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Toy S, Huh DD, Materi J, Nanavati J, Schwengel DA. Use of neuroimaging to measure neurocognitive engagement in health professions education: a scoping review. MEDICAL EDUCATION ONLINE 2022; 27:2016357. [PMID: 35012424 PMCID: PMC8757598 DOI: 10.1080/10872981.2021.2016357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/19/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To map the current literature on functional neuroimaging use in medical education research as a novel measurement modality for neurocognitive engagement, learning, and expertise development. METHOD We searched PubMed, Embase, Cochrane, ERIC, and Web of Science, and hand-searched reference lists of relevant articles on April 4, 2019, and updated the search on July 7, 2020. Two authors screened the abstracts and then full-text articles for eligibility based on inclusion criteria. The data were then charted, synthesized, and analyzed descriptively. RESULTS Sixty-seven articles published between 2007 and 2020 were included in this scoping review. These studies used three main neuroimaging modalities: functional magnetic resonance imaging, functional near-infrared spectroscopy, and electroencephalography. Most of the publications (90%, n = 60) were from the last 10 years (2011-2020). Although these studies were conducted in 16 countries, 68.7% (n = 46) were from three countries: the USA (n = 21), UK (n = 15), and Canada (n = 10). These studies were mainly non-experimental (74.6%, n = 50). Most used neuroimaging techniques to examine psychomotor skill development (57%, n = 38), but several investigated neurocognitive correlates of clinical reasoning skills (22%, n = 15). CONCLUSION This scoping review maps the available literature on functional neuroimaging use in medical education. Despite the heterogeneity in research questions, study designs, and outcome measures, we identified a few common themes. Included studies are encouraging of the potential for neuroimaging to complement commonly used measures in education research and may help validate/challenge established theoretical assumptions and provide insight into training methods. This review highlighted several areas for further research. The use of these emerging technologies appears ripe for developing precision education, establishing viable study protocols for realistic operational settings, examining team dynamics, and exploring applications for real-time monitoring/intervention during critical clinical tasks.
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Affiliation(s)
- Serkan Toy
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dana D Huh
- The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Joshua Materi
- The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Julie Nanavati
- Welch Medical Library, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Deborah A. Schwengel
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kamat A, Makled B, Norfleet J, Schwaitzberg SD, Intes X, De S, Dutta A. Directed information flow during laparoscopic surgical skill acquisition dissociated skill level and medical simulation technology. NPJ SCIENCE OF LEARNING 2022; 7:19. [PMID: 36008451 PMCID: PMC9411170 DOI: 10.1038/s41539-022-00138-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 08/04/2022] [Indexed: 05/11/2023]
Abstract
Virtual reality (VR) simulator has emerged as a laparoscopic surgical skill training tool that needs validation using brain-behavior analysis. Therefore, brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) from seven experienced right-handed surgeons and six right-handed medical students during the performance of Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks in a physical and a VR simulator. Multiple regression and path analysis (MRPA) found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F (2, 114) = 9, p < 0.001, and R2 = 0.136. Additionally, a two-way multivariate analysis of variance (MANOVA) found a statistically significant effect of the simulator technology on the interregional directed functional connectivity from the right prefrontal cortex to the left primary motor cortex (F (1, 15) = 6.002, p = 0.027; partial η2 = 0.286) that can be related to differential right-lateralized executive control of attention. Then, MRPA found that the coefficient of variation (CoV) of the FLS performance score was statistically significantly associated with the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary motor cortex and the left primary motor cortex to the left prefrontal cortex with F (2, 22) = 3.912, p = 0.035, and R2 = 0.262. This highlighted the importance of the efference copy information from the motor cortices to the prefrontal cortex for postulated left-lateralized perceptual decision-making to reduce behavioral variability.
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Affiliation(s)
- Anil Kamat
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Basiel Makled
- US Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, USA
| | - Jack Norfleet
- US Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, USA
| | | | - Xavier Intes
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Anirban Dutta
- Neuroengineering and Informatics for Rehabilitation Laboratory, Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA.
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Walia P, Fu Y, Norfleet J, Schwaitzberg SD, Intes X, De S, Cavuoto L, Dutta A. Error related fNIRS-EEG microstate analysis during a complex surgical motor task. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:941-944. [PMID: 36083946 DOI: 10.1109/embc48229.2022.9871175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Fundamentals of Laparoscopic Surgery (FLS) is a standard education and training module with a set of basic surgical skills. During surgical skill acquisition, novices need to learn from errors due to perturbations in their performance which is one of the basic principles of motor skill acquisition. This study on thirteen healthy novice medical students and nine expert surgeons aimed to capture the brain state during error epochs using multimodal brain imaging by combining functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG). We performed error-related microstate analysis in the latent space that was found using regularized temporally embedded Canonical Correlation Analysis from fNIRS-EEG recordings during the performance of FLS "suturing and intracorporeal knot-tying" task - the most difficult among the five psychomotor FLS tasks. We found from two-way analysis of variance (ANDVA) with factors, skill level (expert, novice), and microstate type (1-6) that the proportion of the total time spent in microstates in the error epochs was significantly affected by the skill level ( ), microstate type ( ), and the interaction between the skill level and the microstate type ( ). Therefore, our study highlighted the relevance of portable brain imaging to capture error behavior when comparing the skill level during a complex surgical task. Clinical Relevance-This establishes the brain-behavior relationship for monitoring complex surgical motor task errors that differentiated experts from novices.
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Kalun P, Dunn K, Wagner N, Pulakunta T, Sonnadara R. Recent evidence on visual-spatial ability in surgical education: A scoping review. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e111-e127. [PMID: 33349760 PMCID: PMC7749687 DOI: 10.36834/cmej.69051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Understanding the relationships between structures is critical for surgical trainees. However, the heterogeneity of the literature on visual-spatial ability (VSA) in surgery makes it challenging for educators to make informed decisions on incorporating VSA into their programs. We conducted a scoping review of the literature on VSA in surgery to provide a map of the literature and identify where gaps still exist for future research. METHODS We searched databases until December 2019 using keywords related to VSA and surgery. The resulting articles were independently screened by two researchers for inclusion in our review. RESULTS We included 117 articles in the final review. Fifty-nine articles reported significant correlations between VSA tests and surgical performance, and this association is supported by neuroimaging studies. However, it remains unclear whether VSA should be incorporated into trainee selection and whether there is a benefit of three-dimensional (3D) over two-dimensional (2D) training. CONCLUSIONS It appears that VSA correlates with surgical performance in the simulated environment, particularly for novice learners. Based on our findings, we make suggestions for how surgical educators may use VSA to support novice learners. Further research should determine whether VSA remains correlated to surgical performance when trainees move into the operative environment.
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Affiliation(s)
- Portia Kalun
- Department of Surgery, McMaster University, Ontario, Canada
| | - Krista Dunn
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Natalie Wagner
- Department of Surgery, McMaster University, Ontario, Canada
- Office of Professional Development & Educational Scholarship, Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | | | - Ranil Sonnadara
- Department of Surgery, McMaster University, Ontario, Canada
- Department of Surgery, University of Toronto, Ontario, Canada
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Abstract
In this paper, a map of the state of the art of recent medical simulators that provide evaluation and guidance for surgical procedures is performed. The systems are reviewed and compared from the viewpoint of the used technology, force feedback, learning evaluation, didactic and visual aid, guidance, data collection and storage, and type of solution (commercial or non-commercial). The works’ assessment was made to identify if—(1) current applications can provide assistance and track performance in training, and (2) virtual environments are more suitable for practicing than physical applications. Automatic analysis of the papers was performed to minimize subjective bias. It was found that some works limit themselves to recording the session data to evaluate them internally, while others assess it and provide immediate user feedback. However, it was found that few works are currently implementing guidance, aid during sessions, and assessment. Current trends suggest that the evaluation process’s automation could reduce the workload of experts and let them focus on improving the curriculum covered in medical education. Lastly, this paper also draws several conclusions, observations per area, and suggestions for future work.
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Brain activation during laparoscopic tasks in high- and low-performing medical students: a pilot fMRI study. Surg Endosc 2019; 34:4837-4845. [PMID: 31754848 DOI: 10.1007/s00464-019-07260-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Up to 20% of medical students are unable to reach competency in laparoscopic surgery. It is unknown whether these difficulties arise from heterogeneity in neurological functioning across individuals. We sought to examine the differences in neurological functioning during laparoscopic tasks between high- and low-performing medical students using functional magnetic resonance imaging (fMRI). METHODS This prospective cohort study enrolled North American medical students who were within the top 20% and bottom 20% of laparoscopic performers from a previous study. Brain activation was recorded using fMRI while participants performed peg-pointing, intracorporeal knot tying (IKT), and the Pictorial Surface Orientation (PicSOr) test. Brain activation maps were created and areas of activation were compared between groups. RESULTS In total, 9/12 high and 9/13 low performers completed the study. High performers completed IKT faster and made more successful knot ties than low performers [standing: 23.5 (5.0) sec vs. 37.6 (18.4) sec, p = 0.03; supine: 23.2 (2.5) sec vs. 72.7 (62.8) sec, p = 0.02; number of successful ties supine, 3 ties vs. 1 tie, p = 0.01]. Low performers showed more brain activation than high performers in the peg-pointing task (q < 0.01), with no activation differences in the IKT task. There were no behavioral differences in the PiCSOr task. CONCLUSIONS This study is the first to show differences between low and high performers of laparoscopic tasks at the brain level. This pilot study has shown the feasibility of using fMRI to examine laparoscopic surgical skills. Future studies are needed for further exploration of our initial findings.
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Karabanov AN, Irmen F, Madsen KH, Haagensen BN, Schulze S, Bisgaard T, Siebner HR. Getting to grips with endoscopy - Learning endoscopic surgical skills induces bi-hemispheric plasticity of the grasping network. Neuroimage 2018; 189:32-44. [PMID: 30583066 DOI: 10.1016/j.neuroimage.2018.12.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022] Open
Abstract
Endoscopic surgery requires skilled bimanual use of complex instruments that extend the peri-personal workspace. To delineate brain structures involved in learning such surgical skills, 48 medical students without surgical experience were randomly assigned to five training sessions on a virtual-reality endoscopy simulator or to a non-training group. Brain activity was probed with functional MRI while participants performed endoscopic tasks. Repeated task performance in the scanner was sufficient to enhance task-related activity in left ventral premotor cortex (PMv) and the anterior Intraparietal Sulcus (aIPS). Simulator training induced additional increases in task-related activation in right PMv and aIPS and reduced effective connectivity from left to right PMv. Skill improvement after training scaled with stronger task-related activation of the lateral left primary motor hand area (M1-HAND). The results suggest that a bilateral fronto-parietal grasping network and left M1-HAND are engaged in bimanual learning of tool-based manipulations in an extended peri-personal space.
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Affiliation(s)
- Anke Ninija Karabanov
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - Friederike Irmen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Germany
| | - Kristoffer Hougaard Madsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Applied Mathematics and Computer Science, Technical University of Denmark, Denmark
| | - Brian Numelin Haagensen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Svend Schulze
- Gastrounit Surgical Division, Centre for Surgical Research (CSR), Copenhagen University Hospital Hvidovre, Denmark
| | - Thue Bisgaard
- Gastrounit Surgical Division, Centre for Surgical Research (CSR), Copenhagen University Hospital Hvidovre, Denmark
| | - Hartwig Roman Siebner
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kok E, De Bruin AB, van Geel K, Gegenfurtner A, Heyligers I, Sorger B. The Neural Implementation of Surgical Expertise Within the Mirror-Neuron System: An fMRI Study. Front Hum Neurosci 2018; 12:291. [PMID: 30079016 PMCID: PMC6062624 DOI: 10.3389/fnhum.2018.00291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/29/2018] [Indexed: 11/30/2022] Open
Abstract
Motor expertise is an important aspect of high-level performance in professional tasks such as surgery. While recently it has been shown that brain activation as measured by functional magnetic resonance imaging (fMRI) within the mirror-neuron system (MNS) is modulated by expertise in sports and music, little is known about the neural underpinnings of professional, e.g., surgical expertise. Here, we investigated whether and (if so) how surgical expertise is implemented in the MNS in medical professionals across three levels of surgical qualification. In order to answer the more specific research question, namely, if the neural implementation of motor expertise develops in a linear or non-linear fashion, the study compares not only brain activation within the MNS related to action observation of novices and experts, but also intermediates. Ten novices (medical students), ten intermediates (residents in orthopedic surgery) and ten experts (orthopedic surgeons) watched 60 video clips (5 s each) of daily-life activities and surgical procedures each while their brain activation was measured using a 3-T fMRI scanner. An established localization procedure was followed to functionally define the MNS for each participant individually. A 2 (video type: daily-life activities, surgical procedures) × 3 (expertise level: novice, intermediate, expert) ANOVA yielded a non-significant interaction. Furthermore, separate analyses of the precentral and parietal part of the MNS also yielded non-significant interactions. However, post hoc comparisons showed that intermediates displayed marginally significantly lower brain activation in response to surgery-related videos within the MNS than novices. No other significant differences were found. We did not find evidence for the hypothesis that the brain-activation level in the MNS evoked by observing surgical videos reflects the level of surgical expertise in the professional task of (orthopedic) surgery. However, the results suggest a potential non-linear relationship between expertise level and MNS-activation level.
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Affiliation(s)
- Ellen Kok
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Anique B De Bruin
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Koos van Geel
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Andreas Gegenfurtner
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands.,Institut für Qualität und Weiterbildung, Technische Hochschule Deggendorf, Deggendorf, Germany
| | - Ide Heyligers
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands.,Department of Orthopedic Surgery, Orbis Medisch Centrum, Sittard, Netherlands
| | - Bettina Sorger
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands
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Modi HN, Singh H, Yang GZ, Darzi A, Leff DR. A decade of imaging surgeons' brain function (part II): A systematic review of applications for technical and nontechnical skills assessment. Surgery 2017; 162:1130-1139. [PMID: 29079277 DOI: 10.1016/j.surg.2017.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Functional neuroimaging technologies enable assessment of operator brain function and can deepen our understanding of skills learning, ergonomic optima, and cognitive processes in surgeons. Although there has been a critical mass of data detailing surgeons' brain function, this literature has not been reviewed systematically. METHODS A systematic search of original neuroimaging studies assessing surgeons' brain function and published up until November 2016 was conducted using Medline, Embase, and PsycINFO databases. RESULTS Twenty-seven studies fulfilled the inclusion criteria, including 3 feasibility studies, 14 studies exploring the neural correlates of technical skill acquisition, and the remainder investigating brain function in the context of intraoperative decision-making (n = 1), neurofeedback training (n = 1), robot-assisted technology (n = 5), and surgical teaching (n = 3). Early stages of learning open surgical tasks (knot-tying) are characterized by prefrontal cortical activation, which subsequently attenuates with deliberate practice. However, with complex laparoscopic skills (intracorporeal suturing), prefrontal cortical engagement requires substantial training, and attenuation occurs over a longer time course, after years of refinement. Neurofeedback and interventions that improve neural efficiency may enhance technical performance and skills learning. CONCLUSION Imaging surgeons' brain function has identified neural signatures of expertise that might help inform objective assessment and selection processes. Interventions that improve neural efficiency may target skill-specific brain regions and augment surgical performance.
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Affiliation(s)
- Hemel Narendra Modi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Harsimrat Singh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Guang-Zhong Yang
- Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Daniel Richard Leff
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom.
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Modi HN, Singh H, Yang GZ, Darzi A, Leff DR. A decade of imaging surgeons' brain function (part I): Terminology, techniques, and clinical translation. Surgery 2017; 162:1121-1130. [PMID: 28807409 DOI: 10.1016/j.surg.2017.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/19/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Functional neuroimaging has the potential to deepen our understanding of technical and nontechnical skill acquisition in surgeons, particularly as established assessment tools leave unanswered questions about inter-operator differences in ability that seem independent of experience. METHODS In this first of a 2-part article, we aim to utilize our experience in neuroimaging surgeons to orientate the nonspecialist reader to the principles of brain imaging. Terminology commonly used in brain imaging research is explained, placing emphasis on the "activation response" to an surgical task and its effect on local cortical hemodynamic parameters (neurovascular coupling). RESULTS Skills learning and subsequent consolidation and refinement through practice lead to reorganization of the functional architecture of the brain (known as "neuroplasticity"), evidenced by changes in the strength of regional activation as well as alterations in connectivity between brain regions, culminating in more efficient use of neural resources during task performance. CONCLUSION Currently available neuroimaging techniques that either directly (ie, measure electrical activity) or indirectly (ie, measure tissue hemodynamics) assess brain function are discussed. Finally, we highlight the important practical considerations when conducting brain imaging research in surgeons.
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Affiliation(s)
- Hemel Narendra Modi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Harsimrat Singh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Guang-Zhong Yang
- Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Daniel Richard Leff
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom.
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Systematic Review of fMRI Compatible Devices: Design and Testing Criteria. Ann Biomed Eng 2017; 45:1819-1835. [DOI: 10.1007/s10439-017-1853-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/10/2017] [Indexed: 12/22/2022]
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Andreu-Perez J, Leff DR, Shetty K, Darzi A, Yang GZ. Disparity in Frontal Lobe Connectivity on a Complex Bimanual Motor Task Aids in Classification of Operator Skill Level. Brain Connect 2016; 6:375-88. [PMID: 26899241 DOI: 10.1089/brain.2015.0350] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective metrics of technical performance (e.g., dexterity, time, and path length) are insufficient to fully characterize operator skill level, which may be encoded deep within neural function. Unlike reports that capture plasticity across days or weeks, this articles studies long-term plasticity in functional connectivity that occurs over years of professional task practice. Optical neuroimaging data are acquired from professional surgeons of varying experience on a complex bimanual coordination task with the aim of investigating learning-related disparity in frontal lobe functional connectivity that arises as a consequence of motor skill level. The results suggest that prefrontal and premotor seed connectivity is more critical during naïve versus expert performance. Given learning-related differences in connectivity, a least-squares support vector machine with a radial basis function kernel is employed to evaluate skill level using connectivity data. The results demonstrate discrimination of operator skill level with accuracy ≥0.82 and Multiclass Matthew's Correlation Coefficient ≥0.70. Furthermore, these indices are improved when local (i.e., within-region) rather than inter-regional (i.e., between-region) frontal connectivity is considered (p = 0.002). The results suggest that it is possible to classify operator skill level with good accuracy from functional connectivity data, upon which objective assessment and neurofeedback may be used to improve operator performance during technical skill training.
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Affiliation(s)
| | | | - Kunal Shetty
- 1 The Hamlyn Centre Imperial College London , London, United Kingdom
| | - Ara Darzi
- 1 The Hamlyn Centre Imperial College London , London, United Kingdom
| | - Guang-Zhong Yang
- 1 The Hamlyn Centre Imperial College London , London, United Kingdom
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Bahrami P, Graham SJ, Grantcharov TP, Cusimano MD, Rotstein OD, Mansur A, Schweizer TA. Neuroanatomical correlates of laparoscopic surgery training. Surg Endosc 2014; 28:2189-98. [PMID: 24570013 DOI: 10.1007/s00464-014-3452-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/16/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Better understanding of the brain regions involved in performing laparoscopic surgery is likely to provide important insights for improving laparoscopic training and assessment in the future. To our knowledge, this is the first study using real Fundamentals of Laparoscopy Training (FLS)-based laparoscopic surgery training tasks in the functional magnetic resonance imaging (fMRI) environment to provide extensive characterization of the brain regions involved in this specific task execution. METHODS Nine right-handed subjects practiced five FLS-modified laparoscopic surgery-training tasks with a training box for ten sessions in a simulated fMRI environment. Following the last practice session, they underwent 3 T fMRI while performing each task. RESULTS An increase in the extent of brain activation was observed as the complexity of the tasks increased. Activation in the precentral gyrus, postcentral gyrus, and premotor regions was observed in the performance of all tasks, whereas the superior parietal lobe (SPL) was activated in the more complex tasks. The mean score and brain activation for performance with the dominant hand were larger than those observed during performance with the non-dominant hand. CONCLUSIONS Performing more complex tasks requires higher visual spatial ability and motor planning. Given the need for ambidextrous skills during laparoscopic tasks, the finding that lower scores and smaller brain recruitment occurred in executing tasks with the non-dominant hand than with the dominant hand suggests designing future training tasks to train the non-dominant hand more effectively. This may serve to improve overall performance in bi-manual tasks. Studies of this kind may facilitate the evidence-based development of strategies to improve the quality of laparoscopy training and assessment.
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Affiliation(s)
- Parisa Bahrami
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Kalkan B, Sonneville C, Martinet C, Champagnon B, Aitken BG, Clark SM, Sen S. Hysteretically reversible phase transition in a molecular glass. J Chem Phys 2012; 137:224503. [PMID: 23249013 DOI: 10.1063/1.4769794] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pressure induced densification in a molecular arsenic sulfide glass is studied at ambient temperature using x-ray scattering, absorption and Raman spectroscopic techniques in situ in a diamond anvil cell. The relatively abrupt changes in the position of the first sharp diffraction peak, FSDP, and the pressure-volume equation of state near ∼2 GPa suggest a phase transition between low- and high-density amorphous phases characterized by different densification mechanisms and rates. Raman spectroscopic results provide clear evidence that the phase transition corresponds to a topological transformation between a low-density molecular structure and a high-density network structure via opening of the constituent As(4)S(3) cage molecules and bond switching. Pressure induced mode softening of the high density phase suggests a low dimensional nature of the network. The phase transformation is hysteretically reversible, and therefore, reminiscent of a first-order phase transition.
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Affiliation(s)
- B Kalkan
- Advanced Light Source, Lawrence Berkeley Laboratory, Berkeley, California 20015, USA
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Kan K, Schweizer TA, Tam F, Graham SJ. Methodology for functional MRI of simulated driving. Med Phys 2012; 40:012301. [DOI: 10.1118/1.4769107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
The Mozart Effect is a phenomenon whereby certain pieces of music induce temporary enhancement in "spatial temporal reasoning." To determine whether the Mozart Effect can improve surgical performance, 55 male volunteers (mean age = 20.6 years, range = 16-27), novice to surgery, were timed as they completed an activity course on a laparoscopic simulator. Subjects were then randomized for exposure to 1 of 2 musical pieces by Mozart (n = 21) and Dream Theater (n = 19), after which they repeated the course. Following a 15-minute exposure to a nonmusical piece, subjects were exposed to one of the pieces and performed the activity course a third time. An additional group (n = 15) that was not corandomized performed the tasks without any exposure to music. The percent improvements in completion time between 3 successive trials were calculated for each subject and group means compared. In 2 of the tasks, subjects exposed to the Dream Theater piece achieved approximately 30% more improvement (26.7 ± 8.3%) than those exposed to the Mozart piece (20.2 ± 7.8%, P = .021) or to no music (20.4 ± 9.1%, P = .049). Distinct patterns of covariance between baseline performance and subsequent improvement were observed for the different musical conditions and tasks. The data confirm the existence of a Mozart Effect and demonstrate for the first time its practical applicability. Prior exposure to certain pieces may enhance performance in practical skills requiring spatial temporal reasoning.
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Enhanced frontoparietal network architectures following "gaze-contingent" versus "free-hand" motor learning. Neuroimage 2012; 64:267-76. [PMID: 22960153 DOI: 10.1016/j.neuroimage.2012.08.056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/26/2012] [Accepted: 08/22/2012] [Indexed: 01/21/2023] Open
Abstract
Longitudinal changes in cortical function are known to accompany motor skills learning, and can be detected as an evolution in the activation map. These changes include attenuation in activation in the prefrontal cortex and increased activation in primary and secondary motor regions, the cerebellum and posterior parietal cortex. Despite this, comparatively little is known regarding the impact of the mode or type of training on the speed of activation map plasticity and on longitudinal variation in network architectures. To address this, we randomised twenty-one subjects to learn a complex motor tracking task delivered across six practice sessions in either "free-hand" or "gaze-contingent motor control" mode, during which frontoparietal cortical function was evaluated using functional near infrared spectroscopy. Results demonstrate that upon practice termination, gaze-assisted learners had achieved superior technical performance compared to free-hand learners. Furthermore, evolution in frontoparietal activation foci indicative of expertise was achieved at an earlier stage in practice amongst gaze-assisted learners. Both groups exhibited economical small world topology; however, networks in learners randomised to gaze-assistance were less costly and showed higher values of local efficiency suggesting improved frontoparietal communication in this group. We conclude that the benefits of gaze-assisted motor learning are evidenced by improved technical accuracy, more rapid task internalisation and greater neuronal efficiency. This form of assisted motor learning may have occupational relevance for high precision control such as in surgery or following re-learning as part of stroke rehabilitation.
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