'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
Abstracts are not currently available in GtR for all funded research. This is normally because the abstract was not required at the time of proposal submission, but may be because it included sensitive information such as personal details.
People |
ORCID iD |
Mark Wilson (Principal Investigator) |
Publications
Bright A
(2011)
Differences in the Visuomotor Control of Experts and Novices Performing a Virtual Reality TURP
in British Journal of Medical and Surgical Urology
Bright E
(2012)
Face validity, construct validity and training benefits of a virtual reality TURP simulator.
in International journal of surgery (London, England)
Elizabeth Bright (Author)
(2012)
Differences in the visuomotor control of experts and novices performing a virtual reality TURP
Frank Zhu (Author)
(2011)
Measuring verbal-analytical processes in skill acquisition
John McGrath (Author)
(2009)
The role of gaze analysis in developing laparoscopic training programmes
Malhotra N
(2012)
Cutting errors in surgery: experience limits underestimation bias in a simulated surgical environment.
in Journal of surgical education
Malhotra N
(2012)
Conscious monitoring and control (reinvestment) in surgical performance under pressure.
in Surgical endoscopy
Mark Wilson (Author)
(2012)
Gaze training improves performance in a virtual reality laparoscopic surgery task
Mark Wilson (Author)
(2011)
Gaze training improves technical performance and resistance to distractions in virtual laparoscopic surgery
Neha Malhotra (Author)
(2011)
Conscious monitoring and control in surgical performance under pressure
Poolton JM
(2011)
A comparison of evaluation, time pressure, and multitasking as stressors of psychomotor operative performance.
in Surgery
Wilson M
(2011)
Development and Validation of a Surgical Workload Measure: The Surgery Task Load Index (SURG-TLX)
in World Journal of Surgery
Wilson M
(2011)
Clarifying Assumptions about Intraoperative Stress during Surgical Performance: More Than a Stab in the Dark: Reply
in World Journal of Surgery
Wilson M
(2010)
Psychomotor control in a virtual laparoscopic surgery training environment: gaze control parameters differentiate novices from experts.
in Surgical endoscopy
Wilson M
(2010)
Developing basic hand-eye coordination skills for laparoscopic surgery using gaze training.
in BJU international
Wilson MR
(2011)
Perceptual impairment and psychomotor control in virtual laparoscopic surgery.
in Surgical endoscopy
Wilson MR
(2011)
Gaze training enhances laparoscopic technical skill acquisition and multi-tasking performance: a randomized, controlled study.
in Surgical endoscopy
Zhu FF
(2011)
Implicit motor learning promotes neural efficiency during laparoscopy.
in Surgical endoscopy
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 | 08/2016 |
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 |