Where Do We Look? Assessing Gaze Patterns in Breast Reconstructive Surgery with Eye-Tracking Technology.

BACKGROUND: Aesthetics plays a large role in determining a successful outcome in plastic and reconstructive surgery. As such, understanding perceptions of favorable aesthetics is crucial for optimizing patient satisfaction. Eye-tracking technology offers an unbiased way of measuring how viewers evaluate breast reconstructions. METHODS: Twenty-nine raters with varied plastic surgery experience were shown 20 images of breast reconstruction at various stages. Breasts were divided into those with nipples and no reconstruction scars, those with nipples and reconstruction scars, and those with reconstruction scars and no nipples. Raters viewed each image for 8 seconds to evaluate aesthetic outcomes. Eye-tracking equipment and software were used to track raters' gaze and analyze the distribution of attention. RESULTS: In breasts with reconstruction scars and no nipples, viewers spent 53.9 percent of the view time examining scars, whereas viewers' attention was divided evenly in breasts with both reconstruction scars and nipples, spending 27.5 percent and 27.7 percent of view time examining the nipples and reconstruction scars, respectively. When examining complete reconstructions, viewers spent more time scanning the entire image before fixating on scars and spent less time on single-site fixation. CONCLUSIONS: Complete reconstructions, which notably include the final nipple-areola complex, appear to play an important role in restoring normal viewing parameters. In essence, completed breast reconstructions with nipple-areola complexes divert attention from extraneous surgical scars and lead viewers to assess the breasts more holistically. Eye-tracking technology provides a powerful link between objective gaze and viewer attention that may potentially be used to predict subjective aesthetic preferences.

Validation of a Cognitive Task Simulation and Rehearsal Tool for Open Carpal Tunnel Release.

BACKGROUND: Carpal tunnel release is one of the most common surgical procedures performed by hand surgeons. The authors created a surgical simulation of open carpal tunnel release utilizing a mobile and rehearsal platform app. This study was performed in order to validate the simulator as an effective training platform for carpal tunnel release. METHODS: The simulator was evaluated using a number of metrics: construct validity (the ability to identify variability in skill levels), face validity (the perceived ability of the simulator to teach the intended material), content validity (that the simulator was an accurate representation of the intended operation), and acceptability validity (willingness of the desired user group to adopt this method of training). Novices and experts were recruited. Each group was tested, and all participants were assigned an objective score, which served as construct validation. A Likert-scale questionnaire was administered to gauge face, content, and acceptability validity. RESULTS: Twenty novices and 10 experts were recruited for this study. The objective performance scores from the expert group were significantly higher than those of the novice group, with surgeons scoring a median of 74% and medical students scoring a median of 45%. The questionnaire responses indicated face, content, and acceptability validation. CONCLUSIONS: This mobile-based surgical simulation platform provides step-by-step instruction for a variety of surgical procedures. The findings of this study help to demonstrate its utility as a learning tool, as we confirmed construct, face, content, and acceptability validity for carpal tunnel release. This easy-to-use educational tool may help bring surgical education to a new-and highly mobile-level.

Video-based self-review: comparing Google Glass and GoPro technologies.

INTRODUCTION: Professionals in a variety of specialties use video-based review as a method of constant self-evaluation. We believe critical self-reflection will allow a surgical trainee to identify methods for improvement throughout residency and beyond. We have used 2 new popular technologies to evaluate their role in accomplishing the previously mentioned objectives. METHODS: Our group investigated Google Glass and GoPro cameras. Medical students, residents, and faculty were invited to wear each of the devices during a scheduled operation. After the case, each participant was asked to comment on a number of features of the device including comfort, level of distraction/interference with operating, ease of video acquisition, and battery life. Software and hardware specifications were compiled and compared by the authors. A "proof-of-concept" was also performed using the video-conferencing abilities of Google Glass to perform a simulated flap check. RESULTS: The technical specifications of the 2 cameras favor GoPro over Google Glass. Glass records in 720p with 5-MP still shots, and the GoPro records in 1080p with 12-MP still shots. Our tests of battery life showed more than 2 hours of continuous video with GoPro, and less than 1 hour for Glass. Favorable features of Google Glass included comfort and relative ease of use; they could not comfortably wear loupes while operating, and would have preferred longer hands-free video recording. The GoPro was slightly more cumbersome and required a nonsterile team member to activate all pictures or video; however, loupes could be worn. Google Glass was successfully used in the hospital for a simulated flap check, with overall audio and video being transmitted--fine detail was lost, however. CONCLUSIONS: There are benefits and limitations to each of the devices tested. Google Glass is in its infancy and may gain a larger intraoperative role in the future. We plan to use Glass as a way for trainees to easily acquire intraoperative footage as a means to "review tape" and will use the GoPro to amass a video library of commonly performed operations.

Commentary: The relationship status of digital media and professionalism: it's complicated.

The rising popularity of digital applications, such as social networking, media share sites, and blogging, has significantly affected how medical trainees interact with educators, colleagues, and the public. Despite the increased popularity and use of such applications amongst the current generation of trainees, medical educators have little evidence or guidance about preventing misuse and ensuring standards for professional conduct. As trainees become more technologically savvy, it is the responsibility of medical educators to familiarize themselves not only with the advantages of this technology but also with the potential negative effects of its misuse. Professionalism, appropriateness for public consumption, and individual or institutional representation in digital media content are just some of the salient issues that arise when considering the ramifications of trainees' digital behavior in the absence of established policies or education on risk. In this commentary the authors explore the rising use of digital media and its reflection of medical trainees' professionalism. To address possible issues related to professionalism in digital media, the authors hypothesize potential solutions, including exploring faculty familiarity with digital media and policy development, educating students on the potential risks of misuse, and modeling professionalism in this new digital age.