Assessing Wire Navigation Performance in the Operating Room

Leah K Taylor; Geb W Thomas; Matthew D Karam; Clarence D Kreiter; Donald D Anderson

doi:10.1016/j.jsurg.2016.03.018

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Assessing Wire Navigation Performance in the Operating Room

Journal article

Peer reviewed

Assessing Wire Navigation Performance in the Operating Room

Leah K Taylor, Geb W Thomas, Matthew D Karam, Clarence D Kreiter and Donald D Anderson

Journal of surgical education, Vol.73(5), pp.780-787

09/2016

DOI: 10.1016/j.jsurg.2016.03.018

PMCID: PMC5131706

PMID: 27184177

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Abstract

There are no widely accepted, objective, and reliable tools for measuring surgical skill in the operating room (OR). Ubiquitous video and imaging technology provide opportunities to develop metrics that meet this need. Hip fracture surgery is a promising area in which to develop these measures because hip fractures are common, the surgery is used as a milestone for residents, and it demands technical skill. The study objective is to develop meaningful, objective measures of wire navigation performance in the OR. Resident surgeons wore a head-mounted video camera while performing surgical open reduction and internal fixation using a dynamic hip screw. Data collected from video included: duration of wire navigation, number of fluoroscopic images, and the degree of intervention by the surgeon׳s supervisor. To determine reliability of these measurements, 4 independent raters performed them for 2 cases. Raters independently measured the tip-apex distance (TAD), which reflects the accuracy of the surgical placement of the wire, on all the 7 cases. University of Iowa Hospitals and Clinics in Iowa City, IA—a public tertiary academic center. In total 7 surgeries were performed by 7 different orthopedic residents. All 10 raters were biomedical engineering graduate students. The standard deviations for anteroposterior, lateral, and combined TAD measurements of the 10 raters were 2.7, 1.9, and 3.7mm, respectively, and interrater reliability produced a Cronbach α of 0.97. The interrater reliability analysis for all 9 video-based measures produced a Cronbach α of 0.99. Several video-based metrics were consistent across the 4 video reviewers and are likely to be useful for performance assessment. The TAD measurement was less reliable than previous reports have suggested, but remains a valuable metric of performance. Nonexperts can reliably measure these values and they offer an objective assessment of OR performance.

orthopedic residency

Patient Care

skill assessment

competency

Medical Knowledge

Practice-Based Learning and Improvement

objective

operating room

Details

Title: Subtitle: Assessing Wire Navigation Performance in the Operating Room
Creators: Leah K Taylor - Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
Geb W Thomas - Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
Matthew D Karam - Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
Clarence D Kreiter - Department of Family Medicine, The University of Iowa, Iowa City, Iowa
Donald D Anderson - Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
Resource Type: Journal article
Publication Details: Journal of surgical education, Vol.73(5), pp.780-787
DOI: 10.1016/j.jsurg.2016.03.018
PMID: 27184177
PMCID: PMC5131706
NLM abbreviation: J Surg Educ
ISSN: 1931-7204
eISSN: 1878-7452
Publisher: Elsevier Inc
Grant note: DOI: 10.13039/100000133, name: Agency for Healthcare Research and Quality, award: 1 R18 HS022077-01A1
Language: English
Date published: 09/2016
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation; Industrial and Systems Engineering; Family and Community Medicine
Record Identifier: 9984040262902771

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