Perceived Usefulness and Acceptance of Communication Support System in Laparoscopic Surgery.

In laparoscopic surgery, senior surgeons spend great efforts to convey knowledge to their trainees. Any misinterpretation of the instructions may lead to inevitable errors that have a great impact on patient safety. To support efficient knowledge sharing, we design a communication support system, Virtual Pointer, to convey trainers' gestures directly onto the laparoscopic video for trainees to see. We implement the design in an international surgical conference and evaluate the perceived usefulness and acceptance of the system among senior surgeons and surgical trainees. The results showed that the system facilitated the trainees to complete the task, increased their knowledge, and reduced the trainers' guiding efforts. The study indicates that conveying the gestures directly onto video has the potential to support the intraoperative communication. Barriers in the acceptance of the system highlight the design of novel interaction mechanisms to unobtrusively integrate this technique into the surgical workflow.

Effects of a Virtual Pointer on Trainees' Cognitive Load and Communication Efficiency in Surgical Training.

We investigated the cognitive load effect of a trainer providing surgical instruction by pointing/drawing over laparoscopic video to a trainee. Results showed that while cognitive load is higher overall with the use of the instructional system, there is a decrease by the second experience of being instructed by the Virtual Pointer. Further analysis showed that trainees were more likely to perform the surgical task and watch/listen to the trainer's instruction at the same time when the instructional system was used. This is thought to be an indication of more efficient communication when using the instructional system. Thus, although there is a small cognitive overload with the instructional system initially, the more efficient communication allows trainees to better integrate the knowledge and instructions being conveyed into the actions they must perform - indicating a better learning environment.

A virtual pointer to support the adoption of professional vision in laparoscopic training.

PURPOSE: To assess a virtual pointer in supporting surgical trainees' development of professional vision in laparoscopic surgery. METHODS: We developed a virtual pointing and telestration system utilizing the Microsoft Kinect movement sensor as an overlay for any imagine system. Training with the application was compared to a standard condition, i.e., verbal instruction with un-mediated gestures, in a laparoscopic training environment. Seven trainees performed four simulated laparoscopic tasks guided by an experienced surgeon as the trainer. Trainee performance was subjectively assessed by the trainee and trainer, and objectively measured by number of errors, time to task completion, and economy of movement. RESULTS: No significant differences in errors and time to task completion were obtained between virtual pointer and standard conditions. Economy of movement in the non-dominant hand was significantly improved when using virtual pointer ([Formula: see text]). The trainers perceived a significant improvement in trainee performance in virtual pointer condition ([Formula: see text]), while the trainees perceived no difference. The trainers' perception of economy of movement was similar between the two conditions in the initial three runs and became significantly improved in virtual pointer condition in the fourth run ([Formula: see text]). CONCLUSIONS: Results show that the virtual pointer system improves the trainer's perception of trainee's performance and this is reflected in the objective performance measures in the third and fourth training runs. The benefit of a virtual pointing and telestration system may be perceived by the trainers early on in training, but this is not evident in objective trainee performance until further mastery has been attained. In addition, the performance improvement of economy of motion specifically shows that the virtual pointer improves the adoption of professional vision- improved ability to see and use laparoscopic video results in more direct instrument movement.

The bit doesn't fit: Evaluation of a commercial activity-tracker at slower walking speeds.

Accelerometer-based commercial activity trackers are a low-cost and convenient method for monitoring and assessing health measures such as gait. However, the accuracy of these activity trackers in slow walking conditions on a minute-by-minute basis is largely unknown. In this study, the accuracy of a hip-worn commercial activity tracker (FitBit Ultra) was examined through step counts. Accuracy was evaluated through four minute trials of treadmill walking at speeds representative of older adults (0.9, 1.1, and 1.3m/s). Minute-by-minute step count was extracted through the FitBit API and compared it to observer counted steps through video recordings. Results highlighted a significant over-reporting of steps at the highest speed, and a significant under-reporting of steps at the slowest speed, with the FitBit Ultra failing to count steps for one or more minutes at the slowest speed for 11 participants. This study highlights problems with using the FitBit Ultra by slow-walking populations, and recommends that researchers and clinicians should carefully consider the trade-off between accuracy and convenience when using commercial activity trackers with slow-walking populations.

Comparison of tri-axial accelerometers step-count accuracy in slow walking conditions.

Accelerometers have shown great promise and popularity for monitoring gait. However, the accuracy of accelerometers for gait analysis in slow walking conditions is largely unknown. In this study, we compared the accuracy of three accelerometers recommended for gait analysis - Axivity AX3, APDM Opal, and the Actigraph wGT3X-BT, by holding the step-count algorithm constant. We evaluated device accuracy in four minutes of treadmill walking at the speeds of 0.9m/s, 1.1m/s, and 1.3m/s. We constructed a symbolization of the gait data to count the steps using Piecewise Aggregate Approximation and compared the estimated step counts with observer counted steps from video recordings. Our results highlight the variation between the performance of devices - the Axivity AX3 provides more accurate step counts than the other two devices. In this, we provide evidence for future scientific teams to make decisions on selecting accelerometers which can more accurately measure steps taken at slower walking speeds, and suggest ways to improve the design of algorithms and accelerometers.

Improving Common Ground Development in Surgical Training through Talk and Action.

In surgical training, senior surgeons and residents rely on more than just verbal utterances to share information and coordinate their work practices - their actions also contribute to and shape the development of common ground. However, the function of actions in the grounding process and how that is interdependent with verbal utterances have not been made explicit. We have investigated actions and utterances using a dialogue act coding scheme that highlights the communicative functions of each act towards common ground development during a laparoscopic surgery. We show that utterances provide detailed information for surgeons to develop content common ground, whereas actions contribute to process common ground development. Thus, utterances and actions, by providing different forms of information, depend on each other to develop and maintain common ground. Based on this understanding, we discuss opportunities in transforming actions into perceivable knowledge on the laparoscopic display that supports effective communication and surgical training.

A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training.

BACKGROUND: Distractions during surgical procedures have been linked to medical error and team inefficiency. This systematic review identifies the most common and most significant forms of distraction in order to devise guidelines for mitigating the effects of distractions in the OR. METHODS: In January 2015, a PubMed and Google Scholar search yielded 963 articles, of which 17 (2 %) either directly observed the occurrence of distractions in operating rooms or conducted a laboratory experiment to determine the effect of distraction on surgical performance. RESULTS: Observational studies indicated that movement and case-irrelevant conversation were the most frequently occurring distractions, but equipment and procedural distractions were the most severe. Laboratory studies indicated that (1) auditory and mental distractions can significantly impact surgical performance, but visual distractions do not incur the same level of effects; (2) task difficulty has an interaction effect with distractions; and (3) inexperienced subjects reduce their speed when faced with distractions, while experienced subjects did not. CONCLUSION: This systematic review suggests that operating room protocols should ensure that distractions from intermittent auditory and mental distractions are significantly reduced. In addition, surgical residents would benefit from training for intermittent auditory and mental distractions in order to develop automaticity and high skill performance during distractions, particularly during more difficult surgical tasks. It is unclear as to whether training should be done in the presence of distractions or distractions should only be used for post-training testing of levels of automaticity.

Supporting Common Ground Development in the Operation Room through Information Display Systems.

Effective information sharing is crucial for clinical team coordination. Most information display systems have been designed to replace verbal communication. However, information may not be available for capture before a communication event and information needs often become clear and evident through an evolving discourse. Thus, to build tools to support clinical team in situ information sharing, we need a better understanding of how evolving information needs are identified and satisfied. In this study, we used sequential analysis techniques to explore the ways communication and information sharing events between an attending surgeon and a resident change throughout a laparoscopic surgery. We demonstrate how common ground is developed and maintained, and how information needs change through the efforts of grounding. From our findings, we suggest that the design for information display systems could encourage communication and support the articulation work that is necessary to accomplish the information sharing.