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Feltman KA, Vogl JF, McAtee A, Kelley AM. Measuring aviator workload using EEG: an individualized approach to workload manipulation. FRONTIERS IN NEUROERGONOMICS 2024; 5:1397586. [PMID: 38919336 PMCID: PMC11197431 DOI: 10.3389/fnrgo.2024.1397586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024]
Abstract
Introduction Measuring an operator's physiological state and using that data to predict future performance decrements has been an ongoing goal in many areas of transportation. Regarding Army aviation, the realization of such an endeavor could lead to the development of an adaptive automation system which adapts to the needs of the operator. However, reaching this end state requires the use of experimental scenarios similar to real-life settings in order to induce the state of interest that are able to account for individual differences in experience, exposure, and perception to workload manipulations. In the present study, we used an individualized approach to manipulating workload in order to account for individual differences in response to workload manipulations, while still providing an operationally relevant flight experience. Methods Eight Army aviators participated in the study, where they completed two visits to the laboratory. The first visit served the purpose of identifying individual workload thresholds, with the second visit resulting in flights with individualized workload manipulations. EEG data was collected throughout both flights, along with subjective ratings of workload and flight performance. Results Both EEG data and workload ratings suggested a high workload. Subjective ratings were higher during the high workload flight compared to the low workload flight (p < 0.001). Regarding EEG, frontal alpha (p = 0.04) and theta (p = 0.01) values were lower and a ratio of beta/(alpha+theta) (p = 0.02) were higher in the baseline flight scenario compared to the high workload scenario. Furthermore, the data were compared to that collected in previous studies which used a group-based approach to manipulating workload. Discussion The individualized method demonstrated higher effect sizes in both EEG and subjective ratings, suggesting the use of this method may provide a more reliable way of producing high workload in aviators.
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Affiliation(s)
- Kathryn A. Feltman
- United States Army Aeromedical Research Laboratory, Fort Novosel, AL, United States
| | - Johnathan F. Vogl
- United States Army Aeromedical Research Laboratory, Fort Novosel, AL, United States
| | - Aaron McAtee
- United States Army Aeromedical Research Laboratory, Fort Novosel, AL, United States
- Goldbelt Inc., Herndon, VA, United States
| | - Amanda M. Kelley
- United States Army Aeromedical Research Laboratory, Fort Novosel, AL, United States
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Andersen AG, Riparbelli AC, Siebner HR, Konge L, Bjerrum F. Using neuroimaging to assess brain activity and areas associated with surgical skills: a systematic review. Surg Endosc 2024; 38:3004-3026. [PMID: 38653901 DOI: 10.1007/s00464-024-10830-x] [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] [Received: 01/02/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Surgical skills acquisition is under continuous development due to the emergence of new technologies, and there is a need for assessment tools to develop along with these. A range of neuroimaging modalities has been used to map the functional activation of brain networks while surgeons acquire novel surgical skills. These have been proposed as a method to provide a deeper understanding of surgical expertise and offer new possibilities for the personalized training of future surgeons. With studies differing in modalities, outcomes, and surgical skills there is a need for a systematic review of the evidence. This systematic review aims to summarize the current knowledge on the topic and evaluate the potential use of neuroimaging in surgical education. METHODS We conducted a systematic review of neuroimaging studies that mapped functional brain activation while surgeons with different levels of expertise learned and performed technical and non-technical surgical tasks. We included all studies published before July 1st, 2023, in MEDLINE, EMBASE and WEB OF SCIENCE. RESULTS 38 task-based brain mapping studies were identified, consisting of randomized controlled trials, case-control studies, and observational cohort or cross-sectional studies. The studies employed a wide range of brain mapping modalities, including electroencephalography, functional magnetic resonance imaging, positron emission tomography, and functional near-infrared spectroscopy, activating brain areas involved in the execution and sensorimotor or cognitive control of surgical skills, especially the prefrontal cortex, supplementary motor area, and primary motor area, showing significant changes between novices and experts. CONCLUSION Functional neuroimaging can reveal how task-related brain activity reflects technical and non-technical surgical skills. The existing body of work highlights the potential of neuroimaging to link task-related brain activity patterns with the individual level of competency or improvement in performance after training surgical skills. More research is needed to establish its validity and usefulness as an assessment tool.
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Affiliation(s)
- Annarita Ghosh Andersen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Ryesgade 53B, 2100, Copenhagen, Denmark.
- Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Agnes Cordelia Riparbelli
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Ryesgade 53B, 2100, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Gastrounit, Surgical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
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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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Tamburro G, Fiedler P, De Fano A, Raeisi K, Khazaei M, Vaquero L, Bruña R, Oppermann H, Bertollo M, Filho E, Zappasodi F, Comani S. An ecological study protocol for the multimodal investigation of the neurophysiological underpinnings of dyadic joint action. Front Hum Neurosci 2023; 17:1305331. [PMID: 38125713 PMCID: PMC10730734 DOI: 10.3389/fnhum.2023.1305331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
A novel multimodal experimental setup and dyadic study protocol were designed to investigate the neurophysiological underpinnings of joint action through the synchronous acquisition of EEG, ECG, EMG, respiration and kinematic data from two individuals engaged in ecologic and naturalistic cooperative and competitive joint actions involving face-to-face real-time and real-space coordinated full body movements. Such studies are still missing because of difficulties encountered in recording reliable neurophysiological signals during gross body movements, in synchronizing multiple devices, and in defining suitable study protocols. The multimodal experimental setup includes the synchronous recording of EEG, ECG, EMG, respiration and kinematic signals of both individuals via two EEG amplifiers and a motion capture system that are synchronized via a single-board microcomputer and custom Python scripts. EEG is recorded using new dry sports electrode caps. The novel study protocol is designed to best exploit the multimodal data acquisitions. Table tennis is the dyadic motor task: it allows naturalistic and face-to-face interpersonal interactions, free in-time and in-space full body movement coordination, cooperative and competitive joint actions, and two task difficulty levels to mimic changing external conditions. Recording conditions-including minimum table tennis rally duration, sampling rate of kinematic data, total duration of neurophysiological recordings-were defined according to the requirements of a multilevel analytical approach including a neural level (hyperbrain functional connectivity, Graph Theoretical measures and Microstate analysis), a cognitive-behavioral level (integrated analysis of neural and kinematic data), and a social level (extending Network Physiology to neurophysiological data recorded from two interacting individuals). Four practical tests for table tennis skills were defined to select the study population, permitting to skill-match the dyad members and to form two groups of higher and lower skilled dyads to explore the influence of skill level on joint action performance. Psychometric instruments are included to assess personality traits and support interpretation of results. Studying joint action with our proposed protocol can advance the understanding of the neurophysiological mechanisms sustaining daily life joint actions and could help defining systems to predict cooperative or competitive behaviors before being overtly expressed, particularly useful in real-life contexts where social behavior is a main feature.
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Affiliation(s)
- Gabriella Tamburro
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti–Pescara, Chieti, Italy
- Behavioral Imaging and Neural Dynamics Center, University “G. d’Annunzio” of Chieti–Pescara, Chieti, Italy
| | - Patrique Fiedler
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Antonio De Fano
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti–Pescara, Chieti, Italy
- Behavioral Imaging and Neural Dynamics Center, University “G. d’Annunzio” of Chieti–Pescara, Chieti, Italy
| | - Khadijeh Raeisi
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti–Pescara, Chieti, Italy
| | - Mohammad Khazaei
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti–Pescara, Chieti, Italy
| | - Lucia Vaquero
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Pschology, Cognitive Processes and Speech Therapy, Universidad Complutense de Madrid, Madrid, Spain
| | - Ricardo Bruña
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Radiology, Universidad Complutense de Madrid, IdISSC, Madrid, Spain
| | - Hannes Oppermann
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Maurizio Bertollo
- Behavioral Imaging and Neural Dynamics Center, University “G. d’Annunzio” of Chieti–Pescara, Chieti, Italy
- Department of Medicine and Sciences of Aging, “University G. d’Annunzio” of Chieti–Pescara, Chieti, Italy
| | - Edson Filho
- Wheelock College of Education and Human Development, Boston University, Boston, MA, United States
| | - Filippo Zappasodi
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti–Pescara, Chieti, Italy
- Behavioral Imaging and Neural Dynamics Center, University “G. d’Annunzio” of Chieti–Pescara, Chieti, Italy
| | - Silvia Comani
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti–Pescara, Chieti, Italy
- Behavioral Imaging and Neural Dynamics Center, University “G. d’Annunzio” of Chieti–Pescara, Chieti, Italy
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Fabre EF, Somon B, Baragona V, Uhl Q, Causse M. Fast & scrupulous: Gesture-based alarms improve accuracy and reaction times under various mental workload levels. An ERSP study. APPLIED ERGONOMICS 2023; 113:104082. [PMID: 37418909 DOI: 10.1016/j.apergo.2023.104082] [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: 04/04/2022] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
In high-risk environments, fast and accurate responses to warning systems are essential to efficiently handle emergency situations. The aim of the present study was twofold: 1) investigating whether hand action videos (i.e., gesture alarms) trigger faster and more accurate responses than text alarm messages (i.e., written alarms), especially when mental workload (MWL) is high; and 2) investigating the brain activity in response to both types of alarms as a function of MWL. Regardless of MWL, participants (N = 28) were found to be both faster and more accurate when responding to gesture alarms than to written alarms. Brain electrophysiological results suggest that this greater efficiency might be due to a facilitation of the action execution, reflected by the decrease in mu and beta power observed around the response time window observed at C3 and C4 electrodes. These results suggest that gesture alarms may improve operators' performances in emergency situations.
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Affiliation(s)
- Eve Floriane Fabre
- ISAE-SUPAERO, Neuroergonomics and Human Factors Research Group, DCAS, Toulouse University, France.
| | | | - Valeria Baragona
- ISAE-SUPAERO, Neuroergonomics and Human Factors Research Group, DCAS, Toulouse University, France
| | - Quentin Uhl
- ISAE-SUPAERO, Neuroergonomics and Human Factors Research Group, DCAS, Toulouse University, France
| | - Mickaël Causse
- ISAE-SUPAERO, Neuroergonomics and Human Factors Research Group, DCAS, Toulouse University, France
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Yang Y, Gu S, Sang WL, Liu W, Wu SF. Technical, ergonomic and cognitive learning methodology in transumbilical single-port laparoscopic hysterectomy. Int J Gynaecol Obstet 2023; 163:158-166. [PMID: 37254585 DOI: 10.1002/ijgo.14883] [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: 03/01/2023] [Accepted: 05/09/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE We introduced learning curves on a detailed step protocol and ergonomic aspect to determine key surgical points in transumbilical single-port laparoscopic hysterectomy (TSPLH) and to popularize both technical and cognitive methodology on laparoendoscopic single-site surgery (LESS). MATERIALS AND METHODS A retrospective analysis of 87 TSPLH procedures was conducted by a single surgeon in three learning stages. Technical, ergonomic, and cognitive steps were introduced, and surgical outcomes were analyzed. RESULTS Key production points in TSPLH include developing a clear retroperitoneal space, maintaining appropriate strength and direction with a vaginal manipulator, coagulating the uterine artery, and applying an improved vaginal stump suturing method. Technical factors included instrument domination, hand-eye coordination, and alternating hand functions. Ergonomic techniques focused on shoulder, elbow, arm, wrist, and finger movements, range of motion, muscle power, continuous forces, and flexibility. Improved cognitive factors such as confidence, decision-making, and communication were also observed. CONCLUSIONS The study aimed to form methodological education on TSPLH and LESS and benefit more surgeons. The detailed production and key ergonomic points will help guide self-learning and education.
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Affiliation(s)
- Ye Yang
- Obstetrics and Gynecology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Gu
- Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Lin Sang
- Orthopedics Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Liu
- Educational Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Su Fang Wu
- Obstetrics and Gynecology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Toy S, Ozsoy S, Shafiei S, Antonenko P, Schwengel D. Using electroencephalography to explore neurocognitive correlates of procedural proficiency: A pilot study to compare experts and novices during simulated endotracheal intubation. Brain Cogn 2023; 165:105938. [PMID: 36527783 DOI: 10.1016/j.bandc.2022.105938] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/23/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
The objective of this study was to explore the use of EEG as a measure of neurocognitive engagement during a procedural task. In this observational study, self-reported cognitive load, observed performance, and EEG signatures in experts and novices were compared during simulated endotracheal intubation. Twelve medical students (novices) and eight senior anesthesiology trainees (experts) were included in the study. Experts reported significantly lower cognitive load (P < 0.001) and outperformed novices based on the observational checklist (P < 0.001). EEG signatures differed significantly between the experts and novices. Experts showed a greater increase in delta and theta band amplitudes, especially in temporal and frontal locations and in right occipital areas for delta. A machine learning algorithm showed 83.3 % accuracy for expert-novice skill classification using the selected EEG features. Performance scores were positively correlated (P < 0.05) with event-related amplitudes for delta and theta bands at locations where experts and novices showed significant differences. Increased delta and frontal/midline theta oscillations on EEG suggested that experts had better attentional control than novices. This pilot study provides initial evidence that EEG may be a useful, noninvasive measure of neurocognitive engagement in operational settings and that it has the potential to complement traditional clinical skills assessment.
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Affiliation(s)
- Serkan Toy
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - Sahin Ozsoy
- NeuroField Inc, Santa Barbara, CA, USA; BioSoftPro, LLC, Kensington, MD 20895, USA.
| | - Somayeh Shafiei
- Urology Department of Roswell Park Comprehensive Cancer Center in Buffalo, NY, USA.
| | - Pavlo Antonenko
- Educational Technology, College of Education, University of Florida, Gainesville, FL, USA.
| | - Deborah Schwengel
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Natheir S, Christie S, Yilmaz R, Winkler-Schwartz A, Bajunaid K, Sabbagh AJ, Werthner P, Fares J, Azarnoush H, Del Maestro R. Utilizing artificial intelligence and electroencephalography to assess expertise on a simulated neurosurgical task. Comput Biol Med 2023; 152:106286. [PMID: 36502696 DOI: 10.1016/j.compbiomed.2022.106286] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022]
Abstract
Virtual reality surgical simulators have facilitated surgical education by providing a safe training environment. Electroencephalography (EEG) has been employed to assess neuroelectric activity during surgical performance. Machine learning (ML) has been applied to analyze EEG data split into frequency bands. Although EEG is widely used in fields requiring expert performance, it has yet been used to classify surgical expertise. Thus, the goals of this study were to (a) develop an ML model to accurately differentiate skilled and less-skilled performance using EEG data recorded during a simulated surgery, (b) explore the relative importance of each EEG bandwidth to expertise, and (c) analyze differences in EEG band powers between skilled and less-skilled individuals. We hypothesized that EEG recordings during a virtual reality surgery task would accurately predict the expertise level of the participant. Twenty-one participants performed three simulated brain tumor resection procedures on the NeuroVR™ platform (CAE Healthcare, Montreal, Canada) while EEG data was recorded. Participants were divided into 2 groups. The skilled group was composed of five neurosurgeons and five senior neurosurgical residents (PGY4-6), and the less-skilled group was composed of six junior residents (PGY1-3) and five medical students. A total of 13 metrics from EEG frequency bands and ratios (e.g., alpha, theta/beta ratio) were generated. Seven ML model types were trained using EEG activity to differentiate between skilled and less-skilled groups. The artificial neural network achieved the highest testing accuracy of 100% (AUROC = 1.0). Model interpretation via Shapley analysis identified low alpha (8-10 Hz) as the most important metric for classifying expertise. Skilled surgeons displayed higher (p = 0.044) low-alpha than the less-skilled group. Furthermore, skilled surgeons displayed significantly lower TBR (p = 0.048) and significantly higher beta (13-30 Hz, p = 0.049), beta 1 (15-18 Hz, p = 0.014), and beta 2 (19-22 Hz, p = 0.015), thus establishing these metrics as important markers of expertise. ACGME CORE COMPETENCIES: Practice-Based Learning and Improvement.
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Affiliation(s)
- Sharif Natheir
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
| | - Sommer Christie
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Recai Yilmaz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Khalid Bajunaid
- Department of Surgery, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Abdulrahman J Sabbagh
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Penny Werthner
- University of Calgary, Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Jawad Fares
- Department of Neurological Surgery Feinberg School of Medicine, Northwestern University Chicago, Illinois, USA
| | - Hamed Azarnoush
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Rolando Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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Armstrong BA, Nemrodov D, Tung A, Graham SJ, Grantcharov T. Electroencephalography can provide advance warning of technical errors during laparoscopic surgery. Surg Endosc 2022; 37:2817-2825. [PMID: 36478137 DOI: 10.1007/s00464-022-09799-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intraoperative adverse events lead to patient injury and death, and are increasing. Early warning systems (EWSs) have been used to detect patient deterioration and save lives. However, few studies have used EWSs to monitor surgical performance and caution about imminent technical errors. Previous (non-surgical) research has investigated neural activity to predict future motor errors using electroencephalography (EEG). The present proof-of-concept cohort study investigates whether EEG could predict technical errors in surgery. METHODS In a large academic hospital, three surgical fellows performed 12 elective laparoscopic general surgeries. Audiovisual data of the operating room and the surgeon's neural activity were recorded. Technical errors and epochs of good surgical performance were coded into events. Neural activity was observed 40 s prior and 10 s after errors and good events to determine how far in advance errors were detected. A hierarchical regression model was used to account for possible clustering within surgeons. This prospective, proof-of-concept, cohort study was conducted from July to November 2021, with a pilot period from February to March 2020 used to optimize the technique of data capture and included participants who were blinded from study hypotheses. RESULTS Forty-five technical errors, mainly due to too little force or distance (n = 39), and 27 good surgical events were coded during grasping and dissection. Neural activity representing error monitoring (p = .008) and motor uncertainty (p = .034) was detected 17 s prior to errors, but not prior to good surgical performance. CONCLUSIONS These results show that distinct neural signatures are predictive of technical error in laparoscopic surgery. If replicated with low false-alarm rates, an EEG-based EWS of technical errors could be used to improve individualized surgical training by flagging imminent unsafe actions-before errors occur and cause patient harm.
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Affiliation(s)
- Bonnie A Armstrong
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada.
| | - Dan Nemrodov
- University of Toronto Scarborough, Toronto, ON, Canada
| | - Arthur Tung
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Simon J Graham
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada
| | - Teodor Grantcharov
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Surgery, Clinical Excellence Research Center, Stanford University, Stanford, USA
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10
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Toy S, Huh DD, Materi J, Nanavati J, Schwengel DA. Use of neuroimaging to measure neurocognitive engagement in health professions education: a scoping review. MEDICAL EDUCATION ONLINE 2022; 27:2016357. [PMID: 35012424 PMCID: PMC8757598 DOI: 10.1080/10872981.2021.2016357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/19/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To map the current literature on functional neuroimaging use in medical education research as a novel measurement modality for neurocognitive engagement, learning, and expertise development. METHOD We searched PubMed, Embase, Cochrane, ERIC, and Web of Science, and hand-searched reference lists of relevant articles on April 4, 2019, and updated the search on July 7, 2020. Two authors screened the abstracts and then full-text articles for eligibility based on inclusion criteria. The data were then charted, synthesized, and analyzed descriptively. RESULTS Sixty-seven articles published between 2007 and 2020 were included in this scoping review. These studies used three main neuroimaging modalities: functional magnetic resonance imaging, functional near-infrared spectroscopy, and electroencephalography. Most of the publications (90%, n = 60) were from the last 10 years (2011-2020). Although these studies were conducted in 16 countries, 68.7% (n = 46) were from three countries: the USA (n = 21), UK (n = 15), and Canada (n = 10). These studies were mainly non-experimental (74.6%, n = 50). Most used neuroimaging techniques to examine psychomotor skill development (57%, n = 38), but several investigated neurocognitive correlates of clinical reasoning skills (22%, n = 15). CONCLUSION This scoping review maps the available literature on functional neuroimaging use in medical education. Despite the heterogeneity in research questions, study designs, and outcome measures, we identified a few common themes. Included studies are encouraging of the potential for neuroimaging to complement commonly used measures in education research and may help validate/challenge established theoretical assumptions and provide insight into training methods. This review highlighted several areas for further research. The use of these emerging technologies appears ripe for developing precision education, establishing viable study protocols for realistic operational settings, examining team dynamics, and exploring applications for real-time monitoring/intervention during critical clinical tasks.
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Affiliation(s)
- Serkan Toy
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dana D Huh
- The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Joshua Materi
- The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Julie Nanavati
- Welch Medical Library, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Deborah A. Schwengel
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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11
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Tjønnås MS, Guzmán-García C, Sánchez-González P, Gómez EJ, Oropesa I, Våpenstad C. Stress in surgical educational environments: a systematic review. BMC MEDICAL EDUCATION 2022; 22:791. [PMID: 36380334 PMCID: PMC9667591 DOI: 10.1186/s12909-022-03841-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The effects of stress on surgical residents and how stress management training can prepare residents to effectively manage stressful situations is a relevant topic. This systematic review aimed to analyze the literature regarding (1) the current stress monitoring tools and their use in surgical environments, (2) the current methods in surgical stress management training, and (3) how stress affects surgical performance. METHODS A search strategy was implemented to retrieve relevant articles from Web of Science, Scopus, and PubMed. The 787 initially retrieved articles were reviewed for further evaluation according to the inclusion/exclusion criteria (Prospero registration number CRD42021252682). RESULTS Sixty-one articles were included in the review. The stress monitoring methods found in the articles showed heart rate analysis as the most used monitoring tool for physiological parameters while the STAI-6 scale was preferred for psychological parameters. The stress management methods found in the articles were mental-, simulation- and feedback-based training, with the mental-based training showing clear positive effects on participants. The studies analyzing the effects of stress on surgical performance showed both negative and positive effects on technical and non-technical performance. CONCLUSIONS The impact of stress responses presents an important factor in surgical environments, affecting residents' training and performance. This study identified the main methods used for monitoring stress parameters in surgical educational environments. The applied surgical stress management training methods were diverse and demonstrated positive effects on surgeons' stress levels and performance. There were negative and positive effects of stress on surgical performance, although a collective pattern on their effects was not clear.
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Affiliation(s)
- Maria Suong Tjønnås
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, N-7491, Trondheim, Norway.
- SINTEF Digital, Health Department, Trondheim, Norway.
| | - Carmen Guzmán-García
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Enrique Javier Gómez
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Cecilie Våpenstad
- SINTEF Digital, Health Department, Trondheim, Norway
- Department of Clinical and Molecular Medicine (IKOM), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Anders C, Arnrich B. Wearable electroencephalography and multi-modal mental state classification: A systematic literature review. Comput Biol Med 2022; 150:106088. [PMID: 36137314 DOI: 10.1016/j.compbiomed.2022.106088] [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] [Received: 05/10/2022] [Revised: 08/10/2022] [Accepted: 09/03/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Wearable multi-modal time-series classification applications outperform their best uni-modal counterparts and hold great promise. A modality that directly measures electrical correlates from the brain is electroencephalography. Due to varying noise sources, different key brain regions, key frequency bands, and signal characteristics like non-stationarity, techniques for data pre-processing and classification algorithms are task-dependent. METHOD Here, a systematic literature review on mental state classification for wearable electroencephalography is presented. Four search terms in different combinations were used for an in-title search. The search was executed on the 29th of June 2022, across Google Scholar, PubMed, IEEEXplore, and ScienceDirect. 76 most relevant publications were set into context as the current state-of-the-art in mental state time-series classification. RESULTS Pre-processing techniques, features, and time-series classification models were analyzed. Across publications, a window length of one second was mainly chosen for classification and spectral features were utilized the most. The achieved performance per time-series classification model is analyzed, finding linear discriminant analysis, decision trees, and k-nearest neighbors models outperform support-vector machines by a factor of up to 1.5. A historical analysis depicts future trends while under-reported aspects relevant to practical applications are discussed. CONCLUSIONS Five main conclusions are given, covering utilization of available area for electrode placement on the head, most often or scarcely utilized features and time-series classification model architectures, baseline reporting practices, as well as explainability and interpretability of Deep Learning. The importance of a 'test battery' assessing the influence of data pre-processing and multi-modality on time-series classification performance is emphasized.
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Affiliation(s)
- Christoph Anders
- Hasso Plattner Institute, University of Potsdam, Potsdam, 14482, Brandenburg, Germany.
| | - Bert Arnrich
- Hasso Plattner Institute, University of Potsdam, Potsdam, 14482, Brandenburg, Germany.
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Chikhi S, Matton N, Blanchet S. EEG
power spectral measures of cognitive workload: A meta‐analysis. Psychophysiology 2022; 59:e14009. [DOI: 10.1111/psyp.14009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/13/2021] [Accepted: 01/10/2022] [Indexed: 12/22/2022]
Affiliation(s)
- Samy Chikhi
- Laboratoire Mémoire, Cerveau et Cognition (MC2Lab, URP 7536), Institute of Psychology University of Paris Boulogne‐Billancourt France
| | - Nadine Matton
- CLLE‐LTC University of Toulouse, CNRS (UMR5263) Toulouse France
- ENAC Research Lab École Nationale d’Aviation Civile Toulouse France
| | - Sophie Blanchet
- Laboratoire Mémoire, Cerveau et Cognition (MC2Lab, URP 7536), Institute of Psychology University of Paris Boulogne‐Billancourt France
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14
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Guzmán-García C, Sánchez-González P, Margallo JAS, Snoriguzzi N, Rabazo JC, Margallo FMS, Gómez EJ, Oropesa I. Correlating Personal Resourcefulness and Psychomotor Skills: An Analysis of Stress, Visual Attention and Technical Metrics. SENSORS 2022; 22:s22030837. [PMID: 35161582 PMCID: PMC8838092 DOI: 10.3390/s22030837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 12/10/2022]
Abstract
Modern surgical education is focused on making use of the available technologies in order to train and assess surgical skill acquisition. Innovative technologies for the automatic, objective assessment of nontechnical skills are currently under research. The main aim of this study is to determine whether personal resourcefulness can be assessed by monitoring parameters that are related to stress and visual attention and whether there is a relation between these and psychomotor skills in surgical education. For this purpose, we implemented an application in order to monitor the electrocardiogram (ECG), galvanic skin response (GSR), gaze and performance of surgeons-in-training while performing a laparoscopic box-trainer task so as to obtain technical and personal resourcefulness' metrics. Eight surgeons (6 nonexperts and 2 experts) completed the experiment. A total of 22 metrics were calculated (7 technical and 15 related to personal resourcefulness) per subject. The average values of these metrics in the presence of stressors were compared with those in their absence and depending on the participants' expertise. The results show that both the mean normalized GSR signal and average surgical instrument's acceleration change significantly when stressors are present. Additionally, the GSR and acceleration were found to be correlated, which indicates that there is a relation between psychomotor skills and personal resourcefulness.
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Affiliation(s)
- Carmen Guzmán-García
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Juan A. Sánchez Margallo
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain; (J.A.S.M.); (J.C.R.); (F.M.S.M.)
| | - Nicola Snoriguzzi
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
| | - José Castillo Rabazo
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain; (J.A.S.M.); (J.C.R.); (F.M.S.M.)
| | | | - Enrique J. Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Correspondence: ; Tel.: +34-910-672-458
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Aliakbaryhosseinabadi S, Lontis R, Farina D, Mrachacz-Kersting N. Effect of motor learning with different complexities on EEG spectral distribution and performance improvement. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Jabur RDO, Gonçalves RCG, Faria KW, Semczik IM, Ramacciato JC, Bortoluzzi MC. Single-channel electroencephalography and its associations with anxiety and pain during oral surgery: a preliminary report. J Dent Anesth Pain Med 2021; 21:155-165. [PMID: 33880408 PMCID: PMC8039158 DOI: 10.17245/jdapm.2021.21.2.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 11/15/2022] Open
Abstract
Background This study aimed to assess the course of anxiety and pain during lower third molar (LTMo) surgery and explore the role of mobile and single-channel electroencephalography under clinical and surgical conditions. Methods The State-Trait Anxiety Inventory (STAI), Corah's Dental Anxiety Scale (DAS), and Interval Scale of Anxiety Response (ISAR) were used. The patient self-rated anxiety (PSA), the pain felt during and after surgery, EEG, heart rate (HR), and blood pressure (BP) were assessed. Results The Attention (ATT) and Meditation (MED) algorithms and indicators evaluated in this study showed several associations. ATT showed interactions and an association with STAI-S, pain during surgery, PSA level, HR, and surgical duration. MED showed an interaction and association with DAS, STAI-S, and pain due to anesthesia. Preclinical anxiety parameters may influence clinical perceptions and biological parameters during LTMo surgeries. High STAI-Trait and PSA scores were associated with postoperative pain, whereas high STAI-State scores were associated with more pain during anesthesia and surgery, as well as DAS, which was also associated with patient interference during surgery due to anxiety. Conclusions The findings suggest that single-channel EEG is promising for evaluating brain responses associated with systemic reactions related to anxiety, surgical stress, and pain during oral surgery.
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Affiliation(s)
| | | | | | - Izabelle Millene Semczik
- Science Initiation Program, School of Dentistry, State University of Ponta Grossa (UEPG), Ponta Grossa, Brazil
| | | | - Marcelo Carlos Bortoluzzi
- Health Sciences Post-Graduate Program, State University of Ponta Grossa (UEPG), Ponta Grossa, Brazil.,Dentistry Post-Graduate Program, State University of Ponta Grossa (UEPG), Ponta Grossa, Brazil.,Oral and Maxillofacial Surgery Residency Program at University Hospital of Campos Gerais (HUCG), Ponta Grossa, Brazil
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17
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Instructional Design of Virtual Learning Resources for Anatomy Education. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1317:75-110. [PMID: 33945133 DOI: 10.1007/978-3-030-61125-5_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Virtual learning resources (VLRs) developed using immersive technologies like virtual reality are becoming popular in medical education, particularly in anatomy. However, if VLRs are going to be more widely adopted, it is important that they are designed appropriately. The overarching aim of this study was to propose guidelines for the instructional design of VLRs for anatomy education. More specifically, the study grounded these guidelines within cognitive learning theories through an investigation of the cognitive load imposed by VLRs. This included a comparison of stereoscopic and desktop VLR deliveries and an evaluation of the impact of prior knowledge and university experience. Participants were voluntarily recruited to experience stereoscopic and desktop deliveries of a skull anatomy VLR (UNSW Sydney Ethics #HC16592). A MyndBand® electroencephalography (EEG) headset was used to collect brainwave data and theta power was used as an objective cognitive load measure. The National Aeronautics and Space Administration task load index (NASA-TLX) was used to collect perceptions as a subjective measure. Both objective and subjective cognitive load measures were higher overall for the stereoscopic delivery and for participants with prior knowledge, and significantly higher for junior students (P = 0.038). Based on this study's results, those of several of our previous studies and the literature, various factors are important to consider in VLR design. These include delivery modality, their application to collaborative learning, physical fidelity, prior knowledge and prior university experience. Overall, the guidelines proposed based on these factors suggest that VLR design should be learner-centred and aim to reduce extraneous cognitive load.
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18
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Schmidt HG, Mamede S. How cognitive psychology changed the face of medical education research. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:1025-1043. [PMID: 33244724 PMCID: PMC7704490 DOI: 10.1007/s10459-020-10011-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/27/2020] [Indexed: 05/25/2023]
Abstract
In this article, the contributions of cognitive psychology to research and development of medical education are assessed. The cognitive psychology of learning consists of activation of prior knowledge while processing new information and elaboration on the resulting new knowledge to facilitate storing in long-term memory. This process is limited by the size of working memory. Six interventions based on cognitive theory that facilitate learning and expertise development are discussed: (1) Fostering self-explanation, (2) elaborative discussion, and (3) distributed practice; (4) help with decreasing cognitive load, (5) promoting retrieval practice, and (6) supporting interleaving practice. These interventions contribute in different measure to various instructional methods in use in medical education: problem-based learning, team-based learning, worked examples, mixed practice, serial-cue presentation, and deliberate reflection. The article concludes that systematic research into the applicability of these ideas to the practice of medical education presently is limited and should be intensified.
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Affiliation(s)
- Henk G Schmidt
- Department of Psychology, Erasmus University, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands.
| | - Silvia Mamede
- Department of Psychology, Erasmus University, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands
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19
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Diaz-Piedra C, Sebastián MV, Di Stasi LL. EEG Theta Power Activity Reflects Workload among Army Combat Drivers: An Experimental Study. Brain Sci 2020; 10:E199. [PMID: 32231048 PMCID: PMC7226148 DOI: 10.3390/brainsci10040199] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 12/12/2022] Open
Abstract
We aimed to evaluate the effects of mental workload variations, as a function of the road environment, on the brain activity of army drivers performing combat and non-combat scenarios in a light multirole vehicle dynamic simulator. Forty-one non-commissioned officers completed three standardized driving exercises with different terrain complexities (low, medium, and high) while we recorded their electroencephalographic (EEG) activity. We focused on variations in the theta EEG power spectrum, a well-known index of mental workload. We also assessed performance and subjective ratings of task load. The theta EEG power spectrum in the frontal, temporal, and occipital areas were higher during the most complex scenarios. Performance (number of engine stops) and subjective data supported these findings. Our findings strengthen previous results found in civilians on the relationship between driver mental workload and the theta EEG power spectrum. This suggests that EEG activity can give relevant insight into mental workload variations in an objective, unbiased fashion, even during real training and/or operations. The continuous monitoring of the warfighter not only allows instantaneous detection of over/underload but also might provide online feedback to the system (either automated equipment or the crew) to take countermeasures and prevent fatal errors.
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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 Nursing & Health Innovation, Arizona State University, 550 N. 3rd St., Phoenix, AZ 85004, USA
| | - María Victoria Sebastián
- University Centre of Defence, Spanish Army Academy [Centro Universitario de la Defensa, Academia General Militar], Ctra. de Huesca, s/n, 50090 Zaragoza, 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 (CEMIX UGR-MADOC), C/Gran Via de Colon, 48, 18071 Granada, Spain
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Tao D, Tan H, Wang H, Zhang X, Qu X, Zhang T. A Systematic Review of Physiological Measures of Mental Workload. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2716. [PMID: 31366058 PMCID: PMC6696017 DOI: 10.3390/ijerph16152716] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/21/2019] [Accepted: 07/26/2019] [Indexed: 01/04/2023]
Abstract
Mental workload (MWL) can affect human performance and is considered critical in the design and evaluation of complex human-machine systems. While numerous physiological measures are used to assess MWL, there appears no consensus on their validity as effective agents of MWL. This study was conducted to provide a comprehensive understanding of the use of physiological measures of MWL and to synthesize empirical evidence on the validity of the measures to discriminate changes in MWL. A systematical literature search was conducted with four electronic databases for empirical studies measuring MWL with physiological measures. Ninety-one studies were included for analysis. We identified 78 physiological measures, which were distributed in cardiovascular, eye movement, electroencephalogram (EEG), respiration, electromyogram (EMG) and skin categories. Cardiovascular, eye movement and EEG measures were the most widely used across varied research domains, with 76%, 66%, and 71% of times reported a significant association with MWL, respectively. While most physiological measures were found to be able to discriminate changes in MWL, they were not universally valid in all task scenarios. The use of physiological measures and their validity for MWL assessment also varied across different research domains. Our study offers insights into the understanding and selection of appropriate physiological measures for MWL assessment in varied human-machine systems.
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Affiliation(s)
- Da Tao
- State Key Laboratory of Nuclear Power Safety Monitoring Technology and Equipment, China Nuclear Power Engineering Co., Ltd., Shenzhen 518172, China
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen 518060, China
| | - Haibo Tan
- State Key Laboratory of Nuclear Power Safety Monitoring Technology and Equipment, China Nuclear Power Engineering Co., Ltd., Shenzhen 518172, China
| | - Hailiang Wang
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen 518060, China
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, Shenzhen University, Shenzhen 518060, China
| | - Xu Zhang
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen 518060, China
| | - Xingda Qu
- State Key Laboratory of Nuclear Power Safety Monitoring Technology and Equipment, China Nuclear Power Engineering Co., Ltd., Shenzhen 518172, China
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen 518060, China
| | - Tingru Zhang
- State Key Laboratory of Nuclear Power Safety Monitoring Technology and Equipment, China Nuclear Power Engineering Co., Ltd., Shenzhen 518172, China.
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen 518060, China.
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Rieiro H, Diaz-Piedra C, Morales JM, Catena A, Romero S, Roca-Gonzalez J, Fuentes LJ, Di Stasi LL. Validation of Electroencephalographic Recordings Obtained with a Consumer-Grade, Single Dry Electrode, Low-Cost Device: A Comparative Study. SENSORS (BASEL, SWITZERLAND) 2019; 19:E2808. [PMID: 31234599 PMCID: PMC6630628 DOI: 10.3390/s19122808] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/15/2019] [Accepted: 06/20/2019] [Indexed: 12/25/2022]
Abstract
The functional validity of the signal obtained with low-cost electroencephalography (EEG) devices is still under debate. Here, we have conducted an in-depth comparison of the EEG-recordings obtained with a medical-grade golden-cup electrodes ambulatory device, the SOMNOwatch + EEG-6, vs those obtained with a consumer-grade, single dry electrode low-cost device, the NeuroSky MindWave, one of the most affordable devices currently available. We recorded EEG signals at Fp1 using the two different devices simultaneously on 21 participants who underwent two experimental phases: a 12-minute resting state task (alternating two cycles of closed/open eyes periods), followed by 60-minute virtual-driving task. We evaluated the EEG recording quality by comparing the similarity between the temporal data series, their spectra, their signal-to-noise ratio, the reliability of EEG measurements (comparing the closed eyes periods), as well as their blink detection rate. We found substantial agreement between signals: whereas, qualitatively, the NeuroSky MindWave presented higher levels of noise and a biphasic shape of blinks, the similarity metric indicated that signals from both recording devices were significantly correlated. While the NeuroSky MindWave was less reliable, both devices had a similar blink detection rate. Overall, the NeuroSky MindWave is noise-limited, but provides stable recordings even through long periods of time. Furthermore, its data would be of adequate quality compared to that of conventional wet electrode EEG devices, except for a potential calibration error and spectral differences at low frequencies.
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Affiliation(s)
- Héctor Rieiro
- Department of Signal Theory and Communications, University of Vigo, 36310 Vigo, Spain.
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain.
| | - Carolina Diaz-Piedra
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain.
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA.
| | - José Miguel Morales
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain.
- Department of Computer Architecture and Technology, University of Granada, 18071 Granada, Spain.
| | - Andrés Catena
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain.
| | - Samuel Romero
- Department of Computer Architecture and Technology, University of Granada, 18071 Granada, Spain.
| | - Joaquin Roca-Gonzalez
- Department of Bioengineering, Technical University of Cartagena, 30202 Cartagena, Spain.
| | - Luis J Fuentes
- Department of Basic Psychology and Methodology, University of Murcia, 30100 Murcia, Spain.
| | - Leandro L Di Stasi
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain.
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