Xueying Tang
A Latent Hidden Markov Model for Process Data
Psychometrika
live feedback operating room essential surgical training despite role feedback plays developing surgical skills accepted methodology characterize salient features feedback defined quantify intraoperative feedback provided trainees live surgical cases propose standardized deconstruction feedback qualitative study using mixed methods analysis surgeons single academic tertiary care hospital audio video recorded operating room april october 2022 urological residents fellows faculty attending surgeons involved robotic teaching cases trainees active control robotic console least portion surgery eligible voluntarily participate feedback time stamped transcribed verbatim iterative coding process performed using recordings transcript data recurring themes emerged feedback audiovisual recorded surgery primary outcomes reliability generalizability feedback classification system characterizing surgical feedback secondary outcomes included assessing utility system 29 surgical procedures recorded analyzed 4 attending surgeons 6 minimally invasive surgery fellows 5 residents postgraduate years 35 involved reliability system 3 trained raters achieved moderate substantial interrater reliability coding cases using 5 types triggers 6 types feedback 9 types responses prevalenceadjusted biasadjusted range 056 95 ci 045068 minimum triggers 099 95 ci 097100 maximum feedback responses generalizability system 6 types surgical procedures 3711 instances feedback analyzed coded types triggers feedback responses significant differences triggers feedback responses reflected surgeon experience level surgical task performed example response attending surgeons took safety concerns often fellows residents prevalence rate ratio rr 397 95 ci 312482 p 002 suturing involved errors triggered feedback dissection rr 165 95 ci 103333 p 007 utility system different combinations trainer feedback associations rates different trainee responses example technical feedback visual component associated increased rate trainee behavioral change verbal acknowledgment responses rr 111 95 ci 103120 p 02 findings suggest identifying different types triggers feedback responses may feasible reliable method classifying surgical feedback across several robotic procedures outcomes suggest system generalized across surgical specialties trainees different experience levels may help galvanize novel surgical education strategies