Brittany L. Anderson-Montoya

Developing a coaching mechanism for practicing surgeons

BACKGROUND While performance feedback and assessment are hallmarks of surgical training, they abruptly cease after training is completed. In their absence, performance may stagnate and poor habits persist. Our aim was to develop a coaching mechanism for practicing surgeons with feedback provision based on objective performance assessment. METHODS Technical and nontechnical intraoperative video recordings from laparoscopic or robotic cholecystectomies, colectomies, and hysterectomies were assessed by a blinded surgeon and a human factors expert, respectively. Aspects of performance in need of improvement were noted, and a coaching session was developed for feedback provision to participating surgeons. This 4-hour coaching session consisted of a didactic lecture with video review and hands-on practice using procedural and mannequin-based simulation. RESULTS Thirty-two practicing surgeons (18 general; 14 gynecologists) from 6 different hospitals were assessed, and 9 of them participated in coaching. Technical aspects identified for performance improvement included suboptimal trocar placement, inadequate critical view achievement during laparoscopic cholecystectomies, poor visualization of the operating field, bimanual dexterity, and dissection techniques, while nontechnical aspects included inappropriate handling of distractions and interruptions, poor ergonomic positioning and situational awareness, and inadequate mitigation of delays. Most surgeons appropriately accomplished some of the objectives of the distraction scenario, but none was able to achieve expert levels on Fundamentals of Laparoscopy tasks. Participants perceived the coaching sessions as highly valuable. CONCLUSION Our study identified several technical and nontechnical skill sets of practicing surgeons in need of improvement and provided support for the implementation of coaching programs for surgeons on an ongoing basis.

Resident handoff training: initial evaluation of a novel method.

Introduction:Residencies are required to have a standardized process for transitioning patient care. This study was designed to assess a novel method of training and evaluating handoffs using both a lecture format and standardized patient (SP) interactions. Methods:Matched group design was used to randomly assign interns to trained versus control groups, with the trained group receiving formal handoff training before SP encounters. The residents evaluated three ER SPs and read four written scenarios and then transitioned patients to an SP acting as a resident. All handoffs were videotaped and scored by two blind raters using a rating scale developed based on specialists interviews. Results:Thirty-two interns were included in the study. The trained interns performed significantly better with lower scores on patient handoffs (mean = 10.08, SD = 2.46) than the untrained interns (mean = 16.56, SD = 2.79). There was also a significant effect for case, with the ER SP cases (mean = 12.23, SD = 14.41) resulting in better performance than the written cases in both surgery and pediatrics (mean = 14.41, SD = 4.29). Conclusions:A protocol was designed and implemented for training residents to perform handoffs, with initial results showing that the curriculum is effective.

The Influence of Visual Aids on Detecting Early and Late Decelerations in Maternal-Fetal Heart Rate Patterns

The present study examined how well individuals could differentiate between two different types of signals (early and late decels) in maternal-fetal heart rate tracings with and without the use of a visual aid. Twenty-one undergraduates twice viewed 80 simulated images under four different signal-to-noise (S/N) ratios. Further, the late decels were delayed in 4-sec increments. In one block of trials, the images were presented without a visual aid, and in the other block a visual aid consisting of a large turquoise crosshair was overlaid on the images. The results indicated that lower S/N ratios and shorter onset delays made signals more difficult to distinguish. However, overall levels of accuracy were significantly higher when the visual aid was present. These results provide initial evidence that utilizing visual aids can enhance the ability to detect critical signals in maternal-fetal heart rate patterns.

Qualitative Assessment of Face Validity and Cross-Cultural Acceptability of the Faces Pain Scale: “Revised” in Cameroon:

The Faces Pain Scale–Revised (FPS-R) is a self-report pain scale validated in numerous countries, but not in Cameroon. We postulated that while cultural factors influence pain perception and expression, the FPS-R should remain culturally acceptable for pediatric use. A convenience sample of 36 pediatric patients, aged 4 to 16 years, representing three primary language groups, was enrolled at Mbingo Baptist Hospital (MBH). Pre- and postanalgesia FPS-R scores and vital signs were obtained. Audio-recorded cognitive interviews were performed with each participant. Written questionnaires were also provided to physicians, nurses, and caretakers to further explore cultural perceptions of pain. Four independent reviewers analyzed interview transcripts and questionnaires using inductive reasoning and identified common themes pertaining to gender differences, societal roles, and pain perception. Basic comprehension of the FPS-R was present across language groups, vital sign changes corresponded with FPS-R alterations, and the FPS-R appears intuitive for pediatric use.

Running Memory for Clinical Handoffs: A Look at Active and Passive Processing:

Objective: The goal of the present study was to examine the effects of domain-relevant expertise on running memory and the ability to process handoffs of information. In addition, the role of active or passive processing was examined. Background: Currently, there is little research that addresses how individuals with different levels of expertise process information in running memory when the information is needed to perform a real-world task. Method: Three groups of participants differing in their level of clinical expertise (novice, intermediate, and expert) performed an abstract running memory span task and two tasks resembling real-world activities, a clinical handoff task and an air traffic control (ATC) handoff task. For all tasks, list length and the amount of information to be recalled were manipulated. Results: Regarding processing strategy, all participants used passive processing for the running memory span and ATC tasks. The novices also used passive processing for the clinical task. The experts, however, appeared to use more active processing, and the intermediates fell in between. Conclusion: Overall, the results indicated that individuals with clinical expertise and a developed mental model rely more on active processing of incoming information for the clinical task while individuals with little or no knowledge rely on passive processing. Application: The results have implications about how training should be developed to aid less experienced personnel identify what information should be included in a handoff and what should not.

The Influence of a Crosshair Visual Aid on Observer Detection of Simulated Fetal Heart Rate Signals

Objective To determine whether a visual aid overlaid on fetal heart rate (FHR) tracings increases detection of critical signals relative to images with no visual aid. Study Design In an experimental study, 21 undergraduate students viewed 240 images of simulated FHR tracings twice, once with the visual aids and once without aids. Performance was examined for images containing three different types of FHR signals (early deceleration, late deceleration, and acceleration) and four different FHR signal-to-noise ratios corresponding to FHR variability types (absent, minimal, moderate, and marked) identified by the National Institute of Child Health and Human Development (2008). Performance was analyzed using repeated-measures analyses of variance. Results The presence of the visual aid significantly improved correct detections of signals overall and decreased false alarms for the marked variability condition. Conclusion The results of the study provide evidence that the presence of a visual aid was useful in helping novices identify FHR signals in simulated maternal-fetal heart rate images. Further, the visual aid was most useful for conditions in which the signal is most difficult to detect (when FHR variability is highest).

User Placement of a Visual Aid for Detecting Critical Signals in Fetal-Heart Rate Tracings A Yoke-Control Study

The present study examined the ability of participants to detect critical signals embedded within dynamic fetal-heart rate (FHR) tracings using a visual aid. Participants inspected tracings for deviations in the FHR under different levels of heart rate variability. One group was given control over placement of the visual aid. A second yoke-control group monitored the same presentation of critical signals and aid placements but could not alter the visual aids. In phase 1, student participants placed the aid and in phase 2 the experimenter placed the aid. Performance was compared to a control group that had no aids. The results showed that no group detected all critical signals but those who placed the aid performed better than those who had no aid across all levels of heart rate variability. However, the benefit of the visual aid for the yoke-control participants was limited to the condition where the experimenter placed the aid. These results suggest that a visual aid can improve performance, but that it does not completely overcome the challenge detecting critical signals in FHR tracings.

Observer’s Performance and Perceptual Sensitivity for Detecting Critical Patterns in Static Maternal-Fetal Heart Rate Images

The present study examined detection performance and perceptual sensitivity for critical patterns in maternal-fetal heart rate (MFHR) signals in single and combined formats. Forty-one undergraduate students viewed simulated images of MFHR signals under four different signal-to-noise (S/N) ratios. The images contained an acceleration, early deceleration, late deceleration, or no deviation. Further, the deviations varied in amplitude. The results showed that as variability increased and amplitude decreased perceptual sensitivity also decreased and participants experienced reduced ability to detect signals and committed more false alarms. These effects were more pronounced when performing the combined condition compared to the single condition. These findings highlight that interpretation of MFHR signals is subject to misinterpretation and underscores the need for countermeasures.