Noninvasive brain imaging shows readiness of trainees to perform operations

A study that used noninvasive brain imaging to evaluate brain activity found that simulator-trained medical students successfully transferred those skills to operating on cadavers and were faster than peers who had no simulator training.

Results of the study, led by Arun Nemani, MS, a PhD candidate at Rensselaer Polytechnic Institute in Troy, N.Y., were presented this month at the American College of Surgeons Clinical Congress 2017. The study evaluated the surgical proficiency of 19 medical students – six of whom practiced cutting tasks on a physical simulator, eight practiced on a virtual simulator, and five had no practice.

"We plan on using these study findings to create robust machine learning-based models that can accurately classify trainees into successfully and unsuccessfully trained candidates using functional brain activation,"Nemani explains.

The medical students who practiced on the physical simulator completed the task in an average of 7.9 minutes with a deviation (±) of 3.3 minutes. Those who used the virtual stimulator did the task in 13.05 minutes (±2.6 minutes) vs. an average of 15.5 minutes (±5.6 minutes) for the group that had no practice.

Brain imaging mesured activity in the primary motor cortex, located in the frontal lobe. The researchers found the simulator groups had significantly higher cortical activity than the group that had no training. "By showing that trained subjects have increased activity in the primary motor cortex when performing surgical tasks when compared to untrained subjects, our noninvasive brain imaging approach can accurately determine surgical motor skill transfer from simulation to ex-vivo environments," Nemani says.

The researchers believe this is the first study to show clear functional changes that transfer into surgical skill in individuals who had simulator training. "This work addresses underlying neurological responses to increased motor skill training that is often missing in current surgical simulator literature," according to Nemani, who says objectively determining if a surgeon in training has achieved the motor skills necessary to perform surgery before actually doing surgery in the OR is crucial. "Brain function-based metrics, which do not depend on subjective or inaccurate task performance metrics, may bring significantly more objectivity in surgical skill transfer assessment."

This study underscores the value of simulation and pre-planning operations by objectively showing functional changes in brain activity as surgeons learn new skills. "Now, we can quantify changes in brain activation as trainees master surgical tasks on a simulator and transfer to more clinically relevant environments," Nemani says.

Future research will expand to include other cortical areas associated with motor skill learning, such as the prefrontal cortex and supplementary motor areas, according to Mr. Nemani. "These next steps will help provide a comprehensive map on functional changes within the brain as surgical motor skill increases."