A Study of Objective Skills Assessment and Learning Rates in a Septoplasty Model

描述(由申请人提供)：在所有医学学科中，患者的安全都是最受关注的。外科教师和执照委员会通过确保外科住院医师进行充分的技术培训，为患者的安全做出贡献。医学研究生教育认证委员会(ACGME)最近对住院医师资格要求的变化要求从学徒式的、非系统的培训转变为基于能力的培训，并进行客观的手术技能评估。到目前为止，有效、公正、自动化的技能评估工具主要用于评估结构化环境中的技能。我们假设这些方法在活体手术条件下是健壮的，因此可以用来直接测量外科医生在进行手术时的技能。我们进一步假设，我们将能够区分四种水平的手术技能(初级、中级、高级和专家)，并且我们将能够确定特定于手术程序的学习曲线。学习曲线，即技能和案例数量之间的关系，是教育工作者非常感兴趣的；我们推测，在案例数量和基于时间的培训向基于能力的培训范式过渡的过程中，它们将发挥重要作用。提出的方法是一般性的，概念验证将在鼻中隔成形术模型中进行。鼻中隔成形术被认为是所有耳鼻咽喉科住院医师的“首选”病例；手术的复杂性使其成为理想的原始候选病例。该项目的核心科学工作是：1)创建一个客观的技能评估平台，用于开发和验证术中技能评估工具；2)证明存在可用于技能评估的手术确定性模型，并深入了解手术过程；3)验证用于客观技能评估的确定性和随机性(隐马尔可夫模型)手术工具；4)测量中隔手术的学习曲线。该项目通过提高外科医生的技术能力来确保患者的安全，从而与公共卫生相关。 公共卫生相关性：认证外科医生的能力对患者安全非常重要，因此是一项重大的公共卫生倡议。目前，几乎没有客观的方法来评估外科医生在手术室的技能。本文提出了一种客观、通用的外科医师技能评价方法，对外科教学、外科医师技能评价、外科医师资格认证具有重要的指导意义。

DESCRIPTION (provided by applicant): Patient safety is of paramount concern in all disciplines of medicine. Surgical educators and licensing boards contribute to patient safety by ensuring adequate technical training of surgical residents. Recent changes to residency requirements by the accreditation Council for Graduate Medical Education (ACGME) mandate a paradigm shift from apprenticeship-style, unsystematic training to competency-based training with objective surgical skills assessment. To date, valid, unbiased, automated skills assessment tools are used primarily to assess skill in structured settings. We hypothesize that these methods are robust under live surgery conditions and therefore can be used to directly measure a surgeon's skill while performing surgery. We further hypothesize that we will be able to distinguish between four levels of surgical skill (beginner, intermediate, advanced, and expert) and that we will be able to determine procedure-specific learning curves. Learning curves, i.e., relationships between skill and case number, are of significant interest to educators; we conjecture they will play a major role during the transition between case number and time based training to competency based training paradigms. The methods presented are general, and proof of concept will be performed in a septoplasty surgery model. Septoplasty is considered an "index" case for all otolaryngology residents; the complexity of the surgery makes it an ideal proto-candidate. The core scientific work in this project is to 1) create an objective skills assessment platform for developing and validating intra-operative skills assessment tools, 2) demonstrate that deterministic models of surgery useful for skills assessment exist and give insight into the surgical process, 3) validate a deterministic and stochastic (Hidden Markov Model) surgery tool for objective skills assessment and 4) measure the learning curve for septal surgery. This project is relevant to public health by ensuring patient safety through improving technical competency of surgeons. PUBLIC HEALTH RELEVANCE: Certifying a surgeon's competency is important for patient safety and therefore a major public health initiative. Currently, few objective methods for evaluating a surgeon's skill in the operating room exist. We present an objective and general method for evaluating a surgeon's technical skill in the operating room; this will play an important role in teaching surgery, evaluating surgeons' technical skills, and certifying surgeons.