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

描述（由申请人提供）：患者安全在所有医学学科中都是最重要的。外科教育工作者和执照委员会通过确保外科住院医师得到充分的技术培训来促进患者安全。研究生医学教育认证委员会（ACGME）最近对住院医师的要求进行了修改，要求从学徒式、非系统的培训转变为以能力为基础的培训，并进行客观的外科技能评估。迄今为止，有效的、公正的、自动化的技能评估工具主要用于评估结构化设置中的技能。我们假设这些方法在现场手术条件下是稳健的，因此可以用来直接衡量外科医生在进行手术时的技能。我们进一步假设，我们将能够区分四个级别的手术技能（初级、中级、高级和专家），我们将能够确定特定手术的学习曲线。学习曲线，即技能和案例数之间的关系，是教育工作者非常感兴趣的；我们推测，在案例数和时间为基础的培训模式向能力为基础的培训模式转变的过程中，他们将发挥重要作用。所提出的方法是一般的，概念的证明将在一个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喉科居民的“指标”病例；手术的复杂性使其成为理想的候选原型。该项目的核心科学工作是：1)创建一个客观技能评估平台，用于开发和验证术中技能评估工具；2)证明存在用于技能评估的确定性手术模型，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（隐马尔可夫模型）手术工具；4)测量室间隔手术的学习曲线。该项目通过提高外科医生的技术能力来确保病人的安全，从而与公共卫生有关。

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.