A key aspect of the practice of anaesthesia is the ability to perform practical procedures efficiently and safely. Decreased working hours during training, an increasing focus on patient safety, and greater accountability have resulted in a paradigm shift in medical education. The resulting international trend towards competency-based training demands robust methods of evaluation of all domains of learning. The assessment of procedural skills in anaesthesia is poor compared with other domains of learning and has fallen behind surgical fields. Logbooks and procedure lists are best suited to providing information regarding likely opportunities within training programmes. Retrospective global scoring and direct observation without specific criteria are unreliable. The current best evidence for a gold standard for assessment of procedural skills in anaesthesia consists of a combination of previously validated checklists and global rating scales, used prospectively by a trained observer, for a procedure performed in an actual patient. Future research should include core assessment parameters to ensure methodological rigor and facilitate robust comparisons with other studies: (i) reliability, (ii) validity, (iii) feasibility, (iv) cost-effectiveness, and (v) comprehensiveness with varying levels of difficulty. Simulation may become a key part of the future of formative and summative skills assessment in anaesthesia; however, research is required to develop and test simulators that are realistic enough to be suitable for use in high-stakes evaluation.

Assessment of procedural skills in anaesthesia

Background: By enabling individuals to self-regulate their brainwave activity in the field of optimal performance in healthy individuals, neurofeedback has been found to improve cognitive and artistic performance. Here we assessed whether two distinct EEG neurofeedback protocols could develop surgical skill, given the important role this skill plays in medicine. Results: National Health Service trainee ophthalmic microsurgeons (N = 20) were randomly assigned to either Sensory Motor Rhythm-Theta (SMR) or Alpha-Theta (AT) groups, a randomized subset of which were also part of a wait-list 'no-treatment' control group (N = 8). Neurofeedback groups received eight 30-minute sessions of EEG training. Pre-post assessment included a skills lab surgical procedure with timed measures and expert ratings from video-recordings by consultant surgeons, together with state/trait anxiety self-reports. SMR training demonstrated advantages absent in the control group, with improvements in surgical skill according to 1) the expert ratings: overall technique (d = 0.6, p < 0.03) and suture task (d = 0.9, p < 0.02) (judges' intraclass correlation coefficient = 0.85); and 2) with overall time on task (d = 0.5, p = 0.02), while everyday anxiety (trait) decreased (d = 0.5, p < 0.02). Importantly the decrease in surgical task time was strongly associated with SMR EEG training changes (p < 0.01), especially with continued reduction of theta (4–7 Hz) power. AT training produced marginal improvements in technique and overall performance time, which were accompanied by a standard error indicative of large individual differences. Notwithstanding, successful within session elevation of the theta-alpha ratio correlated positively with improvements in overall technique (r = 0.64, p = 0.047). Conclusion: SMR-Theta neurofeedback training provided significant improvement in surgical technique whilst considerably reducing time on task by 26%. There was also evidence that AT training marginally reduced total surgery time, despite suboptimal training efficacies. Overall, the data set provides encouraging evidence of optimised learning of a complex medical specialty via neurofeedback training.

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Optimizing microsurgical skills with EEG neurofeedback.

Skills Acquisition and Assessment after a Microsurgical Skills Course for Ophthalmology Residents

Purpose: The purpose of this study was to show the validity of a motion analysis system in its ability to differentiate between surgeons and non-surgeons when performing simple arthroscopic tasks. Methods: We divided 35 subjects into a surgeons group (n = 20) and a non-surgeons group (n = 15). The surgeons group was further subdivided based on the amount of previous arthroscopic experience. Each participant performed 2 separate simulated arthroscopic tasks while being assessed with motion analysis equipment. The time taken, total path length, and number of movements were recorded. Results: A significant difference in performance was identified between surgeons and non-surgeons ( P P Conclusions: This study shows the validity of a motion analysis system as a means of objective assessment of arthroscopic skills in orthopaedics. The system has been shown to differentiate between non-surgeons, junior surgeons, and senior surgeons in performing simple arthroscopic tasks. Clinical Relevance: In the context of concerns regarding reductions in training time, this study validates the use of a simple, affordable, and reliable means of objective assessment of arthroscopic skills and training in such skills. The motion analysis system could subsequently be used as an adjunct to more traditional methods of assessment when planning strategies to teach, learn, and practice arthroscopic skills in the future.

Motion Analysis: A Validated Method for Showing Skill Levels in Arthroscopy

Update on simulation-based surgical training and assessment in ophthalmology: A systematic review

Objective To evaluate motion tracking as an aid to a more objective assessment of ophthalmic microsurgical skill. Methods In a cohort study, 3 groups of differing levels of surgical experience were assessed. The groups included novice surgeons (n = 10) with fewer than 5 previously performed corneal sutures, trainee surgeons (n = 10) with 5 to 100 previously performed corneal sutures, and expert surgeons (n = 10) with more than 100 previously performed corneal sutures. The Imperial College Surgical Assessment Device was used for the objective assessment of surgical dexterity during corneal suturing. Each of the subjects used a 10-0 nylon suture in a 3-1-1 pattern on an artificial eye (Royal College of Ophthalmologists, London, England). The Imperial College Surgical Assessment Device measures 3-dimensional spatial vectors via electromagnetic sensors attached to the surgeon's fingers. The number of movements, path length for the respective movements, and time taken to complete the given task were recorded. Results Highly statistically significant differences were found between the 3 grades of surgeon experience for time taken ( P P P  = .002) to complete the given task. Conclusions Motion analysis measured by this technology may be useful in the formal surgical training of residents and as an objective quantitative measure of dexterity.

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/815249/ecs60042.pdf

Yiorgos Voyazis

Papers

Evaluating Surgical Dexterity During Corneal Suturing