title: Motion Analysis for Microsurgical Training: Objective Measures of Dexterity, Economy of Movement, and Ability.
abstract: BACKGROUND
  Evaluation of skill acquisition in microsurgery has traditionally relied on subjective opinions of senior faculty, but is shifting toward early competency-based training using validated models. No objective measures of dexterity, economy of movement, and ability exist. The authors propose a novel video instrument motion analysis scoring system to objectively measure motion.
  
  
  METHODS
  Video of expert microsurgeons was analyzed and used to develop a resident motion analysis scoring system based on a mathematical model. Motion analysis scores were compared to blinded, global rating scores of the same videos using the Stanford Microsurgery and Resident Training scale.
  
  
  RESULTS
  Eighty-five microsurgical anastomoses from 16 residents ranging from postgraduate years 1 through 6 were analyzed. Composite motion analysis scores for each segmented video correlated positively to arterial anastomotic experience (rho, +0.77; p < 0.001). Stanford Microsurgery and Resident Training scale interrater reliability was consistent between expert assessors, and mean composite motion analysis overall performance and Stanford scores were well matched for each level of experience. Composite motion analysis scores correlated significantly with combined Stanford Microsurgery and Resident Training [instrument handling (rho, +0.66; p < 0.01), efficiency (rho, +0.59; p < 0.01), suture handling (rho, +0.83; p < 0.001), operative flow (rho, +0.67; p < 0.001), and overall performance (rho, +89; p < 0.001)] motion components of the scale.
  
  
  CONCLUSIONS
  Instrument motion analysis provides a novel, reliable, and consistent objective assessment for microsurgical trainees. It has an associated cost, but is timely, repeatable, and senior physician independent, and exposes patients to zero risk.
authors.affiliation: Stanford, Calif. From Stanford University.
authors.forename: Rory B
authors.initials: RB
authors.lastname: McGoldrick
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Davis
authors.forename: Jon
authors.initials: J
authors.lastname: Paro
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hui
authors.forename: Dung
authors.initials: D
authors.lastname: Nguyen
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Lee
mesh_terms: D000328:Adult; D002140:California; D002983:Clinical Competence; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D008866:Microsurgery / Q000193:education*; D015588:Observer Variation; D015203:Reproducibility of Results; D013647:Task Performance and Analysis; D013996:Time and Motion Studies; D014741:Video Recording