'Bilateral (Hong Kong):' Gaze strategies of laparoscopy surgeons: Observational learning, implicit knowledge and performance in demanding conditions

Lead Research Organisation: University of Exeter
Department Name: Sport and Health Sciences

Abstract

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Description This bilateral project explored the role of experience, stress, and training in the performance of laparoscopic surgical skills. In Exeter, we first uncovered consistent expert-novice gaze strategy differences on a virtual reality simulator: Experts focused only on the object to be manipulated ("target locking"), whereas novices switched gaze between the target and their tools. We then developed two novel training protocols to teach novices to adopt this target locking gaze strategy: one using observational learning and one using a bespoke training template that implicitly guided the novice where to look. Not only did trainees using the gaze training programs learn the skills more quickly than those adopting traditional training instructions, but they were also more robust under stress. We further tested the validity of our gaze measurements by examining the eye movements of consultant surgeons in theatre. We found that they utilised similar gaze strategies as when performing virtual reality training tasks and simulated operations.
In Hong Kong, we manipulated stress in a variety of ways to determine how and why it might impact on technical skill performance in trainee surgeons. This included examining a personality characteristic ("reinvestment") that influenced technical skill performance under stress, and developing a workload assessment questionnaire for surgery. This information was used to develop a laparoscopic training program (implicit learning) that used fewer attentional resources than traditional explicit instructions. Differences in attentional processing were assessed using brain imaging (EEG), uncovering advantages for implicit learning for performance under stress.
Exploitation Route From a clinical perspective, this project enabled us to gain further funding from a simulator company (Intuitive Surgical Ltd.) to see what the benefits of robotic surgery might be over traditional laparoscopic surgery.
We are also looking at the possibility of setting up workshops with surgeons at Exeter RD&E hospital to translate our findings into practical training advice for trainee surgeons.

Mr McGrath (our surgical lead at Exeter hospital) is the Clinical Lead in the South West of England for SIMULATE (the new National Initiative by the British Association of Urology Surgeons [BAUS] to introduce simulation to all current and future UK urology trainees). Our collaborative group hope to inform SIMULATE curriculum by generating educational theory related to the transfer of motor learning to stressful environments, and indeed our current work is already cited on the SIMULATE website (www.surgical-simulation.com.) with more to follow.

In a separate industry we have also applied our training techniques developed in this grant to the military - with a grant from Dstl.
Sectors Aerospace, Defence and Marine,Healthcare,Leisure Activities, including Sports, Recreation and Tourism
 
Description We have achieved scientific impact with this work in that we have published >15 papers in high impact surgery journals. To date the research has had the most impact on academic surgeons and urologists, who are the readership of the journals in which we published. There is interest in how surgical curricula should be developed to support the acquisition of technical surgical skills (particularly in laparoscopy). The fact that two of our studies created sufficient interest to cause surgeons to respond by letters to the editor is testament to this interest. I have also given a number of invited talks at medical conferences to discuss the role of stress in learning and performance. However, we have yet to directly inform current practice. Our recently awarded ESRC Impact cultivation Award (June 2015) provided information on what sort of support young surgical trainees wanted but it has been difficult to make practical changes as curriculum change is a complicated process. We are hoping to work on leveraging some regional impact in the hospitals that we have some access to (Exeter RD&E and Torbay). Our work in skill acquisition has resulted in funding from Intuitive Surgical Inc, an American company who make the Da Vinci surgical robot (the leading surgical robot in the world). Our first grant with them resulted in three publications that they refer to in supporting the benefits of their system over laparoscopic techniques. Our current grant is looking at how skill scan best be acquire don their system and we hope to provide resources for their website.
First Year Of Impact 2013
Sector Healthcare,Pharmaceuticals and Medical Biotechnology
Impact Types Economic,Policy & public services
 
Description Intuitive Surgical Research Grant
Amount $50,000 (USD)
Organisation Intuitive Surgical Inc 
Sector Private
Country United States
Start 09/2016 
End 08/2017
 
Description Surgical fellowship 1
Amount £50,000 (GBP)
Organisation Royal Devon and Exeter Hospital 
Department HesRU / Urology Department Exeter
Sector Hospitals
Country United Kingdom
Start 01/2010 
End 12/2011
 
Description Surgical fellowship 2
Amount £50,000 (GBP)
Organisation Royal Devon and Exeter Hospital 
Department HesRU / Urology Department Exeter
Sector Hospitals
Country United Kingdom
Start 01/2011 
End 12/2012
 
Description The da Vinci robot vs. conventional laparoscopy : examining benefits for the surgeon
Amount £35,000 (GBP)
Organisation Intuitive Surgical Inc 
Sector Private
Country United States
Start 02/2013 
End 03/2014
 
Description Exeter Royal Devon and Exeter NHS Foundation Trust 
Organisation Royal Devon and Exeter Hospital
Department Exeter Surgical Health Services Research Unit
Country United Kingdom 
Sector Hospitals 
PI Contribution Collaboration with Exeter Surgical Health Services Research Unit
Start Year 2011
 
Description Torbay hospital teaching 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact I provide a talk to medical practitioners taking a Masters qualification in 'Simulation and Enhanced Learning Programme' at Torbay Hospital.
Year(s) Of Engagement Activity 2014,2015,2016,2017