Development and application of a non-technical skills coaching intervention framework for surgeons: A pilot quality improvement initiative.

Non-technical skills (NTS) challenges experienced by surgeons may degrade performance, ultimately impacting the safety and quality of care delivered to patients. The objectives of this work were to develop a framework for NTS coaching for surgeons and implement a coaching program utilizing the developed NTS coaching framework. Leveraging adult learning and self-determination theories, a specialty-agnostic NTS coaching framework was developed for individual coaching sessions with robotic surgeons.

Passive Exoskeletons During Live Surgeries: Supporting Forward Head Postures Among Veterinary Surgeons.

TECHNICAL ABSTRACT Musculoskeletal symptoms (MSS) are prevalent among veterinary surgeons. Recent research has proposed exoskeletons as potential solutions in reducing the risk of musculoskeletal disorders among surgeons, but no studies have addressed the neck forward postures (opposite of overhead work), a unique ergonomic neck risk, commonly required during live, open surgery. We explored the effectiveness of a passive neck-support exoskeleton during live veterinary surgical procedures with experienced surgeons.

Nontechnical Skills Assessment in Acute Care Trauma Simulations: A Mixed Methods Approach Using Eye Tracking and Behavioral Marker Systems.

Introduction: The condition of trauma patients and the urgent need for timely resuscitation present unique challenges to trauma teams. These difficulties are exacerbated for military trauma teams in combat environments. Consequently, there is a need for continued improvement of nontechnical skills (NTS) training for trauma teams.

Deep learning enables accurate soft tissue tendon deformation estimation in vivo via ultrasound imaging.

Image-based deformation estimation is an important tool used in a variety of engineering problems, including crack propagation, fracture, and fatigue failure. These tools have been important in biomechanics research where measuring in vitro and in vivo tissue deformations are important for evaluating tissue health and disease progression. However, accurately measuring tissue deformation in vivo is particularly challenging due to limited image signal-to-noise ratio.

Evaluation of a passive arm-support exoskeleton for surgical team members: Results from live surgeries.

Background: Musculoskeletal symptoms and injuries adversely impact the health of surgical team members and their performance in the operating room (OR). Though ergonomic risks in surgery are well-recognized, mitigating these risks is especially difficult. In this study, we aimed to assess the impacts of an exoskeleton when used by OR team members during live surgeries.

Eye tracking and audio sensors to evaluate surgeon's non-technical skills: An empirical study.

Non-Technical Skills (NTS) of medical teams are currently measured using subjective and resource-intensive ratings given by experts. This study explores if objective NTS assessment approaches with eye-tracking and audio sensors can measure teamwork and communication skills in surgery. Eight surgeons participated in a simulated two-phase surgical scenario developed to assess their NTS.

Granular estimation of user cognitive workload using multi-modal physiological sensors.

Mental workload (MWL) is a crucial area of study due to its significant influence on task performance and potential for significant operator error. However, measuring MWL presents challenges, as it is a multi-dimensional construct. Previous research on MWL models has focused on differentiating between two to three levels.

Utilizing Eye Tracking to Assess Medical Student Non-Technical Performance During Scenario-Based Simulation: Results of a Pilot Study.

Background: Non-technical skills (NTS) are essential for safe surgical patient management. However, assessing NTS involves observer-based ratings, which can introduce bias. Eye tracking (ET) has been proposed as an effective method to capture NTS.

Adaptive Human-Robotic Interaction for Robotic-assisted Surgical Settings.

Introduction: Increased complexity in robotic-assisted surgical system interfaces introduces problems with human-robot collaboration that result in excessive mental workload (MWL), adversely impacting a surgeon's task performance and increasing error probability. Real-time monitoring of the operator's MWL will aid in identifying when and how interventions can be best provided to moderate MWL. In this study, an MWL-based adaptive automation system is constructed and evaluated for its effectiveness during robotic-assisted surgery.

Worker and work-related factors influence on musculoskeletal symptoms among veterinary surgeons.

Worker and work-related musculoskeletal symptoms are prevalent among surgeons operating on human patients. Despite incidence rates for accidents among veterinarians and their staff being 2.9 times higher than that of general practitioners of human medicine, little is known about musculoskeletal symptoms among veterinary surgeons.

An Eye-Fixation Related Electroencephalography Technique for Predicting Situation Awareness: Implications for Driver State Monitoring Systems.

Objective: This study developed a fixation-related electroencephalography band power (FRBP) approach for situation awareness (SA) assessment in automated driving.

Background: Maintaining good SA in Level 3 automated vehicles is crucial to drivers' takeover performance when the automated system fails. A multimodal fusion approach that enables the analysis of the visual behavioral and cognitive processes of SA can facilitate real-time assessment of SA in future driver state monitoring systems.

A sensor-based framework for layout and workflow assessment in operating rooms.

Due to their large sizes and impediments to personnel workflows, integrating robotic technologies into the existing operating rooms (OR) is a challenge. In this study, we developed an ultra-wideband sensor-based human-machine-environment framework for layout and workflow assessments within the OR. In addition to providing best practices for use of the framework, we also demonstrated its effectiveness in understanding layout and workflow inefficiencies in 12 robotic-assisted surgeries (RAS) across 4 different surgical specialties.

Development of an Automated Composite Ureteroscopic Efficiency Score Through Simulated Ureteroscopic Skills Assessment.

Flexible ureteroscopy (fURS) is the most common procedure for treatment of urolithiasis. We previously utilized kinematic evaluations of simulated fURS to demonstrate that certain body movements are associated with efficient ureteroscopic manipulation for complex tasks. In this study, we incorporated computer vision to create an efficiency score using the ureteroscope travel distance (DIST), task time (TIME), spectral arc length (SPARC), and percentage of purposeful wall collisions (COLL).

Physiological Metrics of Surgical Difficulty and Multi-Task Requirement during Robotic Surgery Skills.

Previous studies in robotic-assisted surgery (RAS) have studied cognitive workload by modulating surgical task difficulty, and many of these studies have relied on self-reported workload measurements. However, contributors to and their effects on cognitive workload are complex and may not be sufficiently summarized by changes in task difficulty alone. This study aims to understand how multi-task requirement contributes to the prediction of cognitive load in RAS under different task difficulties.

Detailing experienced nurse decision making during acute patient care simulations.

Introduction: Nurse decision making (DM) is critical for patient safety. Eye-tracking methods can effectively assess nurse DM. The purpose of this pilot study was to use eye-tracking methods to assess nurse DM during a clinical simulation.

Prevalence of Work-Related Musculoskeletal Symptoms in Veterinary Surgeons-A Cross-Sectional Survey.

Objectives:  The aim of this study was to determine the prevalence of work-related musculoskeletal symptoms (MSS) in veterinary surgeons using an online survey.

Study Design:  An online survey was distributed to 1,031 diplomates of American College of Veterinary Surgeons. Responses were collected with data regarding surgical activities, experience with various types of MSS in 10 different body sites and attempts to reduce MSS.

An Adaptive Human-Robotic Interaction Architecture for Augmenting Surgery Performance Using Real-Time Workload Sensing-Demonstration of a Semi-autonomous Suction Tool.

Objective: This study developed and evaluated a mental workload-based adaptive automation (MWL-AA) that monitors surgeon cognitive load and assist during cognitively demanding tasks and assists surgeons in robotic-assisted surgery (RAS).

Background: The introduction of RAS makes operators overwhelmed. The need for precise, continuous assessment of human mental workload (MWL) states is important to identify when the interventions should be delivered to moderate operators' MWL.

Investigating gripping force during lifting tasks using a pressure sensing glove system.

Lifting tasks remain one of the leading causes of musculoskeletal disorders (MSDs), primarily in the low back region. Lifting analysis tools are, therefore, designed for assessing the risk of low back pain. Shoulder musculoskeletal problems have emerged as common MSDs associated with manual handling tasks.

Characterizing Exposure to Physical Risk Factors during Veterinary Surgery with Wearable Sensors: A Pilot Study.

OCCUPATIONAL APPLICATIONSVeterinarians provide comprehensive health services for animals, but despite exposure to similar occupational and safety hazards as medical physicians, physical risk factors for these doctors and healthcare teams have not been characterized. In this pilot study, we used wearable sensor technology and showed that veterinary surgeons commonly experience static and demanding postures while performing soft tissue and orthopedic surgeries. Observations showed that muscle activation was highest in the right trapezius.

Detecting Unusual Intravenous Infusion Alerting Patterns with Machine Learning Algorithms.

Objective: To detect unusual infusion alerting patterns using machine learning (ML) algorithms as a first step to advance safer inpatient intravenous administration of high-alert medications.

Materials And Methods: We used one year of detailed propofol infusion data from a hospital. Interpretable and clinically relevant variables were feature engineered, and data points were aggregated per calendar day.

Objective Nontechnical Skills Measurement Using Sensor-based Behavior Metrics in Surgical Teams.

Objective: The purpose of this study was to identify objective measures that predict surgeon nontechnical skills (NTS) during surgery.

Background: NTS are cognitive and social skills that impact operative performance and patient outcomes. Current methods for NTS assessment in surgery rely on observation-based tools to rate intraoperative behavior.

Quantifying Workload and Stress in Intensive Care Unit Nurses: Preliminary Evaluation Using Continuous Eye-Tracking.

Objective: (1) To assess mental workloads of intensive care unit (ICU) nurses in 12-hour working shifts (days and nights) using eye movement data; (2) to explore the impact of stress on the ocular metrics of nurses performing patient care in the ICU.

Background: Prior studies have employed workload scoring systems or accelerometer data to assess ICU nurses' workload. This is the first naturalistic attempt to explore nurses' mental workload using eye movement data.

A neurotechnological aid for semi-autonomous suction in robotic-assisted surgery.

Adoption of robotic-assisted surgery has steadily increased as it improves the surgeon's dexterity and visualization. Despite these advantages, the success of a robotic procedure is highly dependent on the availability of a proficient surgical assistant that can collaborate with the surgeon. With the introduction of novel medical devices, the surgeon has taken over some of the surgical assistant's tasks to increase their independence.

A comparison of laparoscopic and robotic ergonomic risk.

Introduction: Work related injuries in minimally invasive surgery (MIS) are common because of the strains placed on the surgeon's or assistant's body. The objective of this study was to compare specific ergonomic risks among surgeons and surgical trainees performing robotic and laparoscopic procedures.

Materials And Methods: Ergonomic data and discomfort questionnaires were recorded from surgeons and trainees (fellows/residents) for both robotic and laparoscopic procedures.

Evaluating the Ergonomics of Surgical Residents During Laparoscopic Simulation: A Novel Computerized Approach.

Background: Assessment of residents' body positioning during laparoscopy has not been adequately investigated. This study presents a novel computer vision technique to automate ergonomic evaluation and demonstrates this approach through simulated laparoscopy.

Methods: Surgical residents at a single academic institution were video recorded performing tasks from the Fundamentals of Laparoscopic Surgery (FLS).