Medical University of South Carolina Charleston, South Carolina
Objective: To measure surgical instrument movement during resident mastoidectomies and identify metrics that correlate with experience.
Study Design: Retrospective case series
Setting: Tertiary care center
Subjects: Ten PGY2, six PGY3, seven PGY4, and nineteen PGY5 otolaryngology residents Interventions: One-minute intraoperative recordings of mastoidectomies performed during cochlear implantation were collected. Drill and suction-irrigator motion were analyzed with sports motion tracking software.
Main Outcome Measures: Instrument speed, acceleration, distance travelled, angle, and angular velocity were calculated. Mann-Whitney U tests were used to compare mean instrument metrics between PGY levels. Change in drill distance, speed, and acceleration over time for seven residents were individually analyzed.
Results: The mean drill distance, speed and acceleration increased from 11.0 cm, 1.8 cm/s, and 13.8 cm/s2 for PGY2s to 18.4 cm, 2.9 cm/s and 29.1 cm/s2 for PGY5s (p = 0.0007, p = 0.001, p = 0.0008, respectively). The mean suction-irrigator distance travelled increased from 5.8 cm for PGY2s to 9.0 cm for PGY4s (p = 0.04), but decreased to 7.9 cm for PGY5s (p=0.2). Mean suction-irrigator speed increased from 1.0 cm/s for PGY2s to 1.5 cm/s for PGY4s (p = 0.04), then decreased to 1.2 cm/s for PGY5s (p=0.2). Of the seven residents individually analyzed, drill distance, speed, and acceleration increased for five, six and seven residents, respectively. Group mean drill distance, speed, and acceleration improved by 3.3 cm, 0.2 cm/s, and 5.7 cm/s2 yearly.
Conclusions: Drill movement metrics increase with resident experience level and can differentiate novices from more experienced surgeons. These and other objective metrics could be used to evaluate and monitor surgical skills progress.
*Professional Practice Gap & Educational Need: Objective measures of surgical performance are lacking. Resident education continues to rely on subjective forms of feedback to monitor progress and influence promotion and certification.
*Learning Objective: To understand the application of objective video analysis for measuring surgical instrument movement; to compare objective measures of resident surgical instrument movement across experience levels; to understand the variation in progress of surgical instrument movement amongst resident experience level.
*Desired Result: Attendees should appreciate the application of objective video analysis for measuring surgical instrument movement, be able to compare objective measures of resident surgical instrument movement across experience levels, and understand the variation in progress of surgical instrument movement amongst resident experience level.
*Level of Evidence:Level V
*Indicate IRB or IACUC: Approved - IRB Pro00068069 on 10/02/2017 at the Medical University of South Carolina.