Resumen de Understanding the role of nontechnical skills in minimally invasive surgery and their integration in technology enhanced learning environments
In the last decade, minimally invasive surgery (MIS) has gained popularity due to its many benefits for patients. However, this increase in popularity implied that surgeons must acquire a different set of skills. As a result, surgical education shifted to provide learners with the necessary MIS skills, which are known to depend on the combination of various skill sets. These sets can be divided into five inter-related domains: (1) psychomotor skills, (2) declarative knowledge (3) interpersonal skills (4) personal resourcefulness and (5) advanced cognitive skills.
Advancing on the definition of the necessary MIS skills has allowed to improve surgical education by incorporating technology focused on their training and assessment. How to best incorporate technology in education is part of a broader research area known as technology-enhanced learning (TEL).
The purpose of this PhD is to define and integrate TEL-based methods for the training and assessment of nontechnical skills in MIS. To do that, a framework of MIS skills is proposed based on (1) pedagogical background on how to apply technology to cover MIS learning objectives, (2) skills’s definitions and relations to achieve a cross-modal training and assessment, and (3) temporality (i.e., the optimal time to train and assess MIS skills). Based on this framework, two experiments are proposed to prove the feasibility of new cross-modal objective training and assessment methods for (1) personal resourcefulness and psychomotor skills, and (2) declarative knowledge and advanced cognitive skills.
The first experiment consists in evaluating stress and attention management (as part of personal resourcefulness) through monitoring ECG, GSR and gaze, and seeks to prove the relation between them and psychomotor skills (as obtained by the motion analysis parameters calculated by EVA tracking system). The results show that (1) GSR and the acceleration of the surgical instrument are closely related to stress, (2) experts tend to fixate less when stress than nonexperts, and (3) there may be a link between psychomotor skills and personal resourcefulness.
The second experiment consists in evaluating procedural skills and decision making through surgical workflow analysis (SWA), as obtained by an integrated system using endoscopic video and speech. The latter is especially relevant since it indicates that the verbalization of the surgical procedure’s steps could be associated to the cognitive processes taking place while operating. The integrated system obtained 0.912 F1 score, and the analysis of the workflow resulting from its predictions proved the feasibility of the proposed assessment system.
Finally, a digital portfolio based on the framework which integrates the information obtained from multiple MIS skills’ information sources, is designed. The design proves that it might be feasible pull the information obtained from different sources together within a unified portfolio in which they can be uploaded and visualized, while adding assessment functionalities to help students reflect on their progress.
Overall, this PhD corroborates the investigated research hypotheses regarding the integration of nonintrusive monitoring technologies in the educational OR to improve training and assessment of MIS nontechnical skills. New research fields in the training and assessment of MIS surgeons can be proposed based on these foundations, in order to contribute to the definition of structured and objective learning curricula that guarantee patient safety in the OR.
