title: Can a virtual reality assessment of fine motor skill predict successful central line insertion?
abstract: BACKGROUND
  Due to the increased use of peripherally inserted central catheter lines, central lines are not performed as frequently. The aim of this study is to evaluate whether a virtual reality (VR)-based assessment of fine motor skills can be used as a valid and objective assessment of central line skills.
  
  
  METHODS
  Surgical residents (N = 43) from 7 general surgery programs performed a subclavian central line in a simulated setting. Then, they participated in a force discrimination task in a VR environment. Hand movements from the subclavian central line simulation were tracked by electromagnetic sensors. Gross movements as monitored by the electromagnetic sensors were compared with the fine motor metrics calculated from the force discrimination tasks in the VR environment.
  
  
  RESULTS
  Long periods of inactivity (idle time) during needle insertion and lack of smooth movements, as detected by the electromagnetic sensors, showed a significant correlation with poor force discrimination in the VR environment. Also, long periods of needle insertion time correlated to the poor performance in force discrimination in the VR environment.
  
  
  CONCLUSIONS
  This study shows that force discrimination in a defined VR environment correlates to needle insertion time, idle time, and hand smoothness when performing subclavian central line placement. Fine motor force discrimination may serve as a valid and objective assessment of the skills required for successful needle insertion when placing central lines.
authors.affiliation: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53726, USA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Mohamadipanah
authors.affiliation: Department of Mechanical Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Chembian
authors.initials: C
authors.lastname: Parthiban
authors.affiliation: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53726, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Nathwani
authors.affiliation: Department of Kinesiology, School of Education, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Drew
authors.initials: D
authors.lastname: Rutherford
authors.affiliation: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53726, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: DiMarco
authors.affiliation: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53726, USA. Electronic address: pugh@surgery.wisc.edu.
authors.forename: Carla
authors.initials: C
authors.lastname: Pugh
mesh_terms: D002405:Catheterization, Central Venous; D002983:Clinical Competence; D003198:Computer Simulation; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008348:Manikins; D009048:Motor Skills; D013350:Subclavian Vein; D013686:Telemetry; D014481:United States
keywords: Assessment; Fine motor skills; Subclavian central line; Virtual reality