Motion Metrics Reliably Differentiate Competency: Fundamentals Of Endovascular And Vascular Surgery (FEVS)
Viony M. Belvroy, MD1, Barathwaj Murali2, Malachi G. Sheahan, MD3, Marcia K. O'Malley, PhD2, Jean Bismuth, MD1.
1Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA, 2Department of Mechanical Engineering, Mechatronics and Haptic Interfaces Laboratory, Rice University, Houston, TX, USA, 3Department of Vascular Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA.
OBJECTIVES: The Fundamentals of Vascular & Endovascular Surgery (FVES) is a curriculum that includes an endovascular model for skills testing differentiating between competent and non-competent performers. The aim of our study is to further validate the model and test its reliability in assessing the performance of endovascular trainees.
METHODS: The model was tested in a virtual-reality environment. Thirty-nine subjects were divided into three groups, based on their endovascular experience: novice (<50 endovascular cases), intermediate (50 - 500 endovascular cases) and expert (>500 endovascular cases). Performance was evaluated in four tasks, measuring the tool tip position and velocity on the virtual model. Average tool tip velocity and movement smoothness in the velocity frequency domain are validated parameters defining proficiency of movement. The data were filtered and interpolated to calculate the metrics. Trials containing critical tool manipulation errors were discarded. RESULTS: In total 58 tasks completed by novices, 11 completed by intermediates, and 10 completed by experts were analyzed to determine performance. The difference in performance between the novice and expert groups was statistically significant for guidewire smoothness (P < .001). The expert group had a statistically significant higher average guidewire velocity compared to the novice group (p = 0.001)(Figure 1).
CONCLUSIONS: The FEVS model continues to differentiate novices from experts based on their handling of guidewire tools, measured as smoothness and velocity. This model offers a useful instrument to test competency in endovascular surgeons. 
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