title: Objective Measurement of Clinical Competency in Surgical Education Using Electrodermal Activity.
abstract: OBJECTIVE
  Within the realm of surgical education, there is a need for objective means to determine surgical competence and resident readiness to operate independently. We propose a novel, objective method of assessing resident confidence and clinical competence based on measurement of electrodermal activity (EDA) during live surgical procedures. We hypothesized that with progressive training, EDA responses to the stress of performing surgery would exhibit decline, elucidating an objective correlate of clinical competence.
  
  
  METHODS
  EDA was measured using galvanic skin response sensors worn by residents performing laparoscopic cholecystectomy on sequential live human patients over an 8-month period. Baseline, phasic (peak) and tonic EDA responses were measured as a fractional change from baseline.
  
  
  METHODS
  University of Missouri, Columbia, Missouri, an academic tertiary care facility.
  
  
  METHODS
  Fourteen categorical general surgery residents and 5 faculty surgeons were voluntarily enrolled and participated through completion.
  
  
  RESULTS
  Tonic fractional change (FCTONIC) was highest in PGY3 residents compared with postgraduate year (PGY) 1 and 2 residents (7.199 vs. 2.100, p = 0.004, 95% CI: 8.58-1.61 and PGY4 and 5 residents (7.199 vs. 2.079, p = 0.002, 95% CI: 8.38-0.29). Phasic fractional change in EDA (FCPHASIC) exhibited a progressive decline across resident training levels, with PGY1 and 2 residents having the highest response, and faculty displaying the lowest FCPHASICresponses. Statistical differences were seen between FCPHASICfaculty and PGY4 and 5 (3.596 vs. 6.180, p = 0.004, 95% CI: 0.80-4.36), PGY4 and 5, and PGY3 (6.180 vs. 15.998, p = 0.003, 95% CI: 3.33-16.3), as well as among all residents and faculty (13.057 vs. 3.596, p = 0.004, 95% CI: 15.8-3.1).
  
  
  CONCLUSIONS
  Phasic EDA changes decrease with increasing clinical competence. For those participants with the lowest and highest levels of competence, tonic EDA changes are minimal. Tonic EDA changes follow an inverse-U shape with differing levels of clinical competence.
authors.affiliation: Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Quick
authors.affiliation: Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri.
authors.forename: Alex D
authors.initials: AD
authors.lastname: Bukoski
authors.affiliation: Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Doty
authors.affiliation: Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri.
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Bennett
authors.affiliation: Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri.
authors.forename: Megan
authors.initials: M
authors.lastname: Crane
authors.affiliation: Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Barnes
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology*; D006801:Humans; D007396:Internship and Residency; D008297:Male
keywords: Practice-Based Learning and Improvement; competency; electrodermal activity; galvanic skin response; objective; surgical education