Individual differences in learning minimally invasive surgery

Simulation for bronchoscopy (RadboudUMC, UT)

The aim of this project is to provide trainees and supervisors a validated training for bronchoscopy skills that ensures a uniform level of proficiency for all pulmonologists who enter independent practice. While traditionally trainees practice their skills in a master-apprenticeship model in clinical practice, simulation technology has advanced to the point that it allows replacement of early clinical experience with simulation-based training. Simulation-based training thus not only directly benefits the trainee and supervisor but also the patient. However, simulation is more than an interesting education experience. It can and should support both formative and summative evaluation of a trainee’s performance. A uniform and standardized training program will ultimately increase quality of patient care. Bronchoscopy is a complex skill consisting of technical skills, e.g., instrument handling, and navigation and diagnostic reasoning, and non-technical skills, e.g., communication and collaboration. Simulation can support the growing need for more objective and standardized training and assessment of bronchoscopy skill. Also, simulator-based performance metrics can complement the traditional expert evaluation of trainee performance.


The aim of this project is to examine the role of experience and cognitive ability in explaining individual differences of learning endovascular procedures. Minimally invasive surgery (MIS) such as endovascular surgery has benefits for patients, but places additional burdens on the surgeons, because they have to work with reduced tactile feedback and loss of 3D vision. Hand-eye coordination is different for minimally invasive procedures than open procedures because the instruments need to be navigated in a 3D environment while the surgeon is looking at a 2D image on a screen. Some trainees adapt to the perceptual and psychomotor difficulties of minimally invasive procedures better than others. Individuals with lower abilities struggle more to automate a skill and use more attentional resources to concentrate on the task. In addition, practice and feedback are required for progressive skill acquisition and the contribution of abilities changes from one skill acquisition stage to the next. In this project we investigate how experience and cognitive ability contribute to learning to perform complex endovascular skill.

Getting lost in the anatomy: surgical navigation in laparoscopic surgery (meander Mc, UT)

The aim of this project is to to understand how navigation abilities influence the learning curve for minimally invasive surgical procedures to further develop individualized training programs. Learning to perform minimally invasive surgical procedures (‘keyhole’ surgery) differs from learning to perform regular, open surgical procedures. During the first procedures that a surgeon performs the risk of complications is increased compared to open surgical procedures. Surgical errors are related to ergonomic factors, such as the technology used, human (cognitive) factors and the amount of training a surgeon has received. Minimally invasive surgery places high demands on human perception and spatial orientation. Surgeons have to translate 2D images from a monitor into 3D information of the human body. Furthermore, hand-eye coordination is limited because surgeons do not have a direct view of the area where they are operating. These limitations often cause surgeons to have the feeling of ‘ being lost in the anatomy’ and results in disorientation. In this project we investigate to what extent navigation abilities are related to learning to perform minimally invasive surgical procedures.

procedural skill training embedded in the surgical patient flow

Simulation-based training (SBT) is growing rapidly in surgical training. A growing body of evidence supports simulation for training and assessment of surgical skills. However, despite efforts to create standardised curricula, implementation of these curricula is lagging behind. In this project, we adopt a systems approach with the clinical workflow as a tool to connect separate surgical cognitive and procedural skills in a coherent and meaningful way. Ideally, SBT is profiency-based: trainees have to master a particular skill before they progress to a more complex skill or environment. Embedding the separate skills in a whole-task training focusing on the the clinical workflow will further facilitate transfer from the simulation environment to clinical practice. The aim of this project is to design and evaluate a learning environment for graduate surgical education that: 1) promotes integration of knowledge and skills by emphasising clinical workflow, and 2) stimulates proactive learning. 

technology enhanced assessment of advanced life support skill

Research in medical teams, has shown that especially high-quality team interaction, such as efficient team communication, coordination and coping with stress, are essential for effective task execution. Although research on team interaction dates back as far as team research itself, precisely and objectively capturing these team interactions remains a challenge. In this project, we use a multimodal design to capture effective team interaction of advanced life support teams, including a combination of sociometric badges, psychophysiology equipment (i.e., the Empatica E4) and video- and audio-recording. Using sensor technology, we aim to reveal patterns of effective communication and coordination between team leaders and followers. These insights can be used to optimize simulation environments to help prospective and current medical professionals not only to improve their medical, but also their team interaction skills.