Work domain constraints for modelling surgical performance.
OBJECTIVE
Three main approaches can be identified for modelling surgical performance: a competency-based approach, a task-based approach, both largely explored in the literature, and a less known work domain-based approach. The work domain-based approach first describes the work domain properties that constrain the agent's actions and shape the performance. This paper presents a work domain-based approach for modelling performance during cervical spine surgery, based on the idea that anatomical structures delineate the surgical performance. This model was evaluated through an analysis of junior and senior surgeons' actions.


METHODS
Twenty-four cervical spine surgeries performed by two junior and two senior surgeons were recorded in real time by an expert surgeon. According to a work domain-based model describing an optimal progression through anatomical structures, the degree of adjustment of each surgical procedure to a statistical polynomial function was assessed.


RESULTS
Each surgical procedure showed a significant suitability with the model and regression coefficient values around 0.9. However, the surgeries performed by senior surgeons fitted this model significantly better than those performed by junior surgeons. Analysis of the relative frequencies of actions on anatomical structures showed that some specific anatomical structures discriminate senior from junior performances.


CONCLUSIONS
The work domain-based modelling approach can provide an overall statistical indicator of surgical performance, but in particular, it can highlight specific points of interest among anatomical structures that the surgeons dwelled on according to their level of expertise.
Centre de Recherches en Psychologie, Cognition et Communication (CRPCC), EA1285, Université de Bretagne-Sud, Centre Yves Coppens, 56000, Vannes, France. thierry.morineau@univ-ubs.fr.
Thierry
T
Morineau
Department of Neurosurgery, Pontchaillou University Hospital, 35033, Rennes Cedex 9, France.|Laboratoire de Traitement du Signal et de l'Image (LTSI), Inserm, UMR 1099, MediCIS Team, Université de Rennes 1, 35000, Rennes, France.
Laurent
L
Riffaud
Department of Neurosurgery, Pontchaillou University Hospital, 35033, Rennes Cedex 9, France.|Laboratoire de Traitement du Signal et de l'Image (LTSI), Inserm, UMR 1099, MediCIS Team, Université de Rennes 1, 35000, Rennes, France.
Xavier
X
Morandi
Laboratoire de Mathématique de Bretagne Atlantique (LMBA), UMR 6205, Université de Bretagne-Sud, 56000, Vannes, France.
Jonathan
J
Villain
Laboratoire de Traitement du Signal et de l'Image (LTSI), Inserm, UMR 1099, MediCIS Team, Université de Rennes 1, 35000, Rennes, France.
Pierre
P
Jannin
D000465:Algorithms; D002574:Cervical Vertebrae / Q000601:surgery*; D002983:Clinical Competence; D006801:Humans; D008962:Models, Theoretical; D019637:Orthopedic Procedures / Q000592:standards*
Cervical spine surgery; Surgical expertise; Surgical performance; Work domain