Poster3 - 04: A NOVEL TOOL TO MEASURE PERCEPTUAL EXPERTISE IN ROBOTIC SURGEONS
Courtney A Green, MD¹, John R Porterfield, MD², Patricia O'Sullivan, EdD¹; ¹University of California San Francisco, ²University of Alabama

An essential component of surgical expertise is perceptual; through experience, surgeons’ abilities to extract patterns and relationships evolve over thousands of hours ultimately leading to improved intraoperative decision making and mastery of surgical performance. Perceptual expertise is the logical endpoint of the normal trajectory of learning in a domain-specific environment such as surgery. Robotic technology, lacking haptic feedback, heightens the importance of perceptual expertise to ensure safe surgical performance.  No instrument currently exists to measure levels of perceptual expertise in surgery.  As an initial attempt to develop such a tool, robotic surgeons were surveyed to determine which intraoperative behaviors were important to measure this skill in robotic assisted surgery.

Using Goldstone’s (1998) theory of perceptual learning, on screen surgical actions were separated into three categories: attentional weighting, unitization and differentiation. We generated items based on surgical experience in these categories. Survey participation was solicited from robotic surgical education experts. Participants received definitions for the three categories and were asked to rate each of sixty behaviors as unimportant, somewhat, important and very important. Participants also provided edits, indicated missing behaviors and provided additional feedback. To be considered further, items had to receive at least 80% of the respondents rating as important/very important. 

Eleven robotic surgical educators completed the assessment.  Respondents represented junior faculty (27%, n = 3) and senior faculty (73%, n = 8) from four surgical specialties. Most respondents (64%, n =7) had performed more than 300 robotic cases with over 90% of respondents completing more than 100 cases. The following summarizes behaviors surpassing the 80% standard: 21/25 behaviors of attentional weighting, 16/19 behaviors of unitization, 16/16 behaviors of differentiation. There were suggestions for 4 additional items and limited revisions.

The use of visual input to guide operative decision making is critical for mastery of robotic surgery. We describe the initial steps in developing a tool to measure a robotic surgeon’s level of perceptual expertise. Results show emergences of a consensus list of intraoperative behaviors related to perceptual expertise in robotic surgery.  The next step is to validate this novel instrument with a sample of robotic surgeons and learners.