title: Assessing Wire Navigation Performance in the Operating Room.
abstract: OBJECTIVE
  There are no widely accepted, objective, and reliable tools for measuring surgical skill in the operating room (OR). Ubiquitous video and imaging technology provide opportunities to develop metrics that meet this need. Hip fracture surgery is a promising area in which to develop these measures because hip fractures are common, the surgery is used as a milestone for residents, and it demands technical skill. The study objective is to develop meaningful, objective measures of wire navigation performance in the OR.
  
  
  METHODS
  Resident surgeons wore a head-mounted video camera while performing surgical open reduction and internal fixation using a dynamic hip screw. Data collected from video included: duration of wire navigation, number of fluoroscopic images, and the degree of intervention by the surgeon׳s supervisor. To determine reliability of these measurements, 4 independent raters performed them for 2 cases. Raters independently measured the tip-apex distance (TAD), which reflects the accuracy of the surgical placement of the wire, on all the 7 cases.
  
  
  METHODS
  University of Iowa Hospitals and Clinics in Iowa City, IA-a public tertiary academic center.
  
  
  METHODS
  In total 7 surgeries were performed by 7 different orthopedic residents. All 10 raters were biomedical engineering graduate students.
  
  
  RESULTS
  The standard deviations for anteroposterior, lateral, and combined TAD measurements of the 10 raters were 2.7, 1.9, and 3.7mm, respectively, and interrater reliability produced a Cronbach α of 0.97. The interrater reliability analysis for all 9 video-based measures produced a Cronbach α of 0.99.
  
  
  CONCLUSIONS
  Several video-based metrics were consistent across the 4 video reviewers and are likely to be useful for performance assessment. The TAD measurement was less reliable than previous reports have suggested, but remains a valuable metric of performance. Nonexperts can reliably measure these values and they offer an objective assessment of OR performance.
authors.affiliation: Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa; Department of Biomedical Engineering, The University of Iowa, Iowa City, Iowa.
authors.forename: Leah K
authors.initials: LK
authors.lastname: Taylor
authors.affiliation: Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa; Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, Iowa. Electronic address: geb-thomas@uiowa.edu.
authors.forename: Geb W
authors.initials: GW
authors.lastname: Thomas
authors.affiliation: Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Karam
authors.affiliation: Department of Family Medicine, The University of Iowa, Iowa City, Iowa.
authors.forename: Clarence D
authors.initials: CD
authors.lastname: Kreiter
authors.affiliation: Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa; Department of Biomedical Engineering, The University of Iowa, Iowa City, Iowa; Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, Iowa.
authors.forename: Donald D
authors.initials: DD
authors.lastname: Anderson
mesh_terms: D000369:Aged, 80 and over; D001864:Bone Wires; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D005471:Fluoroscopy; D005593:Fracture Fixation, Internal / Q000379:methods*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007396:Internship and Residency; D007484:Iowa; D008297:Male; D009873:Operating Rooms; D019637:Orthopedic Procedures / Q000193:education* / Q000295:instrumentation*; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014741:Video Recording
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; competency; objective; operating room; orthopedic residency; skill assessment