双手固定钉转移、精确的图案切割、使用结扎环和使用髓内和体外打结的结扎。尽管FLS越来越受欢迎，但这种箱式训练器模式存在几个主要问题：（1）评估是主观的，（2）在学习期间没有反馈，除非有经验丰富的培训师在场，（3）在考试期间必须雇用大量合格的监考人员，（4）必须不断更换培训材料，以及（5）考生必须前往27个区域考试中心之一或SAGES年会或ACS临床大会。为了克服这些问题，并使更多的传播，我们建议开发和验证虚拟基本腹腔镜技能训练器（VBLaST），从而在FLS中可用的任务可以在PC和笔记本电脑上进行廉价的触觉（触摸）接口设备，如Phantom（R）OmniTM。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，以开发一个“虚拟导师”，这将提供真实的时间自动反馈给学员。一套全面的研究，涉及学生，居民，研究员和执业外科医生在波士顿地区医院（例如，BIDMC、Tufts Medical Center、剑桥健康联盟、哈佛、MGH、Brigham & Women's、Lahey Clinic）将进行VBLaST作为培训工具的有效性测试，并确定其在将获得的技能转移到手术室方面的有用性。一旦得到验证，VBLaST将在降低培训成本和培训时间方面产生指数级影响，同时改善患者安全性和结局。组建了一个多学科团队，该团队在基于物理的交互式医疗模拟、腹腔镜手术和手术教育以及人为因素工程方面具有集体专业知识，以实现以下具体目标：SA 1）开发一个逼真的虚拟基本腹腔镜技能培训器（VBLaST）平台，以执行FLS培训工具箱中的所有任务。SA 2）确定VBLaST作为培训工具的有效性。SA 3）评价VBLaST作为培训工具的有用性。SA 4）为VBLaST开发一个基于Web的接口。 公共卫生相关性：本研究的目标是开发一种全面的基于计算机的技术，使外科学员能够练习他们的外科技能，并在基于计算机的模型上进行标准化测试。在应用于患者之前以这种无风险的方式学习和完善的外科手术和技术将转化为更少的手术室错误，降低患者发病率并改善患者结局，从而更快地愈合，缩短住院时间并降低术后并发症和治疗成本。

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.