title: Supervised classification of psychomotor competence in minimally invasive surgery based on instruments motion analysis.
abstract: BACKGROUND
  Objective assessment of psychomotor skills has become an important challenge in the training of minimally invasive surgical (MIS) techniques. Currently, no gold standard defining surgical competence exists for classifying residents according to their surgical skills. Supervised classification has been proposed as a means for objectively establishing competence thresholds in psychomotor skills evaluation. This report presents a study comparing three classification methods for establishing their validity in a set of tasks for basic skills’ assessment.
  
  
  METHODS
  Linear discriminant analysis (LDA), support vector machines (SVM), and adaptive neuro-fuzzy inference systems (ANFIS) were used. A total of 42 participants, divided into an experienced group (4 expert surgeons and 14 residents with >10 laparoscopic surgeries performed) and a nonexperienced group (16 students and 8 residents with <10 laparoscopic surgeries performed), performed three box trainer tasks validated for assessment of MIS psychomotor skills. Instrument movements were captured using the TrEndo tracking system, and nine motion analysis parameters (MAPs) were analyzed. The performance of the classifiers was measured by leave-one-out cross-validation using the scores obtained by the participants.
  
  
  RESULTS
  The mean accuracy performances of the classifiers were 71 % (LDA), 78.2 % (SVM), and 71.7 % (ANFIS). No statistically significant differences in the performance were identified between the classifiers.
  
  
  CONCLUSIONS
  The three proposed classifiers showed good performance in the discrimination of skills, especially when information from all MAPs and tasks combined were considered. A correlation between the surgeons’ previous experience and their execution of the tasks could be ascertained from results. However, misclassifications across all the classifiers could imply the existence of other factors influencing psychomotor competence.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Oropesa
authors.forename: Patricia
authors.initials: P
authors.lastname: Sánchez-Gonzáez
authors.forename: Magdalena K
authors.initials: MK
authors.lastname: Chmarra
authors.forename: Pablo
authors.initials: P
authors.lastname: Lamata
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Pérez-Rodríguez
authors.forename: Frank Willem
authors.initials: FW
authors.lastname: Jansen
authors.forename: Jenny
authors.initials: J
authors.lastname: Dankelman
authors.forename: Enrique J
authors.initials: EJ
authors.lastname: Gómez
mesh_terms: D002983:Clinical Competence; D006801:Humans; D007396:Internship and Residency / Q000145:classification*; D010535:Laparoscopy / Q000193:education*; D019060:Minimally Invasive Surgical Procedures / Q000193:education; D009068:Movement / Q000502:physiology*; D010820:Physicians / Q000523:psychology*; D011597:Psychomotor Performance / Q000502:physiology*; D013647:Task Performance and Analysis