title: Quantification of process measures in laparoscopic suturing.
abstract: BACKGROUND
  Process measures describing the generation of movement are useful for evaluation and performance feedback purposes. This study aimed to identify process measures that differ between novice and advanced laparoscopists while completing a suturing skill.
  
  
  METHODS
  A group of junior and a group of senior residents and fellows in surgery (n = 6) placed 10 laparoscopic sutures in a synthetic model. Process measures were quantified using an opto-electric motion/force sensor assembly that recorded: instrument rotation, applied forces, time, and time delays between force application and instrument rotation.
  
  
  RESULTS
  Advanced trainees showed increased instrument rotation, higher peak applied force, and faster performance compared to novices (alll p < .01). However, over trials, only novices showed adaptations for instrument rotation and total time (interactions at p < .01) with no adaptation for the force application. The difference between the moments of force application and instrument rotation was not sensitive to participant training.
  
  
  CONCLUSIONS
  Movement process measures can enhance our understanding of early adaptation processes and how such factors might be used as feedback to facilitate skill acquisition.
authors.affiliation: Department of Surgery, Surgical Skills Centre at Mount Sinai Hospital, University of Toronto, Room 250, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5.
authors.forename: A
authors.initials: A
authors.lastname: Dubrowski
authors.forename: J C
authors.initials: JC
authors.lastname: Larmer
authors.forename: J K
authors.initials: JK
authors.lastname: Leming
authors.forename: R
authors.initials: R
authors.lastname: Brydges
authors.forename: H
authors.initials: H
authors.lastname: Carnahan
authors.forename: J
authors.initials: J
authors.lastname: Park
mesh_terms: D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods*; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D013536:Suture Techniques / Q000592:standards*; D013997:Time Factors