1 2 expertise differences in fixation, quiet eye duration, and surgical performance during...
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Expertise Differences in Fixation, Quiet Eye Duration, and Surgical Performance During Identification and Dissection of the Recurrent
Laryngeal NerveHarvey, A.1 Vickers, JN. 2 Snelgrove, R. 1 Scott, M. 2 &
Morrison, S. 2
Department of Surgery 1
Faculty of Kinesiology 2
Association of Surgical Education
Orlando, Florida
April 24, 2013
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Background Halsted Model
Apprenticeship Based
Graded Responsibility
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Background
High level athlete gaze, focus of attention, and relation to motor skill has been studied for years
Extensive research in sport on the Quiet Eye (QE)
Over 70 refereed studies to date in over 15 sports
Quiet eyelocation
Background Quiet eye fixation = fixation on a specific
location within 1 degree of visual angle (foveal vision) for more than 100 ms prior to successful completion of a critical movement
Elite performers have longer duration quiet eye characteristic
Quiet eye is also longer during high levels of performance
QE training has proven successful in a wide range of sports
Background Limited literature
focus of attention in surgical skills acquirement or training
Moulton et al – “Slowing Down” at critical moments
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Purpose
To examine the surgical movements, fixation durations, and Quiet Eye durations of highly experienced (HE) & less experienced (LE) surgeons/residents
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Hypotheses HE surgeons will be ranked higher than LE
surgeons (blinded external review)
HE surgeons will ‘slow down’ using longer Quiet Eye durations on the Recurrent Laryngeal Nerve
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Methods
Ten Volunteers3 HE surgeons (M = 2391
operations)7 LE surgeons (M = 37
operations)
EquipmentASL mobile eye trackerSynchronized external
video of surgical movements
Surgical Movements and Gaze Data
Gaze DataSurgical Movements
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Results – Global Rating Scores
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Results – Global Rating ScoreRespect for Tissue x Phase
p < .04
Phase 1: Identify Inferior Thyroid ArteryPhase 2: Identify Recurrent Laryngeal NervePhase 3: Divide Ligament of Berry
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Results – Movement Time (MT%)
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p < .98
Total Fixation Duration by Phase
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Quiet Eye (QE) Duration on Recurrent Laryngeal
Nerve
p < .008
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Summary Relative to LE, HE surgeons had:
Higher global rating scores
No significant differences in operating time, or hand movement times (MT%)
Longer fixation durations on the Ligament of Berry
Higher QE duration on the RLN prior to blunt and sharp dissections
Conclusions HE surgeon’s longer QE duration reveals greater
focus of attention on critical structures prior to and during surgical movements
HE surgeon’s longer fixations on the LofB suggest the use of a perceptual anchor that is used to define the underlying structures
HE surgeons cognitively slow down during critical phases of the operation
Moulton & Epstein are correct, “slowing down” is a critical cognitive skill of expert surgeons
Future Directions
Quiet Eye TrainingDurableRobust under conditions of stress/anxietyIncreases success under conditions of
exhaustion
July 2013 – knot tying for R1 surgical residents