Biomedical Engineering Reference
In-Depth Information
12.3 ASSESSMENT OF CLINICAL COMPETENCE AS AN APPROACH
TO PROVIDE QUANTITATIVE INFORMATION
Even though it is widely accepted that introducing advanced tools for medical
education purposes is important; up to now, there is no definite accepted scientific
methodology for the assessment of surgical skills (Moorthy, Darzi, et al. , 2003;
Rosen, Hannaford, et al ., 2006; Solis et al , 2008; etc.). In recent decades, researchers
from the medical field have been proposing different ways of measuring the
clinical competence of trainees. In particular, clinical examinations have been
proposed to perform practical exams to trainees while their performances are eval-
uated. However, examiners lack of information which cannot be obtained through
the simple observation of the task (surgical performance is a complex operation
involving a surgeon-specific mix of cognitive and technical components).
The methodology for assessing surgical skill as a subset of surgical ability, is
gradually shifting from subjective scoring by an expert which may be a variably
biased opinion using vague criteria, toward a more objective, quantitative analysis
(Gallagher et al ., 2002). RT platforms to teach and evaluate the cognitive aspects of
surgery have been developed and shown to be of value to surgical education; tools
to assess the technical aspects of surgery that potentially lead to effective teaching
are currently under development. Such tools can be resumed as: instrumented
tools (Rosen et al ., 2006), motion-efficiency analysis from motion tracking devices
(Datta, 2002; Moorthy, Darzi, et al. , 2003), physical simulators (Pugh and Young-
blood, 2002; Solis et al ., 2008) etc.
12.3.1 Case of Study: Suture Training System
In recent decades, researchers from the medical field have proposed different
ways of measuring the clinical competence of trainees. In particular, the Objective
Structured Clinical Examination (OSCE) has been proposed as a way of measuring
clinical competence that allowed control of many of the biases of conventional
methods (Harden, 1975). However, OSCE may not be as valid in the assessment
of some technical skills. This is because the binary checklist typically used in
most of the OSCEs is insufficiently sensitive detecting some behavioral patterns
while performing the task. Due to the limitations of conventional training devices,
examinees may evaluate trainees' performance through the simple observation
of the task. As a result, up to now, there is no widely accepted quantitative
assessment scheme.
For this purpose, at Waseda University, we have developed a suture training
system designed to provide quantitative information of the trainees' performance
(Solis et al ., 2008). The proposed system is integrated by a personal computer, a
web cam, a dummy skin model with embedded sensors ( Figure 12.3 ) . Arrays of
embedded sensors are used to measure the motion the artificial skin (by sensing
 
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