Background: Reductions in working hours impact training opportunities for surgeons. Surgical simulation is increasingly proposed to help bridge the resultant training gap. For simulation training to translate effectively into the operating theatre, acquisition of technical proficiency must be objectively assessed. Evaluating ‘economy of movement’ is one way to achieve this.
Objective: We sought to validate a practical and economical method of assessing economy of movement during a simulated task. We hypothesized that accelerometers, found in smartphones, provide quantitative, objective feedback when attached to a neurosurgeon’s wrists.
Methods: Subjects (n=25) included consultants, senior registrars (SRs), junior registrars (JRs), junior doctors (FYs), and medical students. Total resultant acceleration (TRA), average resultant acceleration (ARA) and movements with acceleration >0.6g (STAEs) were recorded while subjects performed a simulated dural closure task.
Results: Students recorded an average TRA 97.0+/-31.2ms-2 higher than SRs (p=.03) and 103+/-31.2ms-2 higher than consultants (p=.02). Similarly, FYs accrued an average TRA 181+/-31.2ms-2 higher than SRs (p<.001) and 187+/-31.2ms-2 higher than consultants (p<.001). Significant correlations were observed between surgical outcome (as measured by quality of dural closure) and both TRA (r=.44, p<.001) and number of STAEs (r=.33, p<.001). TRA (219+/-66.6ms-2, p=.01) and number of STAEs (127+/-42.5, p=.02) dropped between 1st and 4th trials for FYs, suggesting procedural learning. TRA was 45.4+/-17.1ms-2 higher in the dominant hand for students (p=.04) and 57.2+/-17.1ms-2 for FYs (p=.005), contrasting even TRA distribution between hands (acquired ambidexterity) in senior groups.
Conclusion: Data from smartphone-based accelerometers show construct validity as an adjunct for assessing technical performance during simulation training.
From: Validating the Use of Smartphone-based Accelerometers for Performance Assessment in a Simulated Neurosurgical Task by Jensen Ang et al.