School of Industrial Engineering, Purdue University, West Lafayette, IN.
Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA.
Surgery. 2020 Apr;167(4):724-731. doi: 10.1016/j.surg.2019.11.008. Epub 2020 Jan 6.
BACKGROUND: The surgical workforce particularly in rural regions needs novel approaches to reinforce the skills and confidence of health practitioners. Although conventional telementoring systems have proven beneficial to address this gap, the benefits of platforms of augmented reality-based telementoring in the coaching and confidence of medical personnel are yet to be evaluated. METHODS: A total of 20 participants were guided by remote expert surgeons to perform leg fasciotomies on cadavers under one of two conditions: (1) telementoring (with our System for Telementoring with Augmented Reality) or (2) independently reviewing the procedure beforehand. Using the Individual Performance Score and the Weighted Individual Performance Score, two on-site, expert surgeons evaluated the participants. Postexperiment metrics included number of errors, procedure completion time, and self-reported confidence scores. A total of six objective measurements were obtained to describe the self-reported confidence scores and the overall quality of the coaching. Additional analyses were performed based on the participants' expertise level. RESULTS: Participants using the System for Telementoring with Augmented Reality received 10% greater Weighted Individual Performance Score (P = .03) and performed 67% fewer errors (P = .04). Moreover, participants with lower surgical expertise that used the System for Telementoring with Augmented Reality received 17% greater Individual Performance Score (P = .04), 32% greater Weighted Individual Performance Score (P < .01) and performed 92% fewer errors (P < .001). In addition, participants using the System for Telementoring with Augmented Reality reported 25% more confidence in all evaluated aspects (P < .03). On average, participants using the System for Telementoring with Augmented Reality received augmented reality guidance 19 times on average and received guidance for 47% of their total task completion time. CONCLUSION: Participants using the System for Telementoring with Augmented Reality performed leg fasciotomies with fewer errors and received better performance scores. In addition, participants using the System for Telementoring with Augmented Reality reported being more confident when performing fasciotomies under telementoring. Augmented Reality Head-Mounted Display-based telementoring successfully provided confidence and coaching to medical personnel.
背景:手术队伍,特别是在农村地区,需要新的方法来增强卫生保健人员的技能和信心。虽然传统的远程指导系统已经被证明对解决这一差距有益,但基于增强现实的远程指导平台在医疗人员的指导和信心方面的益处尚未得到评估。
方法:共有 20 名参与者在两种条件下接受远程专家外科医生的指导,在尸体上进行腿部筋膜切开术:(1)远程指导(使用我们的增强现实远程指导系统)或(2)事先独立复习手术过程。两位现场专家外科医生使用个体表现评分和加权个体表现评分对参与者进行评估。实验后指标包括错误数量、手术完成时间和自我报告的信心评分。总共获得了六个客观测量值来描述自我报告的信心评分和整体指导质量。根据参与者的专业水平进行了额外的分析。
结果:使用增强现实远程指导系统的参与者获得了 10%更高的加权个体表现评分(P =.03),错误减少了 67%(P =.04)。此外,使用增强现实远程指导系统的手术经验较低的参与者获得了 17%更高的个体表现评分(P =.04),17%更高的加权个体表现评分(P <.01),错误减少了 92%(P <.001)。此外,使用增强现实远程指导系统的参与者在所有评估方面的信心提高了 25%(P <.03)。平均而言,使用增强现实远程指导系统的参与者平均接受了 19 次增强现实指导,接受指导的时间占总任务完成时间的 47%。
结论:使用增强现实远程指导系统的参与者在进行腿部筋膜切开术时错误较少,获得了更好的表现评分。此外,使用增强现实远程指导系统的参与者在接受远程指导时报告更有信心。基于增强现实的头戴式显示器的远程指导成功地为医疗人员提供了信心和指导。
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