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Inheriting the Learner's View: A Wearable Computing Platform for Improving Surgical Trainee Performance
Zachary E Brewer, Hutchinson C. Fann, *W. David Ogden, *Thomas A. Burdon, *Ahmad Y Sheikh
Stanford University, Stanford, CA

Balancing resident autonomy with adequate supervision remains challenging, especially when visualization of the operative field is limited (e.g. traditional mitral valve exposure). It is speculated that real-time visualization of the trainee’s viewpoint by the instructor may improve performance and teaching efficacy. We hypothesized that introduction of a wearable computing solution allowing the instructor to visualize otherwise “blind” areas in the operative field could improve trainee performance in a simulated operative setting.
The Google (Mountain View, Ca) Glass wearable computing platform running proprietary software from CrowdOptic (San Francisco, Ca) was utilized for creation of the wearable surgical visualization system. Both the learner and trainer wore Glass devices and video was streamed from the learner’s Glass unit in real-time to the trainer (image latency< 1ms). A specialized simulator was constructed whereby the operative field (consisting of a standardized black and white template) was obscured from the trainer’s view, but readily visualized by the learner. Using a suture placement key and standard script, the trainer directed the learner as to where needles should be placed. The learner had no a priori knowledge of the placement objectives, but simply followed the commands of the trainer. Each participant (n=4) performed a total of 10 needle swings, 5 with the wearable on and 5 with it removed. Needles were left in place and a composite error score calculated based on the accuracy of needle placement per the instructor’s key. Mean completion time was also measured and participants completed a questionnaire following the experimental session.
Introduction of the wearable did not affect mean time to task completion (234±28 vs. 238±33 seconds, NS). However, mean composite error score (MCES) fell significantly once the wearable system was deployed (17±6 vs. 12±4 mm, P=0.05), suggesting improved accuracy of needle placement (Figure 1). Three out of four participants deemed the device unobtrusive, easy to operate, and useful for communication and instruction. All participants reported a similar device would be useful in the actual OR.
The findings suggest that wearable technologies allowing for adoption of the learner’s perspective may be a useful educational adjunct in the operating room. Additional experience and larger sample size will better define the task components that would benefit from this technology.

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