Wearable sensors for modeling and assessing nontechnical skills in surgery - Abstract
Non-technical (NT) skills encompass teamwork, communication, decision-making, leadership, and situational
awareness and are critical aspects for safe care delivery in the operating room (OR). Non-technical skills of
surgery have been identified as the most frequent causes for sentinel events that impact patient mortality, post-
operative pain, and quality of life. Lapses in communication, teamwork, and leadership have been shown to
account for 60% of major perioperative complications, most of which are related to communication failures. Given
this strong link between NT and team skills and patient safety, several NT skills assessment tools have been
validated specifically for surgical teams. However, they require the presence of trained observers or retrospective
review of videos. Such methods are time-consuming and resource intensive to obtain. Importantly, these
assessments are subject to multiple assessment biases of the observer which threatens their objectivity and
value. Automated tools that do not require an expert observer to conduct real-time observations, do not need
time-intensive audio-video analysis, and could provide objective, quantifiable, and continuous measurements of
NT skill are, thus, highly needed and could allow for the more widespread implementation of NT skills training.
The objectives of the current project are to 1) investigate and develop predictive models linking objective sensor-
based data streams with individual and team non-technical skills, 2) test non-intrusive sensing devices in
simulated surgical team simulation training for practicing professionals, and 3) test sensor's accuracy in
distinguishing teams with and without TeamSTEPPS training. To achieve these objectives, three specific aims
are proposed. Aim 1 will validate our multi-modal sensing system for measuring NT skills in surgical simulation.
A collaborative team of human factors engineers and surgeon educators will perform summative usability
evaluation and determine usability with the System Usability Scale and Technology Acceptance Model. For Aim
2, our team will implement sensors in well-validated surgical simulations with experienced and inexperienced
teams. As sensors continuously collect data, observer-based non-technical skill assessment tools will be
performed real-time and video recorded. Analytics, data fusion, and regression analysis will be performed to
model sensor metrics with gold-standard ratings. Finally, we will evaluate whether sensors can distinguish
differences in team skills between teams with/without TeamSTEPPS training. The expected deliverables will
include usability validation of a non-intrusive sensing system and analytics framework for automated skill
assessment that can be implemented in surgical simulation. If proven valid and acceptable through the proposed
work, our objective NT skill assessments could be used in the future to assess effectiveness of team training
and provide structured, individually-tailored feedback to enhance healthcare providers' NT skills. Thus, this work
could ultimately reduce errors due to poor NT skills and enhance patient safety.