Surgical Team and Team Assessment: Psychomotor Evidence

• Author / Creator

  Wenjing He

• Effective teamwork is critical to the success of surgery. In the operating room (OR), a surgical team is generally composed of surgeons, nurses and an anesthesiologist. Of all the factors that might affect patient safety and the success of the surgery, collaboration among team members is considered to be essential. Improvement of team performance in the OR should therefore lead to safer surgery. When applied to a laparoscopic procedure, where surgery is performed through insertion of specialized long-shafted instruments and a fiber-optic video camera (laparoscope) to provide visualization inside the abdominal cavity, the team collaboration between primary surgeon and assistant becomes more important. In laparoscopic surgery, the primary surgeon’s vision is guided by the assistant who maneuvers the laparoscope. If the intended surgical site is not optimally displayed, it might affect the primary surgeon’s decision-making process. However, few studies have been done into studying the teamwork between the primary surgeon and assistant. Although every educator knows the importance of surgical team training, we lack technologies in assessing team performance which are the primary barrier for high quality team study. Without a clear assessment of team performance, it is hard to construct an effective education program for team training. To date, the most common technologies and tools for assessing team performance are based on the subjective feedback from senior surgeons or knowledge testing of individuals in a team. However, these subjective assessment methods are limited in reflecting team performance as they are based on self-filled out test or the subjective feedback from other observers, which may raise bias for team assessment. The purpose of this thesis research is to find objective assessment of team performance through psychomotor evidence. In order to achieve the general research goals, a simulated operating theater was set up in the Surgical Simulation Research Lab (SSRL) at the Department of Surgery, University of Alberta; the operating environment included all the necessary surgical devices for laparoscopic surgery. In such an environment, surgeons were recruited to participate in a simulated laparoscopic surgery, acting as a primary surgeon and an assistant without harming patients. While they performed, their team performance was recorded using a video camera; their eye motion was recorded using cutting-edge technology - remote eye trackers. Then data analysis was carried out, including video analysis on team collaborative behaviour; spatiotemporal analysis of eye tracking trajectories; and synchronization analysis of pupil response from both team members. Video analysis showed that elite performance teams had less movement desynchronization than poor performance teams. Dual eye gaze analysis revealed that elite teams had more overlapping of eye gaze than the poor teams; and also, a higher chance of visiting the same visual spots and a shorter phase delay of eye gaze were observed in the elite teams than in the poor teams. Dual pupil analysis showed that the elite performance teams have higher pupil dilation similarity than the lower-performance teams; and that medium collaboration teams have higher pupil similarity than in the least collaborative teams. Findings from the video and eye tracking signals enable us to look deeply into behaviours and cognition that constructs team collaboration. For example, the overlapping between two people’s eye motion trajectories can be used to describe team’s shared visual attention; the synchronization of pupil dilation can provide rich information for us to describe whether two people detect the change of task load and react simultaneously over time. All this knowledge will provide the foundation for us to develop an advanced methodology for the objective evaluation of team cognition. The thesis concludes with a summary of findings and the contribution to teamwork assessment. I believe the future of assessing teamwork should be more objective and quantitative based on this thesis research.

• Subjects / Keywords

  • Team Cognition
  • Surgical Team
  • Video Analysis
  • Teamwork Assessment
  • Psychomotor Evidence
  • Eye Tracking
  • Pupil

• Graduation date

  Spring 2019

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-416p-e758

• License

  Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.