Rebecca A. Kennedy

Intracorporeal suturing: Transfer from Fundamentals of Laparoscopic Surgery to cadavers results in substantial increase in mental workload.

INTRODUCTION A spatial secondary task developed by the authors was used to measure the mental workload of the participant when transferring suturing skills from a box simulator to more realistic surgical conditions using a fresh cadaver. We hypothesized that laparoscopic suturing on genuine bowel would be more challenging than on the Fundamentals of Laparoscopic Surgery (FLS)-simulated bowel as reflected in differences on both suturing and secondary task scores. METHODS We trained 14 surgical assistant students to FLS proficiency in intracorporeal suturing. Participants practiced suturing on the FLS box for 30 minutes and then were tested on both the FLS box and the bowel of a fresh cadaver using the spatial, secondary dual-task conditions developed by the authors. RESULTS Suturing times increased by >333% when moving from the FLS platform to the cadaver F(1,13) = 44.04, P < .001. The increased completion times were accompanied by a 70% decrease in secondary task scores, F(1,13) = 21.21, P < .001. CONCLUSION The mental workload associated with intracorporeal suturing increases dramatically when trainees transfer from the FLS platform to human tissue under more realistic conditions of suturing. The increase in mental workload is indexed by both an increase in suturing times and a decrease in the ability to attend to the secondary task.

Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial.

OBJECTIVES To assess advanced communication skills among second-year medical students exposed either to a computer simulation (MPathic-VR) featuring virtual humans, or to a multimedia computer-based learning module, and to understand each groups experiences and learning preferences. METHODS A single-blinded, mixed methods, randomized, multisite trial compared MPathic-VR (N=210) to computer-based learning (N=211). Primary outcomes: communication scores during repeat interactions with MPathic-VRs intercultural and interprofessional communication scenarios and scores on a subsequent advanced communication skills objective structured clinical examination (OSCE). Multivariate analysis of variance was used to compare outcomes. SECONDARY OUTCOMES student attitude surveys and qualitative assessments of their experiences with MPathic-VR or computer-based learning. RESULTS MPathic-VR-trained students improved their intercultural and interprofessional communication performance between their first and second interactions with each scenario. They also achieved significantly higher composite scores on the OSCE than computer-based learning-trained students. Attitudes and experiences were more positive among students trained with MPathic-VR, who valued its providing immediate feedback, teaching nonverbal communication skills, and preparing them for emotion-charged patient encounters. CONCLUSIONS MPathic-VR was effective in training advanced communication skills and in enabling knowledge transfer into a more realistic clinical situation. PRACTICE IMPLICATIONS MPathic-VRs virtual human simulation offers an effective and engaging means of advanced communication training.

A Spatial Secondary Task for Measuring Laparoscopic Mental Workload Differences in Surgical Experience

The present study examined whether a spatial secondary task could distinguish among different levels of laparoscopic skill. Novices and surgeons with different levels of laparoscopic experience were asked to perform a peg transfer task on a laparoscopic simulator along with the secondary task. The results showed that novices performed more poorly than the surgeons on both the primary peg task and the secondary task. This pattern of results suggests that the primary task was more difficult for the novices leaving fewer attentional resources for the secondary task. Moreover, the results show that the spatial secondary task used in this study is sensitive to differences in mental resources required by individuals with different levels of laparoscopic surgical skill.

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.

Effects of a retention interval and refresher session on intracorporeal suturing and knot tying skill and mental workload

Background. The effects of refraining from practice for different intervals on laparoscopic suturing and mental workload was assessed with a secondary task developed by the authors. We expected the inability to practice to produce a decrease in performance on the suturing, knot tying, and secondary task and skills to rebound after a single refresher session. Methods. In total, 22 surgical assistant and premedical students trained to Fundamentals of Laparoscopic Surgery proficiency in intracorporeal suturing and knot tying were assessed on that task using a secondary task. Participants refrained from practicing any Fundamentals of Laparoscopic Surgery tasks for 1 or 5 months. At the time of their return, they were assessed immediately on suturing and knot tying with the secondary task, practiced suturing and knot tying for 40 minutes, and then were reassessed. Results. The mean suture times from the initial reassessment were greater than the proficiency times but returned to proficiency levels after one practice session, F(2, 40) = 14.5, P < .001, partial &eegr;2 = .420. Secondary task scores mirrored the results of suturing time, F(2, 40) = 6.128, P < .005, partial &eegr;2 = .235, and were moderated by retention interval. Conclusion. When participants who reached proficiency in suturing and knot tying were reassessed after either 1or 5 months without practice, their performance times increased by 35% and secondary task scores decreased by 30%. These deficits, however, were nearly reversed after a single refresher session.

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).

Laparoscopic Skill and Mental Workload Measured over Retention Interval

Methods: Fourteen students (3 males, 12 females; ages 23Y28 years) from EasternVirginiaMedical School’sMaster of Surgical Assisting Program participated in this IRBapproved study. Participants prac ...

Board 419 - Research Abstract Initial Measures of Mental Workload on Simulated Laparoscopic Tasks (Submission #632)

Introduction/Background Scerbo et al. have used a secondary task to measure mental workload on laparoscopic tasks.1,2 This method is based on multiple resource theory, which states that when two tasks making similar demands on attention are performed simultaneously, they can interfere with one another and increase mental workload.3 Thus, a secondary task requiring the same attentional resources needed for laparoscopy (i.e., judging the spatial positions of objects on a 2D display) should be sensitive to differences in mental workload. In this study, a spatial secondary task was used to assess the mental workload on three tasks from the Fundamentals of Laparoscopic Surgery: peg transfer, cutting and intracorporeal suturing, which are considered to differ from one another by an increasing order of difficulty. The objective was to show that the secondary task could distinguish differences in mental workload corresponding to the difficulty levels of these laparoscopic tasks. Methods Fourteen surgical assistant students with no prior laparoscopic experience participated in this IRB approved, repeated measures study. They practiced the peg transfer, cutting circles and intracorpreal suturing tasks on box trainers for 30-40 minutes each and were assessed with the secondary task at the end of the session. The secondary task presents four balls in a simulated tunnel, superimposed at 50% transparency over the laparoscopic display. The balls are presented for 300 msec approximately every 4 sec. On half of the presentations, one ball changes its position and participants respond to that change by pressing a foot pedal. The secondary task was performed by itself and in conjunction with the laparoscopic tasks. Results A repeated measures ANOVA was used to analyze the data shown in Figure 1. Completion time differences were statistically significant, F(2, 26) = 10.62,p < .001, partial &eegr;2 = .745. Alpha-corrected post hoc tests showed that peg task times were lower than those for the other two tasks, which were statistically equivalent. Differences in secondary task scores were statistically significant, F(3, 39) = 69.18,p < .001, partial &eegr;2 = .918. Scores for the combined secondary task conditions were all lower than baseline and consistent with predictions, but the post hoc tests showed that only the peg and suture tasks differed significantly. Conclusion The Results show that the spatial secondary task was sensitive to the mental workload associated with initial performance on the different laparoscopic tasks. Secondary task scores declined when performed in conjunction with any laparoscopic task. Students completed the peg task quicker than the other two tasks, resulting in lower mental workload as indexed by higher secondary task scores (at least compared to the suturing task). These Results suggest that the spatial secondary task offers an objective index of mental workload that can complement traditional measures of performance on laparoscopic tasks. References 1. Prytz, E, Montano, M., Kennedy, R., Scerbo, M., Britt, R., Davis, S., & Stefanidis, D. (2012). Using a spatial task to measure laparoscopic mental workload: Initial Results. Simulation in Healthcare, 7, 511. 2. Stefanidis, D., Scerbo, M.W., Smith, W., Acker, C.E., & Montero, P.N. (2012). Simulator training to automaticity leads to improved skill transfer compared with traditional proficiency-based training: A randomized controlled trial. Annals of Surgery, 255, 30-37. 3. Wickens, C. D. (2002). Multiple resources and performance prediction. Theoretical Issues in Ergonomic Science, 3, 159-177. Disclosures Medical Cyberworlds, Inc. Gore, Bard honoraria for teaching.

Board 386 - Research Abstract Measuring Changes in Skill Acquisition and Mental Workload on Two Laparoscopic Tasks (Submission #628)

Introduction/Background Laparoscopy places significant demands on visual attention and requires extensive practice to become proficient. Scerbo et al. have developed a method of assessing mental workload with a secondary task that requires spatial abilities.1,2 The task is based on multiple resource theory, which states that “pools” of attentional resources are distinguished by: information processing stages, verbal/spatial codes, and visual/auditory modalities.3 When two tasks performed simultaneously require the same pool of resources, they can interfere with one another and increase mental workload. Thus, when a secondary task requiring the same attentional resources needed for laparoscopy is performed with a laparoscopic task, it can provide an index of mental workload. Our goal was to use a spatial secondary task to measure mental workload during the initial acquisition of basic laparoscopic skills on a simulator. Performance on two laparoscopic tasks differing in difficulty was measured across training sessions. We hypothesized that mental workload would initially be high (and more so on the difficult task) but would decline over sessions as trainees became more proficient as indexed by secondary task performance. Methods Fourteen surgical assistant students with no prior laparoscopic experience participated in this IRB approved, repeated measures study. They practiced cutting (high difficulty) and peg transfer (low difficulty) tasks from the Fundamentals of Laparoscopic Surgery for approximately 45 min over 11 sessions and were assessed with the secondary task at the end of each session. The secondary task presented observers with four balls in a simulated tunnel, superimposed at 50% transparency over the laparoscopic display. The balls were presented for 300 msec approximately every 4 sec. On half the presentations, one ball changed its position and participants responded to that change by pressing a foot pedal. They performed the secondary task by itself and in conjunction with the laparoscopic tasks. Results All data were analyzed with a 2 Condition x 11 Session repeated measures ANOVA. There was a significant effect for laparoscopic tasks, F(1,11) = 15.72, p = .002, partial Æž2 =.59. Completion times were faster for the peg (M = 102.57 sec, SE = 5.30) than the cutting task (M = 121.90 sec, SE = 5.08). Times declined significantly over sessions, F(10,110) = 38.88, p < .001, partial Æž2 =.77, but leveled off by the sixth and second sessions for the peg and cutting tasks, respectively. There were significant effects for the secondary task scores, F(1,12) = 31.88, p = .000, partial Æž2 =.73. The proportion of correct responses for cutting (M = .36, SE = .07) was lower than for pegs (M = .46, SE = .07), and scores on both tasks were lower than the secondary task performed by itself. Scores increased over sessions,F(10,120) = 3.11, p = .001, partial Æž2 =.21; but only the difference between the first (M = .31, SE = .05) and eleventh session (M = .45, SE = .07) was significant. Conclusion The Results show that performance on the peg and cutting tasks reached a plateau midway through the training sessions. The findings for the spatial secondary task supported expectations. Workload was initially higher (lowers scores) and remained higher for the more difficult cutting task and although the scores increased over sessions for both tasks, the improvements were modest. These Results show that the mental workload experienced by novices practicing laparoscopic tasks may be quite high. They also support findings obtained by Stefanidis et al. on a suturing task who observed high levels of mental workload by novices who had met their training goals.2 Collectively, these findings show that the spatial secondary task provides an objective index of mental workload, offering a broader picture of laparoscopic skill acquisition. References 1. Scerbo, M.W., Croll, M.M., Garcia, H.M., Stefanidis, D., Britt, R. C., & Davis, S. S. (2012). A spatial task for measuring laparoscopic mental workload. Simulation in Healthcare, 7, 558. 2. Stefanidis, D., Scerbo, M.W., Smith, W., Acker, C.E., & Montero, P.N. (2012). Simulator training to automaticity leads to improved skill transfer compared with traditional proficiency-based training: A randomized controlled trial. Annals of Surgery, 255, 30–37. 3. Wickens, C. D. (2002). Multiple resources and performance prediction. Theoretical Issues in Ergonomic Science, 3, 159–177. Disclosures Medical Cyberworlds, Inc. Gore, Bard honoraria for teaching.

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.