Quantifying expert vs. novice skill in vivo for development of a laryngoscopy simulator

Many medical procedures require fine motor skills, and these skills are developed over years of practice and through performing hundreds to thousands of procedures. However medical training that is based upon gaining this expertise by performing procedures on patients results in unnecessary risk to the patient. In this project expert medical skill is quantified, so that advanced medical simulators can be created to provide a realistic training environment. This approach is applied to airway intubation with a rigid laryngoscope; a procedure that is performed prior to general anesthesia and during emergency situations. A laryngoscope has been instrumented with a 3 dimensional force/torque sensor, and magnetic position sensors have been placed on the laryngoscope and the patient. Measurements are made in the operating room of both experts and novices as they perform laryngoscopy on consenting patients undergoing general anesthesia. The skill of the laryngoscopist is represented by the motion and force trajectories applied to the laryngoscope during the procedure. Preliminary results show that novices often err in the placement of the tip of the laryngoscope blade. However, when two experts perform laryngoscopy on the same patient, both experts perform key elements of the task consistently. The measured consistency among experts indicates that it will be possible to apply algorithms developed for Human Skill Acquisition, and thereby define regions of expert motion relative to patient anatomy. This is the first step in developing advanced training simulators that will simulate the procedure accurately, provide guidance to the trainee, and can be used for assessment of medical skill.