Feasibility of Remote Administration of the Fundamentals of Laparoscopic Surgery (FLS) skills test using Google Wearable Device

Anton Nikouline, BS1, M. Carolina Jimenez, MD2, Allan Okrainec, MD, MHPE3. 1University of Toronto, 2Temerty/Chang Telesimulation Centre, Toronto, 3Division of General Surgery, University Health Network

Introduction: The Fundamentals of Laparoscopic Surgery (FLS) program is a simulation-based training course designed to teach and assess the basic cognitive and technical skills necessary for laparoscopic surgery. The skills component consists of five tasks scored for both efficiency and precision. Preliminary work has demonstrated the feasibility of using Skype as a telesimulation modality in reliably scoring the exam for remote centers. Google wearable devices (GWDs) (Mountain View, California) are wearable computers containing a heads-up display and front-facing camera allowing point-of-view video transmission. The objective of this study was to evaluate the feasibility of GWDs in scoring the technical skills component of the FLS exam.

Methods and Procedures: Twenty-eight participants consisting of 1 OR nurse, 9 medical students, 13 General Surgery (GS) residents, 2 GS fellows and 3 general surgeons were recruited for the study. Participants were asked to complete the peg transfer and intracorporeal knot tasks of FLS using GWD and Skype setups. GWDs were equipped with HIPAA-compliant Eyesight (Pristine Inc. Austin, TX) software for video transmission. Participants were alternated between setups and evaluated by on-site and remote proctors. Times and errors were recorded by both proctors. Interrater reliability of their FLS scores were compared using Intraclass Correlation Coefficients (ICCs). GWD experience was evaluated based on participant survey responses on a 5 point Likert scale.

Results:GWD trials demonstrated statistically significant correlation between proctors with ICCs of 0.985 (95% Confidence Interval [CI], 0.969-0.993) and 0.997 (95% CI 0.993-0.998), respectively for peg and suture tasks. Skype trials for both tasks demonstrated ICCs of 1.0 (95% CI 1.0-1.0). Average Likert scale responses from users found GWD to be distracting (2.71), obstructive of the view (2.79) and a limitation to task execution (2.75). Although overall there was no statistical difference in scores between GWD and Skype setups for either the peg (t=1.446, p=0.154) or suture tasks (t= – 0.710, p=0.480), only 1/28 participants found the use of GWD superior to Skype.

Conclusions: Our findings suggest that although GWDs are feasible in remote assessment of FLS with strong interrater reliability (ICC >0.95), Skype software is the preferred modality by participants. Further research is needed to better define the role of GWDs and other wearable computers in simulation training and assessment.

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