Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor–trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons’ psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentals of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as well as optimize their already overloaded training schedules.

Adaptive neuro-fuzzy inference systems (ANFIS) for supervised classification of competence in MIS based on psychomotor skills

INTRODUCTION: Objective assessment of motor skills has become an important challenge in minimally invasive surgery (MIS) training.Currently, there is no gold standard defining and determining the residents' surgical competence.To aid in the decision process, we analyze the validity of a supervised classifier to determine the degree of MIS competence based on assessment of psychomotor skills METHODOLOGY: The ANFIS is trained to classify performance in a box trainer peg transfer task performed by two groups (expert/non expert). There were 42 participants included in the study: the non-expert group consisted of 16 medical students and 8 residents (< 10 MIS procedures performed), whereas the expert group consisted of 14 residents (> 10 MIS procedures performed) and 4 experienced surgeons. Instrument movements were captured by means of the Endoscopic Video Analysis (EVA) tracking system. Nine motion analysis parameters (MAPs) were analyzed, including time, path length, depth, average speed, average acceleration, economy of area, economy of volume, idle time and motion smoothness. Data reduction was performed by means of principal component analysis, and then used to train the ANFIS net. Performance was measured by leave one out cross validation. RESULTS: The ANFIS presented an accuracy of 80.95%, where 13 experts and 21 non-experts were correctly classified. Total root mean square error was 0.88, while the area under the classifiers' ROC curve (AUC) was measured at 0.81. DISCUSSION: We have shown the usefulness of ANFIS for classification of MIS competence in a simple box trainer exercise. The main advantage of using ANFIS resides in its continuous output, which allows fine discrimination of surgical competence. There are, however, challenges that must be taken into account when considering use of ANFIS (e.g. training time, architecture modeling). Despite this, we have shown discriminative power of ANFIS for a low-difficulty box trainer task, regardless of the individual significances between MAPs. Future studies are required to confirm the findings, inclusion of new tasks, conditions and sample population.

Riesgo del consumo de cannabis para la práctica físico-deportiva

El consumo de cannabis es uno de los principales problemas de salud pública, especialmente entre los jóvenes, dadas sus prevalencias de consumo. Esta droga puede provocar alteraciones psicomotrices en el individuo, por ello, el presente trabajo de investigación tiene como objetivo principal comprobar si el consumo de cannabis supone un riesgo añadido a la práctica físico-deportiva. Para alcanzar dicho objetivo, se dividió el trabajo en dos estudios interrelacionados entre sí. En el primer estudio o Estudio 1, “Repercusión del consumo de cannabis en las clases de Educación Física”, se realizó un cuestionario autoadministrado, dirigido al profesorado de Educación Física de la Comunidad de Madrid, con el fin de recoger su opinión sobre la posible presencia de consumidores de cannabis en sus aulas. El segundo estudio o Estudio 2, “Influencia del cannabis en el equilibrio, la coordinación, el tiempo de respuesta y la percepción temporal”, consistió en la realización de una serie de pruebas por parte de un grupo control y un grupo de consumidores de cannabis, para así cuantificar y cualificar los efectos de la inhalación de esta droga en la condición motriz. La encuesta que se utilizó para el Estudio 1, “El cannabis, los adolescentes y la práctica físico-deportiva”, pasó primero por una fase de elaboración, corrección y validación, y después, utilizándose la técnica de muestreo aleatorio por conglomerados, fue distribuido por los centros públicos de enseñanzas secundarias de la Comunidad de Madrid seleccionados. Se obtuvo respuesta de 93 profesores de Educación Física pertenecientes a 76 centros, es decir el 22,35% de los centros de la comunidad. Por último, se procedió al análisis, discusión y difusión de los resultados. En el Estudio 2, primero se procedió al diseño de la batería de pruebas a realizar, compuesta por 7 tests con 16 variables que valoraron el equilibrio, la coordinación, el tiempo de respuesta y la percepción temporal de los sujetos. Después se procedió a la selección de la muestra, formada por dos grupos de voluntarios de entre 18 y 30 años: un grupo control de 52 participantes, y un grupo de consumidores de cannabis, de 28 participantes con un hábito de consumo diferente. Los sujetos del grupo de consumidores realizaron las pruebas 20 minutos después de la inhalación de cannabis. Tras la realización de las pruebas por parte de todos los sujetos se procedió al análisis de los resultados obtenidos, segmentándolos por sexo y apareando las variables para evitar posibles efectos confundidores. Los resultados del primer estudio indicaron que el 75,27% del profesorado ha pensado alguna vez que sus alumnos consumían cannabis antes del inicio de su clase, hecho asociado a alteraciones psicológicas (90,63%) y cognitivo-conductuales (68,75%); no siendo factores influyentes el sexo o la experiencia docente de los encuestados (p>0,05). El segundo estudio aportó como principal resultado el empeoramiento de la percepción temporal y la conducta motriz de los sujetos que consumieron cannabis, en especial de su equilibrio y su coordinación (p<0,05). También indicó que hubo ligeras diferencias en función del hábito de consumo de esta droga, si bien los resultados se vieron influenciados por el tamaño de la muestra. Las conclusiones extraídas mostraron que el profesorado de Educación Física percibe la presencia de consumidores de cannabis en sus aulas, utiliza el diálogo con el alumnado como herramienta de actuación, y conoce la influencia negativa que tiene el consumo de esta droga en el rendimiento motor. También demuestran que el cannabis supone un riesgo añadido a la práctica físico-deportiva, debido al empeoramiento de la conducta motriz, en especial de la coordinación y el equilibrio. Además, las diferencias surgidas en base al hábito de consumo no son concluyentes pero si apuntan a que el consumo esporádico puede conllevar un peor rendimiento motor que el consumo habitual. ABSTRACT Cannabis use is one of the most important concerns of public health, particularly among young people, given their use prevalence. This drug can produce psychomotor alterations in the subject; therefore, this research work has as main aim to check if cannabis use is an added risk for physical and sporting practices. In order to achieve the objectives pursued, work was divided in two interrelated studies. First study or Study 1, “Cannabis use impact in Physical Education lessons”, a self-managed questionnaire addressed to Physical Education teachers in Community of Madrid was carried out, in order to gather the opinion about the possible existence of Cannabis users in their classes. Second Study or Study 2, “Cannabis influence in balance, coordination, reaction time and temporal perception”, consisted in a series of tests performed by a control group and a cannabis users group, in order to quantify and qualify the effects of inhalation of this drug in the motor skills. The questionnaire used for Study 1, “Cannabis, teenagers, and physical and sporting practices”, firstly went through an elaboration y correction phase, and then, using cluster sampling technique, was distributed within selected Secondary Education Centres from Community of Madrid. Response from 93 Physical Education teachers from 76 High Schools were obtained, this is 22,35% of total High Schools in Madrid. Finally, analysis, discussion and dissemination of results were held. In Study 2, first of all design of tests to be made was done, consisting on 7 different test with 16 variables that measured balance, coordination, response time and temporal perception in subjects. After that, sample selection was performed, comprised of 2 volunteers groups of ages between 18-30 years: a control group of 52 participants, and a Cannabis Users Group of 28 participants with different consumption habits. Users group subjects carried out tests 20 minutes after cannabis inhalation. After tests were performed by all subjects, results were analyzed and segmented by sex and matching variables in order to avoid confusion effects. First study results brought out that 75,27% of teachers have ever thought that their pupils used cannabis before getting into class, this fact is linked to psychological alterations (90,63%) and cognitive-behavioral (68,75%); not being influencing factors sex or teaching experience of the surveyed (p>0,05). Second study provided as most significant result the worsening of temporal perception and motor tasks behavior in subjects that had used cannabis, especially in regards of their balance and coordination (p<0,05). Also resulted that there were slight differences in consumption habits, although results were influenced by the sample size. Conclusions drawn showed that Physical Education teachers notice the presence of cannabis users in lessons, use dialogue with pupils as an action tool and acknowledge the negative influence this drug has in motor tasks performance. Also, it is shown that cannabis is an additional risk for physical and sporting practices due to deteriorating in motor skills, particularly in coordination and balance. In addition, the differences that may arise depending on the consumption habits are not conclusive, but they suggest that the sporadic drug use may be related to a worse motor performance than usual consumption.