Joseph F. Martinez

Stereoscopic vision display technology in real-time three-dimensional echocardiography-guided intracardiac beating-heart surgery

OBJECTIVE Stereoscopic vision display technology has been shown to be a useful tool in image-guided surgical interventions. However, the concept has not been applied to 3-dimensional echocardiography-guided cardiac procedures. We evaluated stereoscopic vision display as an aid for intracardiac navigation during 3-dimensional echocardiography-guided beating-heart surgery in a model of atrial septal defect closure. METHODS An atrial septal defect (6 mm) was created in 6 pigs using 3-dimensional echocardiography guidance. The defect was then closed using a catheter-based patch delivery system, and the patch was attached with tissue mini-anchors. Stereoscopic vision was generated with a high-performance volume renderer with stereoscopic glasses. Three-dimensional echocardiography with stereoscopic vision display was compared with 3-dimensional echocardiography with standard display for guidance of surgical repair. Task performance measures for each anchor placement (N = 32 per group) were completion time, trajectory of the tip of the anchor deployment device, and accuracy of the anchor placement. RESULTS The mean time of the anchor deployment for stereoscopic vision display group was shorter by 44% compared with the standard display group: 9.7 +/- 0.9 seconds versus 17.2 +/- 0.9 seconds (P < .001). Trajectory tracking of the anchor deployment device tip demonstrated greater navigational accuracy measured by trajectory deviation: 3.8 +/- 0.7 mm versus 6.1 +/- 0.3 mm, 38% improvement (P < .01). Accuracy of anchor placement was not significantly different: 2.3 +/- 0.3 mm for the stereoscopic vision display group versus 2.3 +/- 0.3 mm for the standard display group. CONCLUSION Stereoscopic vision display combined with 3-dimensional echocardiography improved the visualization of 3-dimensional echocardiography ultrasound images, decreased the time required for surgical task completion, and increased the precision of instrument navigation, potentially improving the safety of beating-heart intracardiac surgical interventions.

Examining the Feasibility and Predictive Validity of the SAGAT Tool to Assess Situation Awareness Among Medical Trainees.

Introduction Situational awareness (SA) describes a teams ability to perceive environmental elements, comprehend their meaning, and anticipate future events. Although SA is consistently described as a critical competency among surgical teams, there is a dearth of research identifying efficacious methods to assess and develop SA in such settings. The aim of this study was to investigate the feasibility of implementing an objective tool that has been used to measure SA in other intense and dynamic environments —the Situation Awareness Global Assessment Technique (SAGAT)—and to examine its ability to predict surgical trainee team performance. Methods Ten team-training sessions were conducted involving 2 standardized high-fidelity trauma simulation scenarios. Teams consisted of 4 or 5 participants, and roles were randomly assigned. Team situational awareness was assessed using the SAGAT method, which involves intermittent freezes to probe trainee awareness of the situation. Team performance was assessed using the Mayo High-Performance Teamwork Scale. Hierarchical regression was used to examine SA-performance relationships for each scenario. Results Forty-three third-year medical students participated in the training sessions. Team SA ranged from 45% to 79% and 46% to 97% for the first and second scenarios, respectively. Additionally, team SA significantly predicted team performance for both the first scenario (F(1, 42)=19.57; P<0.001; R2=0.30) and second scenario (F(1,42)=26.18, P<0.001; R2=0.38). Conclusions The SAGAT is a valid, reliable tool for assessing surgical trainee SA. Information provided by the SAGAT can help diagnose team performance problems, inform debriefing discussion points, and inform curriculum development endeavors.

Setting goals, not just roles: Improving teamwork through goal-focused debriefing ☆

INTRODUCTION The role of goal setting within post-simulation debriefing is not well known. This study sought to examine how inclusion of group-level goals, individual-level goals, or no goals in the debriefing process impacts teamwork. METHODS Students participated in two high-fidelity team training scenarios. Between scenarios, teams were assigned to one of three debriefing groups: jointly creating five teamwork goals for the group to achieve (group-level goals); independently creating five teamwork goals for each individual to attain (individual-level goals); or no goals. Paired-samples t tests and one-way ANOVA with post-hoc Tukey tests were used to examine performance improvements and differences between groups. RESULTS 86 MS3s participated in the training program across 22 groups. Percentage of items achieved on the teamwork tool from first to second scenario were 61.7±20.4 to 60.2±8.8 (no goals; ns), 59.8±14.0 to 76.8±7.0 (individual goals; p<0.01), and 62.5±9.5 to 67.0±10.0 (group goals; ns). Performance improvement in the individual goals group was significantly higher than the no goals group (p<0.05). CONCLUSIONS Debriefing facilitators should encourage learners to focus on creating and achieving personal goals contributing to teamwork.