Original Homebuilt Off-the-Job Training System for Vascular Surgeons: System Analysis and Assessment

Concurrent validity of objective assessment by finger tracking for open surgical suturing training

BACKGROUND

The aim of this study is to evaluate whether the parameters 'time' and 'distance', measured by SurgTrac, correlate with the assessment of the same skills by blinded experts.

METHODS

Basic open suturing tasks were executed by medical students. SurgTrac software measured objective parameters by tracking fingers. The executed tasks were recorded by a tablet and additionally assessed by a blinded expert with a Competency Assessment Tool-form (CAT-form). A Pearson's correlation was used to investigate the correlation between the parameters and the outcomes of the expert assessment.

RESULTS

A strong correlation between the measured parameters of SurgTrac and the expert-assessment was found for knot tying by hand (r ​= ​-0.703) and vertical mattress suture (r ​= ​-0.644) and a moderate correlation for transcutaneous suture (r ​= ​-0.555) and intracutaneous suture (r ​= ​-0.451).

CONCLUSION

The use of finger tracking by SurgTrac showed a good concurrent validity for the basic open suturing tasks knot tying by hand, transcutaneous suture and vertical mattress suture.

Motion capture device reveals a quick learning curve in vascular anastomosis training

PURPOSE

Surgical procedures are often evaluated subjectively, and an objective evaluation has been considered difficult to make and rarely reported, especially in open surgery, where the range of motion is wide. This study evaluated the effectiveness of surgical suturing training as an educational tool using the Leap Motion Controller (LMC), which can capture hand movements and reproduce them as data comprising parametric elements.

METHODS

We developed an off-the-job training system (Off-JT) in our department, mainly using prosthetic grafts and various anastomotic methodologies with graded difficulty levels. We recruited 50 medical students (novice group) and 6 vascular surgeons (expert group) for the study. We evaluated four parameters for intraoperative skills: suturing time, slope of the roll, smoothness, and rate of excess motion.

RESULTS

All 4 parameters distinguished the skill of the novice group at 1 and 10 h off-JT. After 10 h of off-JT, all 4 parameters of the novices were comparable to those of the expert group.

CONCLUSION

Our education system using the LMC is relatively inexpensive and easy to set up, with a free application for analyses, serving as an effective and ubiquitous educational tool for young surgeons.

Motion analysis of suturing technique with Leap Motion ControllerTM. Proof-of-concept

PURPOSE

Leap Motion Controller is a device that can capture hand gestures and reproduce these as data comprising several parametric elements. We analyzed surgical suture motion using this device and investigated the optical methodology for clinical applications.

METHODS

We recruited medical students and residents (novice group) and vascular surgeons (specialist group). The operators applied sutures once on a prosthetic graft, and the captured motion was analyzed.

RESULTS

Ten novices, who each received procedural instruction for at least 2 h, and 10 specialists were recruited. The hand gesture consisted of four elements (roll, pitch, yaw, and wrist angle). Since "roll" was the only element in this simple suture movement that showed some difference between the two groups, we analyzed three parameters: (1) the suturing time, (2) the difference in the degree between two piercing points, and (3) slope of the roll. We found that the specialist group demonstrated significantly shorter suturing times and a larger degree of the slope.

CONCLUSION

Leap Motion Controller analysis with the roll revealed that the novices could use the roll motion after only 2 h of instruction; however, the suturing speed and smoothness were secondary to those of the specialists.

Association of off-the-job training with work performance and work-family conflict among physicians: a cross-sectional study in China

OBJECTIVES

To determine whether experiences of off-the-job training in domestic (DT) and overseas study (OS) settings are associated with work performance and work-family conflict in physicians.

DESIGN, SETTING AND PARTICIPANTS

We conducted a national cross-sectional survey in 77 public hospitals across seven provinces in China between July 2014 and April 2015. Participants were 3182 physicians.

EXPOSURE

Participants were categorised into four groups: none, DT only, OS only and DT and OS.

PRIMARY OUTCOME MEASURES

Work performance was assessed by work engagement, career attrition and patient-centred care. Work-family conflict was assessed by affecting care for family, feeling guilty towards family and receiving complaints from family.

RESULTS

A total of 25.89% participants had experienced DT only, 8.71% OS only and 8.47% DT and OS. After adjustment for potential confounders, participants who had experiences of DT and OS compared with those with no training were more likely to report positive work performance (pride in work: OR=2.11, 95% CI: 1.43 to 3.10; enjoyment of work: OR=1.67, 95% CI: 1.11 to 2.51; turnover intention: OR=0.54, 95% CI: 0.38 to 0.77; early retirement: OR=0.63, 95% CI: 0.45 to 0.89; and exhaustion: OR=0.66, 95% CI: 0.45 to 0.98) and less work-family conflicts (feeling guilty towards family: OR=0.51, 95% CI: 0.35 to 0.74; and complaints from family: OR=0.66, 95% CI: 0.47 to 0.91). We found no obvious association between DT/OS experience with patient-centred care.

CONCLUSIONS

Physicians with DT and OS experiences are more likely to have better work performance and less work-family conflict than those without such experience. Physicians face increasing pressure to pursue continuing education and experience associated distress. Therefore, hospitals and government policy-makers should promote DT and OS.