C2B - 02: SURGEONS SEE ANATOMIC STRUCTURES FASTER AND MORE ACCURATELY IN THE OPERATING ROOM COMPARED TO NOVICES: DEVELOPMENT OF A PATTERN RECOGNITION SKILL ASSESSMENT PLATFORM
Tomoko Mizota, MD, Nicholas E Anton, MS, Stefanidis Dimitrios, MD, PhD; Department of Surgery, Indiana University School of Medicine

Background: Accurate recognition of anatomic structures and planes during an operation by surgeons is paramount to safe surgery. Misidentification of anatomic structures can result in inadvertent injuries. Unfortunately, studies that assess surgeons’ pattern recognition skill are lacking. We aimed to develop a platform that enables the study of pattern recognition skills and hypothesized that surgeons would identify anatomic structures faster and more accurately than novices.

Methods: Medical students, surgical residents, and attending surgeons voluntarily enrolled in this IRB-approved study. All participants reviewed three laparoscopic cholecystectomy videos of variable difficulty. Participants were asked to pause the videos when they had confidently identified the cystic duct (CD) or cystic artery (CA) and outline the structures on the monitor using drawing software. Time taken to identify each structure and participant accuracy in localizing the CD and CA, compared to an expert reviewer, were recorded. Accuracy was defined as the percent overlap between the participant and expert drawings. Participants also assessed their perceived work load using the NASA-Task Load Index (TLX). Performance was compared among the three groups using the Kruskal-Wallis test with pairwise comparisons.

Results: Ten students, ten residents and seven attendings completed the review of videos. There were statistical differences in the time and accuracy to identify the CA among the three groups but not to identify the CD. The pairwise comparisons showed that attendings identified the CA faster (p=0.009) and more accurately than students (p=0.002), and faster than residents (p=0.02). Residents identified the CA more accurately than students (p=0.04). The NASA-TLX total score of attendings was significantly lower than that of students and residents.

Conclusions: This study is the first to demonstrate empirically the ability of surgeons to identify anatomic structures during surgery faster, more accurately, and with less effort compared with less experienced individuals. It further introduces a novel and effective platform for the assessment of surgeon pattern recognition skills. We plan to use this platform to develop teaching strategies for novice surgeons to improve their recognition of anatomic structures before they enter the operating room.