Podium 1D - Simulation / Education Technology
REAL-TIME WEARABLE EEG-BASED KANSEI BIOMARKERS REVEAL SURGEONS’ COGNITIVE–EMOTIONAL STATES DURING SURGERY
Yusuke Watanabe1, Susumu Shibasaki2, Yasue Mitsukura3, Shutaro Hori3, Masaya Nakauchi2, Tsuyoshi Tanaka2, Ichiro Uyama2, Tetsuya Toma3, Koichi Suda2; 1Hokkaido University, 2Fujita Health University, 3Keio University
Background:
Understanding surgeons’ cognitive load and mental workload during surgery is recognized as critical for advancing surgical education, simulation-based training, and competency assessment. Recent advances in wearable electroencephalography (EEG) have enabled real-time and noninvasive monitoring of neurophysiological states. Our Kansei estimation model has been developed by analyzing EEG signals in relation to neuroendocrine responses associated with oxytocin, serotonin, dopamine, adrenaline, and cortisol. Based on this mapping, five affective states, Stress, Like, Interest, Concentration, and Calmness, can be algorithmically estimated as quantitative indicators of cognitive load and mental workload.We assessed the feasibility of using wearable EEG for real-time measurement and explored how these Kansei-based biomarkers reflect cognitive–emotional states during standardized simulation tasks.
Methods:
Participants included senior faculty, junior faculty, and trainees who performed two validated simulation tasks: the ATLAS needle handling task and the FLS intracorporeal suturing task using a robotic surgery platform. A wearable EEG-based Kansei analyzer was used to continuously estimate five affective parameters during task execution: Stress, Like, Interest, Concentration, and Calmness, each expressed on a 0–100 scale and measured every second.
Results:
A total of 12 participants completed all tasks (senior faculty n=4, junior faculty n=4, trainees n=4). All participants successfully completed both simulation tasks without technical issues related to EEG acquisition. Across all experience levels, Like, Interest, and Stress demonstrated higher values compared with Concentration and Calmness during task performance. These trends were observed consistently across both simulation tasks. In addition, Stress showed abrupt increases at moments when participants struggled with specific steps, suggesting differential cognitive–emotional activation depending on task demands.
Conclusion:
The feasibility of acquiring stable EEG data during simulation tasks was demonstrated. Preliminary findings indicate that specific Kansei-derived parameters: particularly Like, Interest, and Stress, show measurable variation and may serve as informative biomarkers of cognitive load and mental workload during surgery. These parameters also have potential for use in neurofeedback-based surgical training. Further studies in live operative settings are required to provide additional validity evidence, including the interpretability and educational utility of these digital biomarkers.
OBJECTIVE VIDEO-BASED ASSESSMENT OF RESIDENTS’ SKILL IN IDENTIFYING THE CRITICAL VIEW OF SAFETY IN LAPAROSCOPIC CHOLECYSTECTOMY
Eliza B Littleton, PhD, Bestoun H Ahmed, MD, Anthony R Cyr, MD, PhD, Carl H Snyderman, MD, MBA; University of Pittsburgh School of Medicine
Background: Correct identification of the Critical View of Safety (CVS) is fundamental to preventing bile duct injury during laparoscopic cholecystectomy (LC). Despite its widespread adoption, consistent recognition of CVS can be challenging, particularly for junior residents who must interpret dynamic intraoperative cues under varying visualization and anatomy. We applied theories of pattern recognition and visual cognition for surgery to construct an assessment and training approach. This IRB-approved study evaluated junior surgical residents’ ability to recognize CVS from short operative videos of the hepatocystic triangle. It examined residents’ accuracy when given structured feedback and deliberate practice in recognizing CVS.
Methods: Ten junior residents each completed a 91-item quiz based in video clips from 150 patient cases of LC. For every video clip, participants had to indicate whether it was safe to apply the first clip (Yes/No). Immediately after each response, the platform displayed the correct answer, a written explanation, and a screenshot of the video highlighting the visual cues of CVS. Content was developed by two General surgery faculty. Study execution and psychometric analytics were supported by a new AI-powered technology platform.
Results: Participants took between one and two hours to complete the quiz. Mean accuracy was 74.62% (SD 6.07%; 95% CI 70.27%–78.96%). By the end of the quiz participants had significantly improved their accuracy, F(2, 18) = 10.283, p = .001. Participants’ average scores increased by 50 percent from the first set of questions to the last set. Responses indicated a balanced mix of challenging and introductory items. The distribution of “Yes” responses compared to that of correct “Yes”s suggests participants were cautious or uncertain in their decision-making. Participants indicated in a post-quiz survey that they appreciated the exposure to a wide variety and number of examples of CVS.
Conclusions: Substantive exposures to small video clips from patient cases can be used for assessment and training of CVS knowledge. Supported by AI-enabled analytics and structured visual feedback, the pattern recognition approach offers a scalable, objective method for strengthening cognitive safety skills in laparoscopic cholecystectomy. The pattern-recognition approach is also procedure-neutral and applicable to teaching and assessing safe operating.
RAISING THE BAR IN SIMULATION-BASED TRAINING: FEASIBILITY, PERCEPTIONS AND EARLY OUTCOMES OF THE ADVANCED TRAINING IN LAPAROSCOPIC SUTURING (ATLAS) CURRICULUM FOR SURGICAL TRAINEES
Sofia Garces Palacios1, Angela Guzzetta, MD1, Kaustubh Gopal1, Dmitry Nepomnayshy, MD2, Ganesh Sankaranarayanan, PhD1, Daniel J Scott, MD1; 1University of Texas Southwestern Medical Center (SSO), 2Lahey Hospital and Medical Center
Introduction
Although Fundamentals of Laparoscopic Surgery (FLS) certification is mandatory for general surgery trainees, gaps in advanced laparoscopic suturing skills remain. The Advanced Training in Laparoscopic Suturing (ATLAS) program was developed to address this need; however, its feasibility as a structured curriculum within residency training has not been evaluated. This study reports the experience and outcomes of a two-year pilot implementation of the ATLAS curriculum in an academic program.
Methods
Beginning in early 2024, the ATLAS proficiency-based simulation curriculum was offered to FLS-certified residents (optional) and MIS fellows (required). Participants completed a proctored baseline assessment (pre-test), followed by self-directed training until national “basic” proficiency benchmarks were achieved, and a post-test. Feasibility measures included total time, number of sessions, attrition rate, and faculty/proctor time. Pre and post curriculum surveys assessed participant perceptions. Learning outcomes were analyzed using Wilcoxon Signed-Rank Test
Results
Eighteen trainees enrolled (2 PGY-2, 4 PGY-3, 7 PGY-4, 3 PGY-5, 2 MIS fellows); five (2 PGY-4, 1 PGY-5, and 2 MIS fellows) completed the curriculum, yielding a 75% attrition rate. Among completers, the average total training time was 2 hours 39 minutes (SD ± 31 min, range 2:04 – 3:20) with an average of 5.4 trials per task. Average proctoring time for testing was 54 minutes per trainee, and a single expert faculty member conducted four one-hour live tutoring sessions. Performance analysis revealed statistically significant improvements for all tasks, with all participants surpassing the basic proficiency level (Figure 1). Surveys revealed notable training gaps: 80% of trainees reported low confidence in laparoscopic suturing at baseline, and none had prior simulation experience beyond FLS. All respondents agreed that additional simulation opportunities should be available during residency, and 100% of those who completed training rated the curriculum as very effective, reporting increased comfort and improved OR performance, and stated they would recommend the curriculum to their peers.
Conclusion
These data suggest there is a need for the ATLAS curriculum and that completion results in significant skill improvement. Alternative implementation strategies, including scheduling flexibility or mandatory requirements, may address the high attrition rate observed. Integration into residency training should be further explored.
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POSTURE IN PRACTICE: SURGICAL RESIDENT ERGONOMICS IN A SIMULATED TRAINING EXERCISE
Heather Grubbs, Rachel Davis Bouvette, Christopher Luschen, Katherine White, Blaine Van Hoosier, Marianne Kimmell, Jimmy Le, Arthur Grimes, Jason Lees, Morgan Bonds, Chance Nichols, Alessandra Landmann, Jeremy Johnson, Alexander Raines, Dee Wu, Kristina Booth, Frank Wood; University of Oklahoma
Background
Resident education in procedural specialties relies on hands-on learning for technical skill development in both clinical and simulated environments. Ergonomics is an often-overlooked component of operative education, and early intervention can protect trainees from physical stress and long-term musculoskeletal injury. Our aim is to evaluate trainees during a simulated suturing exercise and assess the impact of self-evaluation on ergonomics.
Methods
Following informed consent, surgical residents performed a filmed simulated complex wound closure, blinded to the study’s focus. Standardized instructions included an offer to adjust operating table height. Following initial closure, residents reviewed their videos with an ergonomic self-assessment guide, repeated the exercise with increased ergonomic awareness, and finished with a post-survey. Representative video clips were analyzed to measure elbow, spine, and neck angles before and after self-evaluation. Standard angles were defined as 90-120° for elbow, <10° for spine, and <25° for neck.
Results
Twenty residents participated across four post-graduate years (PGY): five PGY-4, four PGY-3, four PGY-2, and seven PGY-1. Across all participants, we found significant reduction in spine angle (16.6° vs 5.1°, p=0.016) and neck angle (58.5° vs 46.4° (p=0.004) during the second exercise, but no difference in elbow angle (102.7° vs 101.1°, p=0.743). We also observed a significant increase in the proportion of participants with proper spine angles (40% vs 95%, p=0.003), but no difference in proper elbow angle (55% s 75%, p=0.134) or neck angle (5% vs 5%, p=0.480). To evaluate the impact of level of training, we compared PGY-3/4 to PGY-1/2 with no significant difference in proper initial angles. The post-survey revealed most residents think about their ergonomics in the operating room weekly or daily (60%) and feel physical strain monthly or weekly (75%). All residents reported improved awareness of ergonomics and perceived transferability to the clinical setting.
Discussion
Our study demonstrated a trainee self-assessment of ergonomics led to significant improvement in spinal and neck angles in a simulated exercise with increased awareness of operative ergonomics and perceived transferability to the clinical setting. These findings support the integration of ergonomic education early in surgical training to help reduce physical strain and promote operative longevity.
EVALUATION OF TOOLS FOR ASSESSMENT OF TECHNICAL SKILLS IN ROBOTIC SURGERY: A VALIDITY- FOCUSED SYSTEMATIC REVIEW
Naimisha Badri, BS1, Amber Chen-Goodspeed, MD2, Forlain Adeyemi, MD1, Iman Ghaderi, MD, MSc, MHPE3; 1Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, 2Department of Surgery, New York-Presbyterian Queens, New York, USA., 3Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
Introduction: Objective assessment of operative performance has become essential in competency-based surgical education. While there are well established for open and laparoscopic training, equivalent assessment tools for robotic surgery remain fragmented and sparse. This study reviews current tools for assessment of performance in robotic surgery, identifying areas of strength and existing gaps.
Methods: A PubMed search of current robotic assessment tools was conducted. Each study identified was mapped to 22 robotic equivalents of the American College of Surgeons (ACS) and the Association of Program Directors in Surgery (APDS) skills modules. An established rating scale was used to evaluate available evidence supporting the unitary framework of validity, including the five “sources of validity:” content, response process, internal structure, relationships to other variables, and consequences. Two independent reviewers scored each study, then came to a consensus score for each. Interrater reliability (IRR) was calculated using intraclass correlation coefficient (ICC) and weighted Cohen’s κ.
Results: Only 13 of the 22 robotic equivalents of the ACS/APDS skill modules had corresponding studies, totaling 17 papers, indicating that a significant portion of the robotic skill domains remain unstudied. Most available studies used established tools such as Global Evaluative Assessment of Robotic Skills (GEARS) and Objective Structured Assessment of Technical Skills (OSATS). Content had the highest level of evidence, followed by internal structure and relationships to other variables, while response process and consequences had the lowest. These findings highlight significant gaps in the literature, as most studies applied existing robotic-focused assessment tools rather than developing new ones, assessed only limited aspects of performance, and provided limited evaluation of validity.
Conclusion: The findings highlight a significant lack of robust assessment tools for robotic surgery, with some skill modules having no studies that provide supporting validity evidence. Future research should focus on development and evaluation of assessment tools based on contemporary framework of validity to support competency-based training as robotic surgery continues to expand in surgical practice.
