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Howie EE, Ambler O, Gunn EG, Dias RD, Wigmore SJ, Skipworth RJ, Yule SJ. Surgical Sabermetrics: A Scoping Review of Technology-enhanced Assessment of Nontechnical Skills in the Operating Room. Ann Surg 2024; 279:973-984. [PMID: 38258573 PMCID: PMC11086675 DOI: 10.1097/sla.0000000000006211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical nontechnical skills and investigate the implications for enhancing surgical performance. BACKGROUND Surgeons need high-quality, objective, and timely feedback to optimize performance and patient safety. Digital tools to assess nontechnical skills have the potential to reduce human bias and aid scalability. However, we do not fully understand which of the myriad of digital metrics of performance assessment have efficacy for surgeons. METHODS A systematic review was conducted by searching PubMed, EMBASE, CINAHL, and PSYCINFO databases following PRISMA-ScR guidelines. MeSH terms and keywords included "Assessment," "Surgeons," and "Technology". Eligible studies included a digital assessment of nontechnical skills for surgeons, residents, and/or medical students within an operative context. RESULTS From 19,229 articles screened, 81 articles met the inclusion criteria. The studies varied in surgical specialties, settings, and outcome measurements. A total of 122 distinct objective, digital metrics were utilized. Studies digitally measured at least 1 category of surgical nontechnical skill using a single (n=54) or multiple objective measures (n=27). The majority of studies utilized simulation (n=48) over live operative settings (n=32). Surgical Sabermetrics has been demonstrated to be beneficial in measuring cognitive load (n=57), situation awareness (n=24), communication (n=3), teamwork (n=13), and leadership (n=2). No studies measured intraoperative decision-making. CONCLUSIONS The literature detailing the intersection between surgical data science and operative nontechnical skills is diverse and growing rapidly. Surgical Sabermetrics may provide a promising modifiable technique to achieve desirable outcomes for both the surgeon and the patient. This study identifies a diverse array of measurements possible with sensor devices and highlights research gaps, including the need for objective assessment of decision-making. Future studies may advance the integration of physiological sensors to provide a holistic assessment of surgical performance.
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Affiliation(s)
- Emma E. Howie
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Olivia Ambler
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Eilidh G.M. Gunn
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Roger D. Dias
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
- Human Factors and Cognitive Engineering Lab, STRATUS Centre for Medical Simulation, Brigham & Women’s Hospital, Boston, MA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Stephen J. Wigmore
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Richard J.E. Skipworth
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Steven J. Yule
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
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Ahmadi N, Sasangohar F, Yang J, Yu D, Danesh V, Klahn S, Masud F. Quantifying Workload and Stress in Intensive Care Unit Nurses: Preliminary Evaluation Using Continuous Eye-Tracking. HUMAN FACTORS 2024; 66:714-728. [PMID: 35511206 DOI: 10.1177/00187208221085335] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
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. METHODS Tobii Pro Glasses 2 eye-tracking and Empatica E4 devices were used to collect eye movement and physiological data from 15 nurses during 12-hour shifts (252 observation hours). We used mixed-effect models and an ordinal regression model with a random effect to analyze the changes in eye movement metrics during high stress episodes. RESULTS While the cadence and characteristics of nurse workload can vary between day shift and night shift, no significant difference in eye movement values was detected. However, eye movement metrics showed that the initial handoff period of nursing shifts has a higher mental workload compared with other times. Analysis of ocular metrics showed that stress is positively associated with an increase in number of eye fixations and gaze entropy, but negatively correlated with the duration of saccades and pupil diameter. CONCLUSION Eye-tracking technology can be used to assess the temporal variation of stress and associated changes with mental workload in the ICU environment. A real-time system could be developed for monitoring stress and workload for intervention development.
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Affiliation(s)
- Nima Ahmadi
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Farzan Sasangohar
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA and Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Jing Yang
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Valerie Danesh
- Baylor Scott & White Health, Center for Applied Health Research, Dallas, TX, USA and University of Texas at Austin, School of Nursing, Austin, TX, USA
| | - Steven Klahn
- Center for Critical Care, Houston Methodist Hospital, Houston, TX, USA
| | - Faisal Masud
- Center for Critical Care, Houston Methodist Hospital, Houston, TX, USA
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Finocchiaro M, Banfi T, Donaire S, Arezzo A, Guarner-Argente C, Menciassi A, Casals A, Ciuti G, Hernansanz A. A Framework for the Evaluation of Human Machine Interfaces of Robot-Assisted Colonoscopy. IEEE Trans Biomed Eng 2024; 71:410-422. [PMID: 37535479 DOI: 10.1109/tbme.2023.3301741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The Human Machine Interface (HMI) of intraluminal robots has a crucial impact on the clinician's performance. It increases or decreases the difficulty of the tasks, and is connected to the users' physical and mental stress. OBJECTIVE This article presents a framework to compare and evaluate different HMIs for robotic colonoscopy, with the objective of identifying the optimal HMI that minimises the clinician's effort and maximises the clinical outcomes. METHODS The framework comprises a 1) a virtual simulator (clinically validated), 2) wearable sensors measuring the cognitive load, 3) a data collection unit of metrics correlated to the clinical performance, and 4) questionnaires exploring the users' impressions and perceived stress. The framework was tested with 42 clinicians investigating the optimal device for tele-operated control of robotic colonoscopes. Two control devices were selected and compared: a haptic serial-kinematic device and a standard videogame joypad. RESULTS The haptic device was preferred by the endoscopists, but the joypad enabled better clinical performance and reduced cognitive and physical load. CONCLUSION The framework can be used to evaluate different aspects of a HMI, both hardware and software, and determine the optimal HMI that can reduce the burden on clinicians while improving the clinical outcome. SIGNIFICANCE The findings of this study, and of future studies performed with this framework, can inform the design and development of HMIs for intraluminal robots, leading to improved clinical performance, reduced physical and mental stress for clinicians, and ultimately better patient outcomes.
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Rui M, Fernando M, Ricardo G, Martinho DV, Rui M, Moore SA, Coelho-e-Silva MJ, Gonçalo D. Visual Information in Basketball Jump-Shots: Differences between Youth and Adult Athletes. J Hum Kinet 2023; 89:65-75. [PMID: 38053958 PMCID: PMC10694728 DOI: 10.5114/jhk/163447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2023] Open
Abstract
Basketball shooting is a complex skill that requires visual routines and trained players typically evidence a specific oculomotor pattern. This study aimed to examine visual patterns in male novice youth and professional adult players while performing a jump shot. The sample included 20 basketball players grouped as under-16 youth (n = 10) and professional adult (n = 10) players. Each participant completed 50 shots at two distances (long range: 6.80 m; middle range: 4.23 m). Eye tracking glasses were used to obtain quiet eye (QE), the number of fixations, total fixation duration, duration of first and last fixation. An independent t-test was used to assess differences between groups. Shooting accuracy given by % of efficacy indicated that under-16 players attained poorer scores at both distances: long (t = -4.75, p < 0.01) and middle (t = -2.80, p < 0.012) distance. The groups also differed in QE time (long: 600 ms vs. 551 ms; middle: 572 ms vs. 504 ms) and total duration of the fixations (long: 663 ms vs. 606 ms; middle: 663 ms vs. 564 ms) in both long and middle distance shots. Significant differences also occurred in the last fixation (long distance: t = -4.301, p < 0.01; middle distance: t = -3.656, p < 0.01) with professional adult players presenting the value of, on average, 454-458 ms, while youth shooters 363-372 ms. In summary, visual strategy differed between under-16 youth and professional adult basketball players. To support their long-term sport development, it is recommended that youth basketball players focus their attention with longer final fixation before releasing the ball to improve their shot.
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Affiliation(s)
- Marques Rui
- University of Coimbra, FCDEF, Coimbra, Portugal
- Instituto de Telecomunicações, Delegação da Covilhã, Covilhã, Portugal
| | - Martins Fernando
- Instituto de Telecomunicações, Delegação da Covilhã, Covilhã, Portugal
- Instituto Politécnico de Coimbra, Escola Superior de Educação de Coimbra, Coimbra, Portugal
- Laboratório ROBOCORP, IIA, Instituto Politécnico de Coimbra, Coimbra, Portugal
| | - Gomes Ricardo
- Instituto de Telecomunicações, Delegação da Covilhã, Covilhã, Portugal
- Instituto Politécnico de Coimbra, Escola Superior de Educação de Coimbra, Coimbra, Portugal
- Laboratório ROBOCORP, IIA, Instituto Politécnico de Coimbra, Coimbra, Portugal
- University of Coimbra, CIDAF (uid/04213/2020), Coimbra, Portugal
| | - Diogo V. Martinho
- University of Coimbra, FCDEF, Coimbra, Portugal
- University of Coimbra, CIDAF (uid/04213/2020), Coimbra, Portugal
| | - Mendes Rui
- Instituto Politécnico de Coimbra, Escola Superior de Educação de Coimbra, Coimbra, Portugal
- Laboratório ROBOCORP, IIA, Instituto Politécnico de Coimbra, Coimbra, Portugal
- University of Coimbra, CIDAF (uid/04213/2020), Coimbra, Portugal
| | - Sarah A. Moore
- Faculty of Health, School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - Manuel J. Coelho-e-Silva
- University of Coimbra, FCDEF, Coimbra, Portugal
- University of Coimbra, CIDAF (uid/04213/2020), Coimbra, Portugal
| | - Dias Gonçalo
- University of Coimbra, FCDEF, Coimbra, Portugal
- Instituto de Telecomunicações, Delegação da Covilhã, Covilhã, Portugal
- Instituto Politécnico de Coimbra, Escola Superior de Educação de Coimbra, Coimbra, Portugal
- Laboratório ROBOCORP, IIA, Instituto Politécnico de Coimbra, Coimbra, Portugal
- University of Coimbra, CIDAF (uid/04213/2020), Coimbra, Portugal
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Huang C, Yang B, Nakano K. Impact of duration of monitoring before takeover request on takeover time with insights into eye tracking data. ACCIDENT; ANALYSIS AND PREVENTION 2023; 185:107018. [PMID: 36924623 DOI: 10.1016/j.aap.2023.107018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Safety has become the primary concern of automated driving system (ADS) in recent years. Compared with highly automated driving (L4 and above), conditionally automated driving (L3/L3+ ADS) seems to be a moderate choice, where drivers are required to respond to the takeover request (TOR) whenever necessary. It is the system's responsibility to make sure that the takeovers would be safe at the time of issuing the TOR. To realize that, a lot of factors need to be taken into consideration. As it has been found that drivers' eyes-on-road gazes increase slowly in the first few seconds while transferring to manual driving from automated driving and drivers' gaze behaviors are related with situation awareness, the main aim of this study is to investigate the impact of duration of monitoring before the TOR on takeover time and whether there is a positive or negative relationship between the two. To verify these, we designed a driving simulator study where the TOR was issued 0 s, 5 s, 10 s and ≥ 15 s after the non-driving-related task has ended. Twelve scenarios were designed, and the results from 36 participants showed that there was indeed a statistically significant difference, however, the relationship was neither positive nor negative, which was close to a parabola. Analyzing results of eye movements and gaze behavior further supported this conclusion. It is therefore concluded the duration of monitoring before the TOR should neither be too short nor too long, and 5-7 s would be appropriate choices. This is desirable not only for improving takeover performance of drivers but also for improving the prediction model for predicting takeover performance of drivers that has yet to be studied, so as to improve safety, reliability and acceptance of the ADS.
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Affiliation(s)
- Chao Huang
- Institute of Industrial Science, The University of Tokyo, Tokyo, 153-0041, Japan.
| | - Bo Yang
- Institute of Industrial Science, The University of Tokyo, Tokyo, 153-0041, Japan.
| | - Kimihiko Nakano
- Institute of Industrial Science, The University of Tokyo, Tokyo, 153-0041, Japan.
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Lim C, Barragan JA, Farrow JM, Wachs JP, Sundaram CP, Yu D. Physiological Metrics of Surgical Difficulty and Multi-Task Requirement during Robotic Surgery Skills. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094354. [PMID: 37177557 PMCID: PMC10181544 DOI: 10.3390/s23094354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
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. Multimodal physiological signals (EEG, eye-tracking, HRV) were collected as university students performed simulated RAS tasks consisting of two types of surgical task difficulty under three different multi-task requirement levels. EEG spectral analysis was sensitive enough to distinguish the degree of cognitive workload under both surgical conditions (surgical task difficulty/multi-task requirement). In addition, eye-tracking measurements showed differences under both conditions, but significant differences of HRV were observed in only multi-task requirement conditions. Multimodal-based neural network models have achieved up to 79% accuracy for both surgical conditions.
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Affiliation(s)
- Chiho Lim
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
| | | | | | - Juan P Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
| | | | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
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Li S, Liu Y, Li K, Cao G, Li S, Mao Y, Wang Y, Feng J, Tang ST. Validation and effect of the NASA-TLX score on the assessment of the workload of pediatric robotic operations. Surg Endosc 2023:10.1007/s00464-023-09959-y. [PMID: 36917343 DOI: 10.1007/s00464-023-09959-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/12/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVE The objective of the study was to assess the validity of the NASA-TLX score in rating the workload of pediatric robotic operations. METHODS The workload of 230 pediatric gastrointestinal and thoracic robotic operations was rated using the NASA-TLX score. The difference between the high workload group and the low workload group in each subscale of the NASA-TLX score was analyzed. The correlation of each subscale with the total workload score in the high workload group and low workload group was also analyzed. A logistic regression analysis was subsequently conducted to assess the effects of different factors (sex, age, weight, procedure duration, procedure specialties, combined malformation and blood loss) on the workload. RESULTS The average NASA-TLX score was 56.5 ± 5.1 for the total group, 56.9 ± 5.0 for the gastrointestinal group and 54.6 ± 4.8 for the thoracic group, p = 0.007. The score of the high workload group was 62.7 ± 3.2, while it was 50.6 ± 2.7 for the low workload group (p < 0.001). The score on each subscale was also significantly different between the high and low workload groups. In the high workload group, a stronger correlation was observed between the total score and TD and Fr and a lower correlation with MD and Pe. In the low workload group, all six subscales showed a moderate correlation with the total score. A multivariate logistic regression analysis revealed that the procedure duration was an independent influencing factor for a higher workload score. CONCLUSIONS NASA-TLX is a valid tool to rate the surgeon's workload in pediatric robotic surgery. A longer operative time contributes to a higher workload.
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Affiliation(s)
- Shuai Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yuan Liu
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Kang Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Guoqing Cao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Shiwang Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yongzhong Mao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yong Wang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Jianjun Feng
- Department of Pediatric Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, China.
| | - Shao-Tao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
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Tokuno J, Carver TE, Fried GM. Measurement and Management of Cognitive Load in Surgical Education: A Narrative Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:208-215. [PMID: 36335034 DOI: 10.1016/j.jsurg.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/18/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive load should be considered in designing optimal educational programs in health care. Despite the highly demanding nature of surgery and surgical education, a consensus on how to manage cognitive load has not been established. The objective of this review is to map out how recent surgical education research incorporates cognitive load. METHODS A literature search was performed using keywords related to cognitive load and digital education up to December 2021. Studies published in English relevant to assessment and management of cognitive load in surgical education were included. Terminology, assessment tools, association with different surgical procedures and training modalities, and programs considering cognitive load were reported. RESULTS We identified several terms to describe cognitive load. Cognitive load was measured by subjective, self-reported questionnaires and by objective measurements, such as physiological parameters or estimated by reaction time to secondary tasks. Subjective measurements reported cognitive load in one or multiple dimensions. Correlations between subjective and objective measurements were shown in multiple studies. Overall, higher cognitive load was observed in training for more complex tasks and high-fidelity modalities, and among less experienced trainees. Cognitive load theory has been lately incorporated into designing teaching programs. CONCLUSIONS A broad range of terms and assessment tools were identified for cognitive load. To maximize the learning outcome, management of cognitive load is necessary in surgical education. This review summarizes the current knowledge in assessment and management of cognitive load in surgical education and provides suggestions for future studies.
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Affiliation(s)
- Junko Tokuno
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Science, Montreal, Quebec, Canada
| | - Tamara E Carver
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Science, Montreal, Quebec, Canada; Department of Surgery, McGill University, Montreal, Quebec, Canada; Institute for Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Gerald M Fried
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Department of Surgery, McGill University, Montreal, Quebec, Canada; Institute for Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
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Kulkarni CS, Deng S, Wang T, Hartman-Kenzler J, Barnes LE, Parker SH, Safford SD, Lau N. Scene-dependent, feedforward eye gaze metrics can differentiate technical skill levels of trainees in laparoscopic surgery. Surg Endosc 2023; 37:1569-1580. [PMID: 36123548 PMCID: PMC11062149 DOI: 10.1007/s00464-022-09582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION In laparoscopic surgery, looking in the target areas is an indicator of proficiency. However, gaze behaviors revealing feedforward control (i.e., looking ahead) and their importance have been under-investigated in surgery. This study aims to establish the sensitivity and relative importance of different scene-dependent gaze and motion metrics for estimating trainee proficiency levels in surgical skills. METHODS Medical students performed the Fundamentals of Laparoscopic Surgery peg transfer task while recording their gaze on the monitor and tool activities inside the trainer box. Using computer vision and fixation algorithms, five scene-dependent gaze metrics and one tool speed metric were computed for 499 practice trials. Cluster analysis on the six metrics was used to group the trials into different clusters/proficiency levels, and ANOVAs were conducted to test differences between proficiency levels. A Random Forest model was trained to study metric importance at predicting proficiency levels. RESULTS Three clusters were identified, corresponding to three proficiency levels. The correspondence between the clusters and proficiency levels was confirmed by differences between completion times (F2,488 = 38.94, p < .001). Further, ANOVAs revealed significant differences between the three levels for all six metrics. The Random Forest model predicted proficiency level with 99% out-of-bag accuracy and revealed that scene-dependent gaze metrics reflecting feedforward behaviors were more important for prediction than the ones reflecting feedback behaviors. CONCLUSION Scene-dependent gaze metrics revealed skill levels of trainees more precisely than between experts and novices as suggested in the literature. Further, feedforward gaze metrics appeared to be more important than feedback ones at predicting proficiency.
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Affiliation(s)
- Chaitanya S Kulkarni
- Grado Department of Industrial and Systems Engineering, Virginia Tech, 250 Durham Hall (0118), 1145 Perry Street, Blacksburg, VA, 24061, USA
| | - Shiyu Deng
- Grado Department of Industrial and Systems Engineering, Virginia Tech, 250 Durham Hall (0118), 1145 Perry Street, Blacksburg, VA, 24061, USA
| | - Tianzi Wang
- Grado Department of Industrial and Systems Engineering, Virginia Tech, 250 Durham Hall (0118), 1145 Perry Street, Blacksburg, VA, 24061, USA
| | | | - Laura E Barnes
- Environmental and Systems Engineering, University of Virginia, Charlottesville, VA, USA
| | | | - Shawn D Safford
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Harrisburg, PA, USA
| | - Nathan Lau
- Grado Department of Industrial and Systems Engineering, Virginia Tech, 250 Durham Hall (0118), 1145 Perry Street, Blacksburg, VA, 24061, USA.
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Naik R, Kogkas A, Ashrafian H, Mylonas G, Darzi A. The Measurement of Cognitive Workload in Surgery Using Pupil Metrics: A Systematic Review and Narrative Analysis. J Surg Res 2022; 280:258-272. [PMID: 36030601 DOI: 10.1016/j.jss.2022.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Increased cognitive workload (CWL) is a well-established entity that can impair surgical performance and increase the likelihood of surgical error. The use of pupil and gaze tracking data is increasingly being used to measure CWL objectively in surgery. The aim of this review is to summarize and synthesize the existing evidence that surrounds this. METHODS A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search of OVID MEDLINE, IEEE Xplore, Web of Science, Google Scholar, APA PsychINFO, and EMBASE was conducted for articles published in English between 1990 and January 2021. In total, 6791 articles were screened and 32 full-text articles were selected based on the inclusion criteria. A narrative analysis was undertaken in view of the heterogeneity of studies. RESULTS Seventy-eight percent of selected studies were deemed high quality. The most frequent surgical environment and task studied was surgical simulation (75%) and performance of laparoscopic skills (56%) respectively. The results demonstrated that the current literature can be broadly categorized into pupil, blink, and gaze metrics used in the assessment of CWL. These can be further categorized according to their use in the context of CWL: (1) direct measurement of CWL (n = 16), (2) determination of expertise level (n = 14), and (3) predictors of performance (n = 2). CONCLUSIONS Eye-tracking data provide a wealth of information; however, there is marked study heterogeneity. Pupil diameter and gaze entropy demonstrate promise in CWL assessment. Future work will entail the use of artificial intelligence in the form of deep learning and the use of a multisensor platform to accurately measure CWL.
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Affiliation(s)
- Ravi Naik
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK; Hamlyn Centre for Robotic Surgery, Institute of Global Health Innovation, Imperial College London, London, UK.
| | - Alexandros Kogkas
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK; Hamlyn Centre for Robotic Surgery, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - George Mylonas
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK; Hamlyn Centre for Robotic Surgery, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK; Hamlyn Centre for Robotic Surgery, Institute of Global Health Innovation, Imperial College London, London, UK
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Eye Tracking Use in Surgical Research: A Systematic Review. J Surg Res 2022; 279:774-787. [PMID: 35944332 DOI: 10.1016/j.jss.2022.05.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/18/2022] [Accepted: 05/22/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Eye tracking (ET) is a popular tool to study what factors affect the visual behaviour of surgical team members. To our knowledge, there have been no reviews to date that evaluate the broad use of ET in surgical research. This review aims to identify and assess the quality of this evidence, to synthesize how ET can be used to inform surgical practice, and to provide recommendations to improve future ET surgical studies. METHODS In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature review was conducted. An electronic search was performed in MEDLINE, Cochrane Central, Embase, and Web of Science databases up to September 2020. Included studies used ET to measure the visual behaviour of members of the surgical team during surgery or surgical tasks. The included studies were assessed by two independent reviewers. RESULTS A total of 7614 studies were identified, and 111 were included for data extraction. Eleven applications were identified; the four most common were skill assessment (41%), visual attention assessment (22%), workload measurement (17%), and skills training (10%). A summary was provided of the various ways ET could be used to inform surgical practice, and three areas were identified for the improvement of future ET studies in surgery. CONCLUSIONS This review provided a comprehensive summary of the various applications of ET in surgery and how ET could be used to inform surgical practice, including how to use ET to improve surgical education. The information provided in this review can also aid in the design and conduct of future ET surgical studies.
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12
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Tolvanen O, Elomaa AP, Itkonen M, Vrzakova H, Bednarik R, Huotarinen A. Eye-Tracking Indicators of Workload in Surgery: A Systematic Review. J INVEST SURG 2022; 35:1340-1349. [PMID: 35038963 DOI: 10.1080/08941939.2021.2025282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BackgroundEye tracking is a powerful tool for unobtrusive and real time assessment of workload in clinical settings. Before the complex eye tracking derived surrogates can be proactively utilized to improve surgical safety, the indications, validity and reliability requires careful evaluation.MethodsWe conducted a systematic review of literature from 2010 to 2020 according to PRISMA guidelines. A search on PubMed, Cochrane, Scopus, Web of science, PsycInfo and Google scholar databases was conducted on July 2020. The following search query was used" ("eye tracking" OR "gaze tracking") AND (surgery OR surgical OR operative OR intraoperative) AND (workload OR stress)". Short papers, no peer reviewed or papers in which eye-tracking methodology was not used to investigate workload or stress factors in surgery, were omitted.ResultsA total of 17 (N = 17) studies were identified eligible to this review. Most of the studies (n = 15) measured workload in simulated setting. Task difficulty and expertise were the most studied factors. Studies consistently showed surgeon's eye movements such as pupil responses, gaze patterns, blinks were associated with the level of perceived workload. However, differences between measurements in operational room and simulated environments have been found.ConclusionPupil responses, blink rate and gaze indices are valid indicators of workload. However, the effect of distractions and non-technical factors on workload is underrepresented aspect in the literature even though recognized as underlying factors in successful surgery.
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Affiliation(s)
- Otto Tolvanen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Microsurgery Training Center, Kuopio University Hospital, Kuopio, Finland.,Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Matti Itkonen
- Center of Brain Science (CBS), CBS-TOYOTA Collaboration Center, RIKEN, Nagoya, Japan
| | - Hana Vrzakova
- Microsurgery Training Center, Kuopio University Hospital, Kuopio, Finland
| | - Roman Bednarik
- School of Computing, University of Eastern Finland, Kuopio, Finland
| | - Antti Huotarinen
- School of Computing, University of Eastern Finland, Kuopio, Finland
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13
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Walsh GS. Visuomotor control dynamics of quiet standing under single and dual task conditions in younger and older adults. Neurosci Lett 2021; 761:136122. [PMID: 34293417 DOI: 10.1016/j.neulet.2021.136122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/23/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022]
Abstract
Visual input facilitates stable postural control; however, ageing alters visual gaze strategies and visual input processing times. Understanding the complex interaction between visual gaze behaviour and the effects of age may inform future interventions to improve postural control in older adults. The purpose of this study was to determine effects of age and dual task on gaze and postural sway dynamics, and the sway-gaze complexity coupling to explore the coupling between sensory input and motor output. Ten older and 10 younger adults performed single and dual task quiet standing while gaze behaviour and centre of mass motion were recorded. The complexity and stability of postural sway, saccade characteristics, visual input duration and complexity of gaze were calculated in addition to sway-gaze coupling quantified by cross-sample entropy. Dual tasking increased complexity and decreased stability of sway with increased gaze complexity and visual input duration, suggesting greater automaticity of sway with greater exploration of the visual field but with longer visual inputs to maintain postural stability in dual task conditions. In addition, older adults had lower complexity and stability of sway than younger adults indicating less automated and stable postural control. Older adults also demonstrated lower gaze complexity, longer visual input durations and greater sway-gaze coupling. These findings suggest older adults adopted a strategy to increase the capacity for visual information input, whilst exploring less of the visual field than younger adults.
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Affiliation(s)
- Gregory S Walsh
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK.
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14
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Liang N, Yang J, Yu D, Prakah-Asante KO, Curry R, Blommer M, Swaminathan R, Pitts BJ. Using eye-tracking to investigate the effects of pre-takeover visual engagement on situation awareness during automated driving. ACCIDENT; ANALYSIS AND PREVENTION 2021; 157:106143. [PMID: 34010743 DOI: 10.1016/j.aap.2021.106143] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
Automated driving systems are becoming increasingly prevalent throughout society. In conditionally automated vehicles, drivers may engage in non-driving-related tasks (NDRTs), which can negatively affect their situation awareness (SA) and preparedness to resume control of the vehicle, when necessary. Previous work has investigated engagement in NDRTs, but questions remain unanswered regarding its effect on drivers' SA during a takeover event. The objective of the current study is to use eye-tracking to aid in understanding how visual engagement in NDRTs affects changes in SA of the driving environment after a takeover request (TOR) has been issued. Thirty participants rode in a simulated SAE Level 3 automated driving environment and engaged in three separate pre-TOR tasks (Surrogate Reference Task, Monitoring Task, and Peripheral Detection Task) until presented with a TOR. Situation Awareness Global Assessment Technique (SAGAT) scores and gaze behavior were recorded during the post-TOR segment. Overall, longer times spent viewing the driving scene, and more dispersed visual attention allocation, were observed to be associated with better overall SA. Also, location-based eye tracking metrics show most promise in differentiating between task conditions with significantly different SAGAT scores. Findings from this work can inform the development of real-time SA assessment techniques using eye movements and ultimately contribute to improved operator roadway awareness for next-generation automated transportation.
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Affiliation(s)
- Nade Liang
- School of Industrial Engineering, Purdue University, West Lafayette, IN, United States
| | - Jing Yang
- School of Industrial Engineering, Purdue University, West Lafayette, IN, United States
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, United States
| | | | | | | | | | - Brandon J Pitts
- School of Industrial Engineering, Purdue University, West Lafayette, IN, United States.
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15
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Marín-Conesa E, Sánchez-Ferrer F, Grima-Murcia MD, Sánchez-Ferrer ML. The Application of a System of Eye Tracking in Laparoscopic Surgery: A New Didactic Tool to Visual Instructions. Front Surg 2021; 8:643611. [PMID: 34179065 PMCID: PMC8219847 DOI: 10.3389/fsurg.2021.643611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/29/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Laparoscopic surgery is an increasingly used technique, but it requires a high degree of learning, and communication between the operating room crew is considerably difficult. The use of eye tracking has been proposed as a didactic and evaluation tool in several settings, including in laparoscopy in simulators. Objectives: This study aimed to evaluate the usefulness of the use of eye tracking systems (Tobii glasses 2) in laparoscopic surgery as a didactic and assessment tool to improve communication in the operating room and improve patients' security. Methodology: An anonymous survey was sent to the students and medical teachers of a faculty of medicine and practicing doctors and residents. The message contained an explanation about the use of the Tobii glasses, a link to watch the video showing its use in a laparoscopic surgery, and the survey to complete after watching the video. Results: The survey was answered by 113 participants (51.3% medical students, 27.4% medical teachers, 18.6% practicing doctors, and 2.7% medicine residents). Eighty-three percent agreed with the usefulness of the “Tobii glasses” in the operating room for improving communication between the main surgeon and the assistant, for learning complex surgery techniques, for obtaining didactic videos, and for indicating anatomical structures. The item scored worst was the price of the glasses. Conclusions: It is possible to record and project expert gaze patterns in the operating room in real time using the Tobii glasses. This device allows improving communication among the surgical crew and the learning of residents and also improving the security of surgical patients.
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Affiliation(s)
- Ester Marín-Conesa
- Department of Neurology, 'Reina Sofía' University Hospital of Murcia, Murcia, Spain
| | - Francisco Sánchez-Ferrer
- Department of Pediatrics, "San Juan" University Hospital, Miguel Hernandez University, Alicante, Spain
| | | | - María Luisa Sánchez-Ferrer
- Department of Obstetrics and Gynecology of the University Hospital "Virgen de la Arrixaca", Institute for Biomedical Research of Murcia, IMIB-Arrixaca, University of Murcia, Murcia, Spain
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Wiebel-Herboth CB, Krüger M, Wollstadt P. Measuring inter- and intra-individual differences in visual scan patterns in a driving simulator experiment using active information storage. PLoS One 2021; 16:e0248166. [PMID: 33735199 PMCID: PMC7971706 DOI: 10.1371/journal.pone.0248166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/20/2021] [Indexed: 11/17/2022] Open
Abstract
Scan pattern analysis has been discussed as a promising tool in the context of real-time gaze-based applications. In particular, information-theoretic measures of scan path predictability, such as the gaze transition entropy (GTE), have been proposed for detecting relevant changes in user state or task demand. These measures model scan patterns as first-order Markov chains, assuming that only the location of the previous fixation is predictive of the next fixation in time. However, this assumption may not be sufficient in general, as recent research has shown that scan patterns may also exhibit more long-range temporal correlations. Thus, we here evaluate the active information storage (AIS) as a novel information-theoretic approach to quantifying scan path predictability in a dynamic task. In contrast to the GTE, the AIS provides means to statistically test and account for temporal correlations in scan path data beyond the previous last fixation. We compare AIS to GTE in a driving simulator experiment, in which participants drove in a highway scenario, where trials were defined based on an experimental manipulation that encouraged the driver to start an overtaking maneuver. Two levels of difficulty were realized by varying the time left to complete the task. We found that individual observers indeed showed temporal correlations beyond a single past fixation and that the length of the correlation varied between observers. No effect of task difficulty was observed on scan path predictability for either AIS or GTE, but we found a significant increase in predictability during overtaking. Importantly, for participants for which the first-order Markov chain assumption did not hold, this was only shown using AIS but not GTE. We conclude that accounting for longer time horizons in scan paths in a personalized fashion is beneficial for interpreting gaze pattern in dynamic tasks.
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Affiliation(s)
| | - Matti Krüger
- Honda Research Institute Europe, Offenbach/Main, Germany
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17
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Quantifying the Predictability of Visual Scanpaths Using Active Information Storage. ENTROPY 2021; 23:e23020167. [PMID: 33573069 PMCID: PMC7912697 DOI: 10.3390/e23020167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 12/27/2022]
Abstract
Entropy-based measures are an important tool for studying human gaze behavior under various conditions. In particular, gaze transition entropy (GTE) is a popular method to quantify the predictability of a visual scanpath as the entropy of transitions between fixations and has been shown to correlate with changes in task demand or changes in observer state. Measuring scanpath predictability is thus a promising approach to identifying viewers' cognitive states in behavioral experiments or gaze-based applications. However, GTE does not account for temporal dependencies beyond two consecutive fixations and may thus underestimate the actual predictability of the current fixation given past gaze behavior. Instead, we propose to quantify scanpath predictability by estimating the active information storage (AIS), which can account for dependencies spanning multiple fixations. AIS is calculated as the mutual information between a processes' multivariate past state and its next value. It is thus able to measure how much information a sequence of past fixations provides about the next fixation, hence covering a longer temporal horizon. Applying the proposed approach, we were able to distinguish between induced observer states based on estimated AIS, providing first evidence that AIS may be used in the inference of user states to improve human-machine interaction.
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18
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Melnyk R, Campbell T, Holler T, Cameron K, Saba P, Witthaus MW, Joseph J, Ghazi A. See Like an Expert: Gaze-Augmented Training Enhances Skill Acquisition in a Virtual Reality Robotic Suturing Task. J Endourol 2021; 35:376-382. [PMID: 32967467 DOI: 10.1089/end.2020.0445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: The da Vinci Skills Simulator (DVSS) is an effective platform for robotic skills training. Novel training methods using expert gaze patterns to guide trainees have demonstrated superiority to traditional instruction. Portable head-mounted eye-trackers (HMET) offer the opportunity for eye tracking technology to enhance surgical robotic simulation training. Objective: To evaluate if training guided by expert gaze patterns can improve trainee performance over standard movement training techniques during robotic simulation. Methods: Medical students were recruited and randomized into gaze training (GT, n = 9) and movement training (MT, n = 8) groups. First, the participants reviewed an instructional video, with the GT group emulating expert gaze patterns and the MT group (n = 8) standard movement-based instruction. Training consisted of 10 repetitions of "Suture Sponge 3" on the DVSS while wearing HMET; the first three repetitions were followed by group-appropriate video coaching (gaze vs movement feedback), while the remaining repetitions were without feedback. Finally, two multitasking repetitions with a secondary bell-counting task were completed. Primary outcomes included DVSS scores during training and multitasking. Secondary outcomes included metrics collected from the HMET (gaze patterns and gaze entropy). Results: Total score, efficiency, and penalties improved significantly over the training in both groups; the GT group achieved higher scores on every attempt. Total scores in the GT group were higher than the MT group postvideo review (20.3 ± 21.8 vs 3.0 ± 6.2, p = 0.047), after coaching repetitions (61.8 ± 18.8 vs 30.1 ± 26.2, p = 0.01), and at the last training attempt (73.0 ± 16.5 vs 63.1 ± 17.4, p = 0.247). During multitasking, the GT group maintained higher total scores (75 ± 10.1 vs 63.3 ± 15.3, p = 0.01), efficiency (86.3 ± 7.4 vs 77.4 ± 11.2, p = 0.009), and superior secondary task performance (error: 6.3% ± 0.06 vs 10.7% ± 0.11, p = 0.20). Gaze entropy (cognitive-load indicator) and gaze pattern analysis showed similar trends. Conclusion: Gaze-augmented training leads to more efficient movements through adoption of expert gaze patterns that withstand additional stressors.
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Affiliation(s)
- Rachel Melnyk
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Timothy Campbell
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Tyler Holler
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Katherine Cameron
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Patrick Saba
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael W Witthaus
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jean Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ahmed Ghazi
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
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19
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Wu C, Cha J, Sulek J, Sundaram CP, Wachs J, Proctor RW, Yu D. Sensor-based indicators of performance changes between sessions during robotic surgery training. APPLIED ERGONOMICS 2021; 90:103251. [PMID: 32961465 PMCID: PMC7606790 DOI: 10.1016/j.apergo.2020.103251] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/04/2020] [Accepted: 08/20/2020] [Indexed: 05/27/2023]
Abstract
Training of surgeons is essential for safe and effective use of robotic surgery, yet current assessment tools for learning progression are limited. The objective of this study was to measure changes in trainees' cognitive and behavioral states as they progressed in a robotic surgeon training curriculum at a medical institution. Seven surgical trainees in urology who had no formal robotic training experience participated in the simulation curriculum. They performed 12 robotic skills exercises with varying levels of difficulty repetitively in separate sessions. EEG (electroencephalogram) activity and eye movements were measured throughout to calculate three metrics: engagement index (indicator of task engagement), pupil diameter (indicator of mental workload) and gaze entropy (indicator of randomness in gaze pattern). Performance scores (completion of task goals) and mental workload ratings (NASA-Task Load Index) were collected after each exercise. Changes in performance scores between training sessions were calculated. Analysis of variance, repeated measures correlation, and machine learning classification were used to diagnose how cognitive and behavioral states associate with performance increases or decreases between sessions. The changes in performance were correlated with changes in engagement index (rrm=-.25,p<.001) and gaze entropy (rrm=-.37,p<.001). Changes in cognitive and behavioral states were able to predict training outcomes with 72.5% accuracy. Findings suggest that cognitive and behavioral metrics correlate with changes in performance between sessions. These measures can complement current feedback tools used by medical educators and learners for skills assessment in robotic surgery training.
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Affiliation(s)
- Chuhao Wu
- Purdue University, West Lafayette, IN, United States
| | - Jackie Cha
- Purdue University, West Lafayette, IN, United States
| | - Jay Sulek
- Indiana University, Indianapolis, IN, United States
| | | | - Juan Wachs
- Purdue University, West Lafayette, IN, United States
| | | | - Denny Yu
- Purdue University, West Lafayette, IN, United States.
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20
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Mikula L, Mejía-Romero S, Chaumillon R, Patoine A, Lugo E, Bernardin D, Faubert J. Eye-head coordination and dynamic visual scanning as indicators of visuo-cognitive demands in driving simulator. PLoS One 2020; 15:e0240201. [PMID: 33382720 PMCID: PMC7774948 DOI: 10.1371/journal.pone.0240201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/16/2020] [Indexed: 12/02/2022] Open
Abstract
Driving is an everyday task involving a complex interaction between visual and cognitive processes. As such, an increase in the cognitive and/or visual demands can lead to a mental overload which can be detrimental for driving safety. Compiling evidence suggest that eye and head movements are relevant indicators of visuo-cognitive demands and attention allocation. This study aims to investigate the effects of visual degradation on eye-head coordination as well as visual scanning behavior during a highly demanding task in a driving simulator. A total of 21 emmetropic participants (21 to 34 years old) performed dual-task driving in which they were asked to maintain a constant speed on a highway while completing a visual search and detection task on a navigation device. Participants did the experiment with optimal vision and with contact lenses that introduced a visual perturbation (myopic defocus). The results indicate modifications of eye-head coordination and the dynamics of visual scanning in response to the visual perturbation induced. More specifically, the head was more involved in horizontal gaze shifts when the visual needs were not met. Furthermore, the evaluation of visual scanning dynamics, based on time-based entropy which measures the complexity and randomness of scanpaths, revealed that eye and gaze movements became less explorative and more stereotyped when vision was not optimal. These results provide evidence for a reorganization of both eye and head movements in response to increasing visual-cognitive demands during a driving task. Altogether, these findings suggest that eye and head movements can provide relevant information about visuo-cognitive demands associated with complex tasks. Ultimately, eye-head coordination and visual scanning dynamics may be good candidates to estimate drivers' workload and better characterize risky driving behavior.
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Affiliation(s)
- Laura Mikula
- Faubert Laboratory, School of Optometry, Université de Montréal, Montréal, Québec, Canada
| | - Sergio Mejía-Romero
- Faubert Laboratory, School of Optometry, Université de Montréal, Montréal, Québec, Canada
| | - Romain Chaumillon
- Faubert Laboratory, School of Optometry, Université de Montréal, Montréal, Québec, Canada
| | - Amigale Patoine
- Faubert Laboratory, School of Optometry, Université de Montréal, Montréal, Québec, Canada
| | - Eduardo Lugo
- Faubert Laboratory, School of Optometry, Université de Montréal, Montréal, Québec, Canada
| | - Delphine Bernardin
- Faubert Laboratory, School of Optometry, Université de Montréal, Montréal, Québec, Canada
- Essilor International, Research and Development Department, Paris, France & Essilor Canada, Saint-Laurent, Canada
| | - Jocelyn Faubert
- Faubert Laboratory, School of Optometry, Université de Montréal, Montréal, Québec, Canada
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21
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Wu C, Cha J, Sulek J, Zhou T, Sundaram CP, Wachs J, Yu D. Eye-Tracking Metrics Predict Perceived Workload in Robotic Surgical Skills Training. HUMAN FACTORS 2020; 62:1365-1386. [PMID: 31560573 PMCID: PMC7672675 DOI: 10.1177/0018720819874544] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/05/2019] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The aim of this study is to assess the relationship between eye-tracking measures and perceived workload in robotic surgical tasks. BACKGROUND Robotic techniques provide improved dexterity, stereoscopic vision, and ergonomic control system over laparoscopic surgery, but the complexity of the interfaces and operations may pose new challenges to surgeons and compromise patient safety. Limited studies have objectively quantified workload and its impact on performance in robotic surgery. Although not yet implemented in robotic surgery, minimally intrusive and continuous eye-tracking metrics have been shown to be sensitive to changes in workload in other domains. METHODS Eight surgical trainees participated in 15 robotic skills simulation sessions. In each session, participants performed up to 12 simulated exercises. Correlation and mixed-effects analyses were conducted to explore the relationships between eye-tracking metrics and perceived workload. Machine learning classifiers were used to determine the sensitivity of differentiating between low and high workload with eye-tracking features. RESULTS Gaze entropy increased as perceived workload increased, with a correlation of .51. Pupil diameter and gaze entropy distinguished differences in workload between task difficulty levels, and both metrics increased as task level difficulty increased. The classification model using eye-tracking features achieved an accuracy of 84.7% in predicting workload levels. CONCLUSION Eye-tracking measures can detect perceived workload during robotic tasks. They can potentially be used to identify task contributors to high workload and provide measures for robotic surgery training. APPLICATION Workload assessment can be used for real-time monitoring of workload in robotic surgical training and provide assessments for performance and learning.
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Affiliation(s)
| | - Jackie Cha
- Purdue University, West Lafayette, Indiana, USA
| | - Jay Sulek
- Indiana University, Indianapolis, USA
| | - Tian Zhou
- Purdue University, West Lafayette, Indiana, USA
| | | | | | - Denny Yu
- Purdue University, West Lafayette, Indiana, USA
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Amphetamine-induced alteration to gaze parameters: A novel conceptual pathway and implications for naturalistic behavior. Prog Neurobiol 2020; 199:101929. [PMID: 33091542 DOI: 10.1016/j.pneurobio.2020.101929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/03/2020] [Accepted: 10/08/2020] [Indexed: 12/25/2022]
Abstract
Amphetamine produces a multiplicity of well-documented end-order biochemical, pharmacological and biobehavioural effects. Mechanistically, amphetamine downregulates presynaptic and postsynaptic striatal monoamine (primarily dopaminergic) systems, producing alterations to key brain regions which manifest as stereotyped ridged behaviour which occurs under both acute and chronic dosing schedules and persists beyond detoxification. Despite evidence of amphetamine-induced visual attentional dysfunction, no conceptual synthesis has yet captured how characteristic pharmaco-behavioural processes are critically implicated via these pathways, nor described the potential implications for safety-sensitive behaviours. Drawing on known pathomechanisms, we propose a cross-disciplinary, novel conceptual functional system framework for delineating the biobehavioural consequences of amphetamine use on visual attentional capacity and discuss the implications for functional and behavioural outcomes. Specifically, we highlight the manifest implications for behaviours that are conceptually driven and highly dependent on visual information processing for timely execution of visually-guided movements. Following this, we highlight the potential impact on safety-sensitive, but common behaviours, such as driving a motor vehicle. The close pathophysiological relationship between oculomotor control and higher-order cognitive processes further suggests that dynamic measurement of movement related to the motion of the eye (gaze behaviour) may be a simple, effective and direct measure of behavioural performance capabilities in naturalistic settings. Consequently, we discuss the potential efficacy of ocular monitoring for the detection and monitoring of driver states for this drug user group, and potential wider application. Significance statement: We propose a novel biochemical-physiological-behavioural pathway which delineates how amphetamine use critically alters oculomotor function, visual-attentional performance and information processing capabilities. Given the manifest implications for behaviours that are conceptually driven and highly dependent on these processes, we recommend oculography as a novel means of detecting and monitoring gaze behaviours during naturalistic tasks such as driving. Real-word examination of gaze behaviour therefore present as an effective means to detect driver impairment and prevent performance degradation due to these drugs.
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Keller AM, Taylor HA, Brunyé TT. Uncertainty promotes information-seeking actions, but what information? COGNITIVE RESEARCH-PRINCIPLES AND IMPLICATIONS 2020; 5:42. [PMID: 32894402 PMCID: PMC7477035 DOI: 10.1186/s41235-020-00245-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 08/06/2020] [Indexed: 12/20/2022]
Abstract
Navigating an unfamiliar city almost certainly brings out uncertainty about getting from place to place. This uncertainty, in turn, triggers information gathering. While navigational uncertainty is common, little is known about what type of information people seek when they are uncertain. The primary choices for information types with environments include landmarks (distal or local), landmark configurations (relation between two or more landmarks), and a distinct geometry, at least for some environments. Uncertainty could lead individuals to more likely seek one of these information types. Extant research informs both predictions about and empirical work exploring this question. This review covers relevant cognitive literature and then suggests empirical approaches to better understand information-seeking actions triggered by uncertainty. Notably, we propose that examining continuous navigation data can provide important insights into information seeking. Benefits of continuous data will be elaborated through one paradigm, spatial reorientation, which intentionally induces uncertainty through disorientation and cue conflict. While this and other methods have been used previously, data have primarily reflected only the final choice. Continuous behavior during a task can better reveal the cognition-action loop contributing to spatial learning and decision making.
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Affiliation(s)
- Ashlynn M Keller
- Department of Psychology, Tufts University, 490 Boston Ave., Medford, MA, 02155, USA.
| | - Holly A Taylor
- Department of Psychology, Tufts University, 490 Boston Ave., Medford, MA, 02155, USA.,Tufts University, Center for Applied Brain and Cognitive Sciences, 200 Boston Ave., Suite 1800, Medford, MA, 02155, USA
| | - Tad T Brunyé
- Tufts University, Center for Applied Brain and Cognitive Sciences, 200 Boston Ave., Suite 1800, Medford, MA, 02155, USA.,US Army CCDC Soldier Center, 15 General Greene Ave., Natick, MA, 01760, USA
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van Knobelsdorff MH, van Bergen NG, van der Kamp J, Seifert L, Orth D. Action capability constrains visuo-motor complexity during planning and performance in on-sight climbing. Scand J Med Sci Sports 2020; 30:2485-2497. [PMID: 32749011 PMCID: PMC7754417 DOI: 10.1111/sms.13789] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/07/2020] [Accepted: 07/22/2020] [Indexed: 01/11/2023]
Abstract
The capability to adapt to changing conditions is crucial for safe and successful performance in physical activities and sports. According to the affordance‐based control perspective, individuals act in such a way as to take into account the limits of their capability to act. However, it is not clear how strength interacts with skill in shaping performer‐environment interactions. We, therefore, determined whether fingertip strength influences patterns of gaze and climbing behavior on new routes of ever‐increasing difficulty. We expected that comparatively weaker climbers would show less complex behavior because of an inability to perceive and act. Stronger climbers would show more complex visuo‐motor behavior because more opportunities for action remain, even as route difficulty increases. For very strong climbers the route would not be challenging enough, and less complex patterns suffice. Twenty climbers, ranging from lower grade to elite level participated. Maximum fingertip strength was obtained. Participants previewed and then climbed two separate 3 m long traverses, gradually decreasing in edge depth. Gaze and hip positions were collected for subsequent computation of gaze transition entropy (during preview) and hip displacement entropy (during climbing). Data revealed statistically significant curvilinear relationships between both fingertip strength and gaze transition entropy, and fingertip strength, and hip displacement entropy. Visuo‐motor complexity is scaled by how close the individual must act relative to boundaries of what the environment affords and does not afford for action given the individual constraints. Future research should examine in greater detail relationships between action capabilities and functional movement variability.
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Affiliation(s)
| | - Nikki G van Bergen
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - John van der Kamp
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Institute of Brain and Behavior, Amsterdam, The Netherlands
| | - Ludovic Seifert
- CETAPS - EA 3832, Faculty of Sport Sciences, University of Rouen Normandy, France
| | - Dominic Orth
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Swinburne University of Technology, Melbourne, VIC, Australia
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25
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Golan R, Shah O. Performance Optimization Strategies for Complex Endourologic Procedures. Urology 2020; 139:44-49. [PMID: 32045590 DOI: 10.1016/j.urology.2020.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/10/2020] [Accepted: 01/22/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To identify and address factors that may impact a surgeon's performance during endourologic procedures. METHODS A literature review was performed for articles focusing on surgical ergonomics, education, sports and performance psychology. RESULTS As urologists and trainees have become more comfortable approaching complex pathology endoscopically, there remains an opportunity to refine surgeon-related factors and optimize extrinsic factors to maximize efficiency and provide patients with the highest quality outcomes and safety. CONCLUSION Medical centers and training programs should strive to include formal lessons on stress-coping mechanisms, communication, and dedicated ergonomic training, as these all play a role in physician well-being and may lead to improved clinical outcomes.
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Affiliation(s)
- Ron Golan
- Department of Urology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY.
| | - Ojas Shah
- Department of Urology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY.
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26
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Entropy-Based Effect Evaluation of Delineators in Tunnels on Drivers' Gaze Behavior. ENTROPY 2020; 22:e22010113. [PMID: 33285888 PMCID: PMC7516415 DOI: 10.3390/e22010113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/16/2022]
Abstract
Driving safety in tunnels has always been an issue of great concern. Establishing delineators to improve drivers’ instantaneous cognition of the surrounding environment in tunnels can effectively enhance driver safety. Through a simulation study, this paper explored how delineators affect drivers’ gaze behavior (including fixation and scanpath) in tunnels. In addition to analyzing typical parameters, such as fixation position and fixation duration in areas of interest (AOIs), by modeling drivers’ switching process as Markov chains and calculating Shannon’s entropy of the fit Markov model, this paper quantified the complexity of individual switching patterns between AOIs under different delineator configurations and with different road alignments. A total of 25 subjects participated in this research. The results show that setting delineators in tunnels can attract drivers’ attention and make them focus on the pavement. When driving in tunnels equipped with delineators, especially tunnels with both wall delineators and pavement delineators, the participants exhibited a smaller transition entropy Ht and stationary entropy Hs, which can greatly reduce drivers’ visual fatigue. Compared with left curve and right curve, participants obtained higher Ht and Hs values in the straight section.
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27
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Shiferaw BA, Crewther DP, Downey LA. Gaze entropy measures detect alcohol-induced driver impairment. Drug Alcohol Depend 2019; 204:107519. [PMID: 31479863 DOI: 10.1016/j.drugalcdep.2019.06.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/23/2019] [Accepted: 06/12/2019] [Indexed: 12/16/2022]
Abstract
Driving under the influence of alcohol is an ongoing cause of road traffic accidents. The biphasic nature of alcohol effects on subjective experience appears to contribute to the prevalence of drink-driving, as people perceive the declining phase of the BAC curve as recovery from intoxication and are more willing to drive despite significant impairments in objectively measured functions. The present study investigates whether alcohol-induced changes in gaze behaviour can be detected during engagement in a simulated driving task. In a repeated-measures and placebo-controlled design, this study examines the biphasic influence of moderate alcohol intake (0.6 g/kg) on measures of gaze behaviour and simulated driving performance. Twenty-two healthy young adults completed three driving sessions (baseline, ascending and descending) under two conditions (placebo, alcohol) while their eye movements were simultaneously recorded. The results revealed that gaze behaviour as measured by gaze transition entropy (GTE) and stationary gaze entropy (SGE) and driving performance measured by the standard deviation of lateral position (SDLP) of the vehicle, were significantly affected by alcohol across the ascending and descending sessions. The alcohol-induced reduction in GTE with an increase in SGE is discussed as alcohol's impact on top-down modulation of gaze resulting in more dispersed and erratic pattern of visual scanning. The observed changes in gaze behaviour also mediated the influence of alcohol upon driving performance. These results have significant implications for the development of driver monitoring systems that can detect alcohol-induced impairment.
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Affiliation(s)
- Brook A Shiferaw
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC 3122, Australia.
| | - David P Crewther
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Luke A Downey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC 3122, Australia; Institute for Breathing and Sleep, Austin Hospital, Heidelberg, VIC 3084, Australia
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28
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Morales JM, Ruiz-Rabelo JF, Diaz-Piedra C, Di Stasi LL. Detecting Mental Workload in Surgical Teams Using a Wearable Single-Channel Electroencephalographic Device. JOURNAL OF SURGICAL EDUCATION 2019; 76:1107-1115. [PMID: 30691989 DOI: 10.1016/j.jsurg.2019.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/03/2018] [Accepted: 01/07/2019] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To assess the sensitivity of an electroencephalographic (EEG)-based index, the prefrontal beta power, to quantify the mental workload in surgeons in real scenarios. Such EEG-based index might offer unique and unbiased measures of overload, a crucial factor when designing learning and training surgical programs. DESIGN The experiment followed a 2 × 2 × 2 within subjects design with 3 factors: (1) Surgical Role during the surgery (primary surgeon vs. assistant surgeon), (2) the Surgical Procedure (laparo-endoscopic single-site [LESS] surgery vs. multiport laparoscopic surgery [MPS]), and (3) the Suturing Techniques (interrupted vs. continuous suture). SETTING The study was carried out at the Advanced Multi-Purpose Simulation and Technological Innovation Complex situated at IAVANTE (Granada, Spain). METHODS Four surgical teams (primary surgeon and assistant surgeon, experts in MPS) performed 8 surgical exercises on porcine models, under different task complexities. They performed 2 suturing techniques (continuous and interrupted), employing a low complex procedure (MPS) and a high complex procedure (LESS). Surgeons acted as the primary surgeon during half of the exercises, and, as the assistant surgeon, during the rest of them. Simultaneously, we monitored EEG prefrontal EEG beta power spectra of both surgeons, using 2 synchronized wearable EEG devices. We also collected performance and subjective data. RESULTS Surgical complexity modulated prefrontal beta power. LESS surgery caused significant higher prefrontal beta power for both suturing techniques for both surgical roles which indicates higher demands than MPS. Perceived task complexity, overall surgical evaluation, and laparoscopic execution time confirmed EEG-based results. Finally, subjective ratings of surgical complexity differentiated between surgical roles within the same exercise, even when prefrontal beta power did not. CONCLUSIONS To detect mental overload when surgeons are engaged with complex surgeries, real or simulated, is still guesswork. EEG-based indices have great potential as objective and nonintrusive measures to assess mental overload in surgeons. Furthermore, EEG-based indices might play a relevant role in monitoring surgeons and residents' cognitive state during their training.
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Affiliation(s)
- José M Morales
- Mind, Brain, and Behavior Research Center, University of Granada, Granada, Spain; Department of Computer Architecture and Technology, University of Granada, Granada, Spain
| | - Juan F Ruiz-Rabelo
- Department of General Surgery, Reina Sofia University Hospital, Cordoba, Spain
| | - Carolina Diaz-Piedra
- Mind, Brain, and Behavior Research Center, University of Granada, Granada, Spain; College of Health Solutions, Arizona State University, Phoenix, Arizona.
| | - Leandro L Di Stasi
- Mind, Brain, and Behavior Research Center, University of Granada, Granada, Spain; Joint Center University of Granada-Spanish Army Training and Doctrine Command, Spain
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29
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Diaz-Piedra C, Rieiro H, Cherino A, Fuentes LJ, Catena A, Di Stasi LL. The effects of flight complexity on gaze entropy: An experimental study with fighter pilots. APPLIED ERGONOMICS 2019; 77:92-99. [PMID: 30832783 DOI: 10.1016/j.apergo.2019.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/03/2018] [Accepted: 01/27/2019] [Indexed: 06/09/2023]
Abstract
We studied the effects of task load variations as a function of flight complexity on combat pilots' gaze behavior (i.e., entropy) while solving in-flight emergencies. The second company of the Spanish Army Attack Helicopter Battalion (n = 15) performed three sets of standardized flight exercises with different levels of complexity (low [recognition flights], medium and high [emergency flights]). Throughout the flight exercises we recorded pilots' gaze entropy, as well as pilots' performance (assessed by an expert flight instructor) and subjective ratings of task load (assessed by the NASA-Task Load Index). Furthermore, we used pilots' electroencephalographic (EEG) activity as a reference physiological index for task load variations. We found that pilots' gaze entropy decreased ∼2% (i.e., visual scanning became less erratic) while solving the emergency flight exercises, showing a significant decreasing trend with increasing complexity (p < .05). This is in consonance with the ∼12% increase in the frontal theta band of their EEG spectra during said exercises. Pilots' errors and subjective ratings of task load increased as flight complexity increased (p-values < .05). Gaze data suggest that pilots used nondeterministic visual patterns when the aircraft was in an error-free state (low complexity), and changed their scanning behavior, becoming more deterministic, once emergencies occurred (medium/high complexity). Overall, our findings indicate that gaze entropy can serve as a sensitive index of task load in aviation settings.
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Affiliation(s)
- Carolina Diaz-Piedra
- Mind, Brain, and Behavior Research Center-CIMCYC, University of Granada, Campus de Cartuja s/n, 18071, Granada, Spain; College of Health Solutions, Arizona State University, 500 N. 3rd St, 85004, Phoenix, AZ, USA.
| | - Hector Rieiro
- Mind, Brain, and Behavior Research Center-CIMCYC, University of Granada, Campus de Cartuja s/n, 18071, Granada, Spain
| | - Alberto Cherino
- First Attack Helicopter Battalion I - BHELA I (Spanish Army Airmobile Force), Almagro, Ciudad Real, Spain
| | - Luis J Fuentes
- Department of Basic Psychology and Methodology, University of Murcia, 30100, Murcia, Spain
| | - Andres Catena
- Mind, Brain, and Behavior Research Center-CIMCYC, University of Granada, Campus de Cartuja s/n, 18071, Granada, Spain
| | - Leandro L Di Stasi
- Mind, Brain, and Behavior Research Center-CIMCYC, University of Granada, Campus de Cartuja s/n, 18071, Granada, Spain; Joint Center University of Granada - Spanish Army Training and Doctrine Command, C/ Gran Via de Colon, 48, 18071, Granada, Spain.
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30
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Gao J, Liu S, Feng Q, Zhang X, Jiang M, Wang L, Zhang J, Zhang Q. Subjective and Objective Quantification of the Effect of Distraction on Physician's Workload and Performance During Simulated Laparoscopic Surgery. Med Sci Monit 2019; 25:3127-3132. [PMID: 31030208 PMCID: PMC6503751 DOI: 10.12659/msm.914635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Distracting interference cognitive tasks place undeniable pressure on the minds of people who need high precision and attention during the tasks, such as those tasks performed during surgery; these tasks might affect current surgical procedures. We measured the effect of additional cognitive tasks on the mental load of the physician by measuring the mean change in pupil size, blink rate, and subjective assessment during surgery. Material/Methods We recruited 24 participants with different levels of laparoscopic surgery to perform a complete appendectomy using a standardized virtual reality laparoscopic surgery simulator. The participants then performed the cognitive task (arithmetic problem), after that they performed an appendectomy surgery task while completing the cognitive task on the simulator. All participants wore trackers to monitor pupil size and blink rate during surgery and the cognitive task. The National Aeronautics and Space Administration (NASA) Task Load Index (TLX) score also recorded performance parameters during the surgical mission. Results The double-task pupil size and the blink rate were significantly increased compared to the single-task observation, and the associated increase in psychological load might have been affected by surgical performance, and the performance parameters were also statistically significant. However, for the aforementioned parameters, experienced surgeons had some differences compared with inexperienced surgeons, but these differences did not reach statistical significance. Conclusions Distracted cognitive task stimulation in the operating room can increase the surgeon’s psychological burden while also affecting their operational skills, thereby threatening patient safety; reduced cognitive costs might be obtained by improving or managing cognitive deficits.
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Affiliation(s)
- Jiaqi Gao
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).,Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Shenglin Liu
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).,Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Qingmin Feng
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).,Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Xutian Zhang
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).,Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Mingyin Jiang
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).,Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Linlin Wang
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).,Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Jianyang Zhang
- Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Qiang Zhang
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).,Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
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31
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Shiferaw B, Downey L, Crewther D. A review of gaze entropy as a measure of visual scanning efficiency. Neurosci Biobehav Rev 2019; 96:353-366. [DOI: 10.1016/j.neubiorev.2018.12.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 11/16/2022]
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32
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Vera J, Diaz-Piedra C, Jiménez R, Sanchez-Carrion JM, Di Stasi LL. Intraocular pressure increases after complex simulated surgical procedures in residents: an experimental study. Surg Endosc 2019; 33:216-224. [PMID: 29967993 DOI: 10.1007/s00464-018-6297-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Surgeons' overload is one of the main causes of medical errors that might compromise patient safety. Due to the drawbacks of current options to monitor surgeons' load, new, sensitive, and objective indices of task (over)load need to be considered and tested. In non-health-care scenarios, intraocular pressure (IOP) has been proved to be an unbiased physiological index, sensitive to task complexity (one of the main variables related to overload), and time on task. In the present study, we assessed the effects of demanding and complex simulated surgical procedures on surgical and medical residents' IOP. METHODS Thirty-four surgical and medical residents and healthcare professionals took part in this study (the experimental group, N = 17, and the control group, N = 17, were matched for sex and age). The experimental group performed two simulated bronchoscopy procedures that differ in their levels of complexity. The control group mimicked the same hand-eye movements and posture of the experimental group to help control for the potential effects of time on task and re-measurement on IOP. We measured IOP before and after each procedure, surgical performance during procedures, and perceived task complexity. RESULTS IOP increased as consequence of performing the most complex procedure only in the experimental group. Consistently, residents performed worse and reported higher perceived task complexity for the more complex procedure. CONCLUSIONS Our data show, for the first time, that IOP is sensitive to residents' task load, and it could be used as a new index to easily and rapidly assess task (over)load in healthcare scenarios. An arousal-based explanation is given to describe IOP variations due to task complexity.
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Affiliation(s)
- Jesús Vera
- Department of Optics, Faculty of Science, University of Granada, Granada, Spain.,Mixed University Sport and Health Institute (iMUDS), University of Granada, Granada, Spain
| | - Carolina Diaz-Piedra
- Mind, Brain, and Behavior Research Center - CIMCYC, University of Granada, Campus de Cartuja s/n, 18071, Granada, Spain. .,College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.
| | - Raimundo Jiménez
- Department of Optics, Faculty of Science, University of Granada, Granada, Spain
| | - Jose M Sanchez-Carrion
- IAVANTE, Line of Activity of the Andalusian Public Foundation for Progress and Health, Ministry of Equality, Health and Social Policy of the Regional Government of Andalusia, Granada, Spain
| | - Leandro L Di Stasi
- Mind, Brain, and Behavior Research Center - CIMCYC, University of Granada, Campus de Cartuja s/n, 18071, Granada, Spain.,College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.,Joint Center University of Granada - Spanish Army Training and Doctrine Command, Granada, Spain
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33
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Chew JY, Ohtomi K, Suzuki H. Glance behavior as design indices of in-vehicle visual support system: A study using crane simulators. APPLIED ERGONOMICS 2018; 73:183-193. [PMID: 30098634 DOI: 10.1016/j.apergo.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/22/2018] [Accepted: 07/14/2018] [Indexed: 06/08/2023]
Abstract
A prediction model is used to predict subjective responses of crane operators with respect to different designs of In-Vehicle Visual Support (IVVS). Selected gaze metrics are used as objective metrics to minimize prejudice, which is commonly caused by subjective measures. Experiments are carried out using crane simulator to measure glance behavior of novice operators and the 3D perspective projection method is used for autonomous mapping of gaze fixations to dynamic Area-of-Interests (AOIs). Subjective responses, such as operators' emotion and usability of IVVS, are evaluated using the Likert scale of the Semantic Differential method. Correlation between gaze metrics and subjective responses is established using multiple linear regression. Glance behavior exhibits a statistically significant difference when information on IVVS is perceived as useful to ease operation and reduce tension. Despite this, there are no significant signs of distraction. Glance behavior is found to be a reliable sub-conscious indicator of subjective response and distraction. More importantly, the proposed gaze metrics are found to be a good representation of glance behavior, such as randomness and distribution of attention. The methods and findings are useful to evaluate impact of IVVS, which is becoming more common in many other applications.
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Affiliation(s)
- Jouh Yeong Chew
- Department of Precision Engineering, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8656, Tokyo, Japan; National Institute of Advanced Industrial Science and Technology, AIST Tsukuba Central 1, 1-1-1 Umezono, Tsukuba, 305-8560, Ibaraki, Japan.
| | - Koichi Ohtomi
- Department of Precision Engineering, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8656, Tokyo, Japan.
| | - Hiromasa Suzuki
- Department of Precision Engineering, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8656, Tokyo, Japan.
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34
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Fichtel E, Lau N, Park J, Henrickson Parker S, Ponnala S, Fitzgibbons S, Safford SD. Eye tracking in surgical education: gaze-based dynamic area of interest can discriminate adverse events and expertise. Surg Endosc 2018; 33:2249-2256. [PMID: 30341656 DOI: 10.1007/s00464-018-6513-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/11/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Eye-gaze metrics derived from areas of interest (AOIs) have been suggested to be effective for surgical skill assessment. However, prior research is mostly based on static images and simulated tasks that may not translate to complex and dynamic surgical scenes. Therefore, eye-gaze metrics must advance to account for changes in the location of important information during a surgical procedure. METHODS We developed a dynamic AOI generation technique based on eye gaze collected from an expert viewing surgery videos. This AOI updated as the gaze of the expert moved with changes in the surgical scene. This technique was evaluated through an experiment recruiting a total of 20 attendings and residents to view 10 videos associated with and another 10 without adverse events. RESULTS Dwell time percentage (i.e., gaze duration) inside the AOI differentiated video type (U = 13508.5, p < 0.001) between videos with the presence (Mdn = 16.75) versus absence (Mdn = 19.95) of adverse events. This metric also differentiated participant group (U = 14029.5, p < 0.001) between attendings (Mdn = 15.45) and residents (Mdn = 19.80). This indicates that our dynamic AOIs reflecting the expert eye gaze was able to differentiate expertise, and the presence of unexpected adverse events. CONCLUSION This dynamic AOI generation technique produced dynamic AOIs for deriving eye-gaze metrics that were sensitive to expertise level and event characteristics.
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Affiliation(s)
- Eric Fichtel
- Grado Department of Industrial and Systems Engineering, Virginia Tech, 546 Whittemore Hall, 1185 Perry Street, Blacksburg, VA, 24061, USA
| | - Nathan Lau
- Grado Department of Industrial and Systems Engineering, Virginia Tech, 546 Whittemore Hall, 1185 Perry Street, Blacksburg, VA, 24061, USA.
| | - Juyeon Park
- Virginia Tech Carilion School of Medicine and Carilion Clinic, Virginia Tech, Roanoke, USA
| | | | - Siddarth Ponnala
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, USA
| | - Shimae Fitzgibbons
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Shawn D Safford
- Department of Surgery, Virginia Tech Carilion School of Medicine and Carilion Clinic, Virginia Tech, Roanoke, USA
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35
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Zhang J, Liu S, Feng Q, Gao J, Cheng J, Jiang M, Lan Y, Zhang Q. Ergonomic Assessment of the Mental Workload Confronted by Surgeons during Laparoscopic Surgery. Am Surg 2018. [DOI: 10.1177/000313481808400964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although the mental workload confronted by laparoscopic surgeons is rather high, there is presently no reliable, established method for evaluating this workload. In the present study, four evaluation indices of eye movement metrics were applied to evaluate surgeons’ mental workload. Correlations between these indices and National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores were also explored. Sixteen participants were recruited to complete four laparoscopic procedures. Eye movement was recorded during the tasks, and NASA-TLX scales were also introduced for subjective evaluation. The data were analyzed using R 3.3.2. Significant differences in the mental workload of each task were observed. Statistically significant correlations between mean pupil diameter change and NASA-TLX scores were also observed. The correlation coefficients were 0.763, 0.675, 0.405, and 0.547, and the P values correspondingly were 0.001, 0.004, 0.12, and 0.028, respectively. The results clarify that the mental workload of laparoscopic surgeons is dependent on the specific demands of the operation. Appropriate objective physiological indices can be used to identify the mental workload state of the surgeon.
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Affiliation(s)
- Jianyang Zhang
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Computer and Information Technology, Nanyang Normal University, Nanyang, China
- Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shenglin Liu
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingmin Feng
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqi Gao
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ju Cheng
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingyin Jiang
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yihua Lan
- School of Computer and Information Technology, Nanyang Normal University, Nanyang, China
| | - Qiang Zhang
- Department of Medical Engineering, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Healthcare Ergonomics Lab, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Dias RD, Ngo-Howard MC, Boskovski MT, Zenati MA, Yule SJ. Systematic review of measurement tools to assess surgeons' intraoperative cognitive workload. Br J Surg 2018; 105:491-501. [PMID: 29465749 PMCID: PMC5878696 DOI: 10.1002/bjs.10795] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/09/2017] [Accepted: 11/17/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Surgeons in the operating theatre deal constantly with high-demand tasks that require simultaneous processing of a large amount of information. In certain situations, high cognitive load occurs, which may impact negatively on a surgeon's performance. This systematic review aims to provide a comprehensive understanding of the different methods used to assess surgeons' cognitive load, and a critique of the reliability and validity of current assessment metrics. METHODS A search strategy encompassing MEDLINE, Embase, Web of Science, PsycINFO, ACM Digital Library, IEEE Xplore, PROSPERO and the Cochrane database was developed to identify peer-reviewed articles published from inception to November 2016. Quality was assessed by using the Medical Education Research Study Quality Instrument (MERSQI). A summary table was created to describe study design, setting, specialty, participants, cognitive load measures and MERSQI score. RESULTS Of 391 articles retrieved, 84 met the inclusion criteria, totalling 2053 unique participants. Most studies were carried out in a simulated setting (59 studies, 70 per cent). Sixty studies (71 per cent) used self-reporting methods, of which the NASA Task Load Index (NASA-TLX) was the most commonly applied tool (44 studies, 52 per cent). Heart rate variability analysis was the most used real-time method (11 studies, 13 per cent). CONCLUSION Self-report instruments are valuable when the aim is to assess the overall cognitive load in different surgical procedures and assess learning curves within competence-based surgical education. When the aim is to assess cognitive load related to specific operative stages, real-time tools should be used, as they allow capture of cognitive load fluctuation. A combination of both subjective and objective methods might provide optimal measurement of surgeons' cognition.
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Affiliation(s)
- R D Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - M C Ngo-Howard
- Department of Otolaryngology – Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA,Medical Robotics and Computer Assisted Surgery Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - M T Boskovski
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - M A Zenati
- Harvard Medical School, Boston, Massachusetts, USA,Medical Robotics and Computer Assisted Surgery Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - S J Yule
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA,Correspondence to: Dr S. J. Yule, STRATUS Center for Medical Simulation, Brigham and Women's Hospital, 10 Vining Street, Boston, Massachusetts 02115, USA (e-mail: ; @RogerDaglius; @BWH_STRATUS)
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Stationary gaze entropy predicts lane departure events in sleep-deprived drivers. Sci Rep 2018; 8:2220. [PMID: 29396509 PMCID: PMC5797225 DOI: 10.1038/s41598-018-20588-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 01/15/2018] [Indexed: 12/27/2022] Open
Abstract
Performance decrement associated with sleep deprivation is a leading contributor to traffic accidents and fatalities. While current research has focused on eye blink parameters as physiological indicators of driver drowsiness, little is understood of how gaze behaviour alters as a result of sleep deprivation. In particular, the effect of sleep deprivation on gaze entropy has not been previously examined. In this randomised, repeated measures study, 9 (4 male, 5 female) healthy participants completed two driving sessions in a fully instrumented vehicle (1 after a night of sleep deprivation and 1 after normal sleep) on a closed track, during which eye movement activity and lane departure events were recorded. Following sleep deprivation, the rate of fixations reduced while blink rate and duration as well as saccade amplitude increased. In addition, stationary and transition entropy of gaze also increased following sleep deprivation as well as with amount of time driven. An increase in stationary gaze entropy in particular was associated with higher odds of a lane departure event occurrence. These results highlight how fatigue induced by sleep deprivation and time-on-task effects can impair drivers’ visual awareness through disruption of gaze distribution and scanning patterns.
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Bhavsar P, Srinivasan B, Srinivasan R. Quantifying situation awareness of control room operators using eye-gaze behavior. Comput Chem Eng 2017. [DOI: 10.1016/j.compchemeng.2017.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Di Stasi LL, Díaz-Piedra C, Ruiz-Rabelo JF, Rieiro H, Sanchez Carrion JM, Catena A. Quantifying the cognitive cost of laparo-endoscopic single-site surgeries: Gaze-based indices. APPLIED ERGONOMICS 2017; 65:168-174. [PMID: 28802436 DOI: 10.1016/j.apergo.2017.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 04/14/2017] [Accepted: 06/10/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Despite the growing interest concerning the laparo-endoscopic single-site surgery (LESS) procedure, LESS presents multiple difficulties and challenges that are likely to increase the surgeon's cognitive cost, in terms of both cognitive load and performance. Nevertheless, there is currently no objective index capable of assessing the surgeon cognitive cost while performing LESS. We assessed if gaze-based indices might offer unique and unbiased measures to quantify LESS complexity and its cognitive cost. We expect that the assessment of surgeon's cognitive cost to improve patient safety by measuring fitness-for-duty and reducing surgeons overload. METHODS Using a wearable eye tracker device, we measured gaze entropy and velocity of surgical trainees and attending surgeons during two surgical procedures (LESS vs. multiport laparoscopy surgery [MPS]). None of the participants had previous experience with LESS. They performed two exercises with different complexity levels (Low: Pattern Cut vs. High: Peg Transfer). We also collected performance and subjective data. RESULTS LESS caused higher cognitive demand than MPS, as indicated by increased gaze entropy in both surgical trainees and attending surgeons (exploration pattern became more random). Furthermore, gaze velocity was higher (exploration pattern became more rapid) for the LESS procedure independently of the surgeon's expertise. Perceived task complexity and laparoscopic accuracy confirmed gaze-based results. CONCLUSION Gaze-based indices have great potential as objective and non-intrusive measures to assess surgeons' cognitive cost and fitness-for-duty. Furthermore, gaze-based indices might play a relevant role in defining future guidelines on surgeons' examinations to mark their achievements during the entire training (e.g. analyzing surgical learning curves).
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Affiliation(s)
- Leandro L Di Stasi
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain; College of Nursing and Health Innovation, Arizona State University, 85004 Phoenix, AZ, USA.
| | - Carolina Díaz-Piedra
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain; College of Nursing and Health Innovation, Arizona State University, 85004 Phoenix, AZ, USA
| | | | - Héctor Rieiro
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain
| | - Jose M Sanchez Carrion
- IAVANTE, Line of Activity of the Andalusian Public Foundation for Progress and Health, Ministry of Equality, Health and Social Policy of the Regional Government of Andalusia, 18016 Granada, Spain
| | - Andrés Catena
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain
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Gaze-based Technology as a Tool for Surgical Skills Assessment and Training in Urology. Urology 2017; 107:26-30. [DOI: 10.1016/j.urology.2017.06.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/05/2017] [Accepted: 06/19/2017] [Indexed: 01/02/2023]
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Vera J, Jiménez R, García JA, Cárdenas D. Intraocular pressure is sensitive to cumulative and instantaneous mental workload. APPLIED ERGONOMICS 2017; 60:313-319. [PMID: 28166891 DOI: 10.1016/j.apergo.2016.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/08/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Abstract
We used a repeated-measures design to assess the impact of mental-task complexity on intraocular pressure (IOP). Fourteen participants performed three continuous 11-min blocks of a mental-workload task (3-back) and an oddball version of this task. Also, heart-rate variability (HRV), cognitive-performance scores, and subjective measure of mental load (NASA-TLX) were determined. IOP was taken before each block and afterwards as well as after recovery from mental tasks. We found that IOP increased during heavy mental workloads (p < 0.01). Consistent with this finding, the autonomic control (HRV) and the cognitive performance were significantly lower (p < 0.045, and p < 0.01, respectively), and the NASA-TLX scores were higher during the 3-back task (p < 0.01). We conclude that IOP is sensitive to mental workload, and it could provide a novel neuroergonomic tool to assess mental workload. Our study highlights a potential association between IOP and the nervous system's state of activation.
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Affiliation(s)
- Jesús Vera
- Department of Optics, University of Granada, Spain; Sport and Health University Mixed Institute, University of Granada, Spain.
| | | | | | - David Cárdenas
- Sport and Health University Mixed Institute, University of Granada, Spain; Department of Physical Education and Sport, University of Granada, Spain
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