Kenneth Perrone

All Publications

• Haptics: The Science of Touch as a Foundational Pathway to Precision Education and Assessment. Academic medicine : journal of the Association of American Medical Colleges Perrone, K., Abdelaal, A. E., Pugh, C., Okamura, A. 2023

  Abstract

  Clinical touch is the cornerstone of the doctor-patient relationship and can impact patient experience and outcomes. In the current era, driven by an ever-increasing infusion of point of care technologies, physical exam skills have become undervalued. Moreover, touch and hands-on skills have been difficult to teach due to inaccurate assessments and difficulty with learning transfer through observation. In this article, the authors argue that haptics, the science of touch, provides a unique opportunity to explore new pathways to facilitate touch training. Furthermore, haptics can dramatically increase the density of touch-based assessments without increasing human rater burden-essential for realizing precision assessment. The science of haptics is reviewed, including the benefits of using haptics-informed language for objective structured clinical examinations. The authors describe how haptic devices and haptic language have and can be used to facilitate learning, communication, documentation and a much-needed reinvigoration of physical examination and touch excellence at the point of care. The synergy of haptic devices, artificial intelligence, and virtual reality environments are discussed. The authors conclude with challenges of scaling haptic technology in medical education, such as cost and translational needs, and opportunities to achieve wider adoption of this transformative approach to precision education.

  View details for DOI 10.1097/ACM.0000000000005607

  View details for PubMedID 38109654

• Trainees' Perspectives on the Next Era of Assessment and Precision Education. Academic medicine : journal of the Association of American Medical Colleges Marcotte, K., Negrete Manriquez, J. A., Hunt, M., Spadafore, M., Perrone, K. H., Zhou, C. Y. 2023

  Abstract

  The next era of assessment in medical education promises new assessment systems, increased focus on ensuring high-quality equitable patient care, and precision education to drive learning and improvement. The potential benefits of using learning analytics and technology to augment medical training abound. To ensure that the ideals of this future for medical education are realized, educators should partner with trainees to build and implement new assessment systems. Coproduction of assessment systems by educators and trainees will help to ensure that new educational interventions are feasible and sustainable. In this paper, the authors provide a trainee perspective on 5 key areas that affect trainees in the next era of assessment: (1) precision education, (2) assessor education, (3) transparency in assessment development and implementation, (4) ongoing evaluation of the consequences of assessment, and (5) patient care data as sources of education outcomes.As precision education is developed, it is critical that trainees understand how their educational data is collected, stored, and ultimately utilized for educational outcomes. Since assessors play a key role in generating assessment data, it is important that they are prepared to give high-quality assessments and are continuously evaluated on their abilities. Transparency in the development and implementation of assessments requires communicating how assessments are created, the evidence behind them, and their intended uses. Furthermore, ongoing evaluation of the intended and unintended consequences that new assessments have on trainees should be conducted and communicated to trainees. Finally, trainees should participate in determining what patient care data is used to inform educational outcomes. The authors believe that trainee coproduction is critical to building stronger assessment systems that utilize evidence-based educational theories for improved learning and ultimately, better patient care.

  View details for DOI 10.1097/ACM.0000000000005602

  View details for PubMedID 38109651

• Predictive Value of Clinical Complete Response after Chemoradiation for Rectal Cancer Liu, C., Boncompagni, A. A., Perrone, K., Agarwal, A., Hur, D. G., Lopez, I., Sheth, V., Morris, A. M. LIPPINCOTT WILLIAMS & WILKINS. 2022: S51-S52

  View details for DOI 10.1097/01.XCS.0000893308.54894.46

  View details for Web of Science ID 000867889300080

• Does the location of short-arm cast univalve effect pressure of the three-point mould? Journal of children's orthopaedics Montgomery, B. K., Perrone, K. H., Yang, S., Segovia, N. A., Rinsky, L., Pugh, C. M., Frick, S. L. 2020; 14 (3): 236–40

  Abstract

  Purpose: Forearm and distal radius fractures are among the most common fractures in children. Many fractures are definitively treated with closed reduction and casting, however, the risk for re-displacement is high (7% to 39%). Proper cast application and the three-point moulding technique are modifiable factors that improve the ability of a cast to maintain the fracture reduction. Many providers univalve the cast to accommodate swelling. This study describes how the location of the univalve cut impacts the pressure at three-point mould sites for a typical dorsally displaced distal radius fracture.Methods: We placed nine force-sensing resistors on an arm model to collect pressure data at the three-point mould sites. Sensory inputs were sampled at 15 Hz. Cast padding and a three-point moulded short arm fibreglass cast was applied. The cast was then univalved on the dorsal, volar, radial or ulnar aspect. Pressure recordings were obtained throughout the procedure.Results: A total of 24 casts were analyzed. Casts univalved in the sagittal plane (dorsal or volar surface) retained up to 16% more pressure across the three moulding sites compared with casts univalved in the coronal plane (radial or ulnar border).Conclusion: Maintaining pressure at the three-point mould prevents loss of reduction at the fracture site. This study shows that univalving the cast dorsally or volarly results in less pressure loss at moulding sites. This should improve the chances of maintaining fracture reductions when compared with radial or ulnar cuts in the cast. Sagittal plane univalving of forearm casts is recommended.

  View details for DOI 10.1302/1863-2548.14.200034

  View details for PubMedID 32582392

• Sensors and Psychomotor Metrics: A Unique Opportunity to Close the Gap on Surgical Processes and Outcomes. ACS biomaterials science & engineering Mohamadipanah, H., Perrone, K. H., Peterson, K., Nathwani, J., Huang, F., Garren, A., Garren, M., Witt, A., Pugh, C. 2020; 6 (5): 2630-2640

  Abstract

  The surgical process remains elusive to many. This paper presents two independent empirical investigations where psychomotor skill metrics were used to quantify elements of the surgical process in a procedural context during surgical tasks in a simulated environment. The overarching goal of both investigations was to address the following hypothesis: Basic motion metrics can be used to quantify specific aspects of the surgical process including instrument autonomy, psychomotor efficiency, procedural readiness, and clinical errors. Electromagnetic motion tracking sensors were secured to surgical trainees' (N = 64) hands for both studies, and several motion metrics were investigated as a measure of surgical skill. The first study assessed performance during a bowel repair and laparoscopic ventral hernia (LVH) repair in comparison to a suturing board task. The second study assessed performance in a VR task in comparison to placement of a subclavian central line. The findings of the first study support our subhypothesis that motion metrics have a generalizable application to surgical skill by showing significant correlations in instrument autonomy and psychomotor efficiency during the suturing task and bowel repair (idle time: r = 0.46, p < 0.05; average velocity: r = 0.57, p < 0.05) and the suturing task and LVH repair (jerk magnitude: r = 0.36, p < 0.05; bimanual dexterity: r = 0.35, p < 0.05). In the second study, performance in VR (steering and jerkiness) correlated to clinical errors (r = 0.58, p < 0.05) and insertion time (r = 0.55, p < 0.05) in placement of a subclavian central line. Both gross (dexterity) and fine motor skills (steering) were found to be important as well as efficiency (i.e., idle time, duration, velocity) when seeking to understand the quality of surgical performance. Both studies support our hypotheses that basic motion metrics can be used to quantify specific aspects of the surgical process and that the use of different technologies and metrics are important for comprehensive investigations of surgical skill.

  View details for DOI 10.1021/acsbiomaterials.9b01019

  View details for PubMedID 33463275

• Sensors and Psychomotor Metrics: A Unique Opportunity to Close the Gap on Surgical Processes and Outcomes ACS BIOMATERIALS SCIENCE & ENGINEERING Mohamadipanah, H., Perrone, K. H., Peterson, K., Nathwani, J., Huang, F., Garren, A., Garren, M., Witt, A., Pugh, C. 2020; 6 (5): 2630–40

  View details for DOI 10.1021/acsbiomaterials.9b01019

  View details for Web of Science ID 000535188500014

• Translating motion tracking data into resident feedback: An opportunity for streamlined video coaching Perrone, K. H., Yang, S., Mohamadipanah, H., Wise, B., Witt, A., Goll, C., Pugh, C. EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. 2020: 552–56

  Abstract

  We hypothesized that differences in motion data during a simulated laparoscopic ventral hernia repair (LVH) can be used to stratify top and lower tier performers and streamline video review.Surgical residents (N = 94) performed a simulated partial LVH repair while wearing motion tracking sensors. We identified the top ten and lower ten performers based on a final product quality score (FPQS) of the repair. Two blinded raters independently reviewed motion plots to identify patterns and stratify top and lower tier performers.Top performers had significantly higher FPQS (23.3 ± 1.2 vs 5.7 ± 1.6 p < 0.01). Raters identified patterns and stratified top performers from lower tier performers (Rater 1 χ2 = 3.2 p = 0.07 and Rater 2 χ2 = 2.0 p = 0.16). During video review, we correlated motion plots with the relevant portion of the procedure.Differences in motion data can identify learning needs and enable rapid review of surgical videos for coaching.

  View details for DOI 10.1016/j.amjsurg.2020.01.032

  View details for Web of Science ID 000525802700004

  View details for PubMedID 32014295

• Initial experiences with virtual reality as a tool for observation in needs-driven health technology innovation BMJ INNOVATIONS Perrone, K. H., Blevins, K., Denend, L., Fan, R., Huelman, J., Wall, J. 2020; 6 (1): 10-12

  View details for DOI 10.1136/bmjinnov-2018-000308

  View details for Web of Science ID 000850797400003

• Splenectomy for benign and malignant hematologic pathology: Modern morbidity, mortality, and long-term outcomes. Surgery open science Alobuia, W. M., Perrone, K. n., Iberri, D. J., Brar, R. S., Spain, D. A., Forrester, J. D. 2020; 2 (4): 19–24

  Abstract

  The role of splenectomy to diagnose and treat hematologic disease continues to evolve. In this single-center retrospective review, we describe modern morbidity, mortality, and long-term outcomes associated with splenectomy for benign and malignant hematologic disorders.We analyzed all nontrauma splenectomies performed for benign or malignant hematologic disorders from January 2009 to September 2018. Variables collected included demographics, preexisting comorbidities, laboratory results, intra- and postoperative features, and long-term follow-up. Outcomes of interest included postoperative complications, 30-day mortality, and overall mortality.We identified 161 patients who underwent splenectomy for hematologic disorders. Median age was 54 years (range 19-94), and 83 (52%) were female. Splenectomy was performed for 95 (59%) patients with benign hematologic disorders and for 66 (41%) with malignant conditions. Most splenectomies were laparoscopic (76%), followed by laparoscopic hand assisted (11%), open (8%), and laparoscopic converted to open (6%). Median follow-up was 761 days (interquartile range: 179-2025 days). Major complications occurred in 21 (13%) patients. Three (2%) patients died within 30 days; 16 (9%) died more than 30 days after operation, none from surgical complications, with median time to death of 438 days (interquartile range: 231-1497 days). Among malignant cases, only preoperative thrombocytopenia predicted death (odds ratio = 5.8, 95% confidence interval = 1.1-31.8, P = .04). For benign cases, increasing age was associated with inferior survival (odds ratio = 2.3, 95% confidence interval = 1.0-5.1, P = .05).Splenectomy remains an important diagnostic and therapeutic option for patients with benign and malignant hematologic disorders and can be performed with a low complication rate. Despite considerable burden of comorbid disease in these patients, early postoperative mortality was uncommon.

  View details for DOI 10.1016/j.sopen.2020.06.004

  View details for PubMedID 32939448

  View details for PubMedCentralID PMC7479208

• Use of sensors to quantify procedural idle time: Validity evidence for a new mastery metric. Surgery Perrone, K. H., Yang, S., Wise, B., Witt, A., Goll, C., Dawn, S., Eichhorn, W., Mohamadipanah, H., Pugh, C. 2019

  Abstract

  BACKGROUND: Quantification of mastery is the first step in using objective metrics for teaching. We hypothesized that during orotracheal intubation, top tier performers have less idle time compared to lower tier performers.METHODS: At the Anesthesiology 2018 Annual Meeting, 82 participants intubated a normal airway simulator and a burnt airway simulator. The movements of the participant's laryngoscope were quantified using electromagnetic motion sensors. Top tier performers were defined as participants who intubated both simulators successfully in less than the median time for each simulator. Idle time was defined as the duration of time when the laryngoscope was not moving.RESULTS: Top performers showed less Idle Time when intubating the normal airway compared to lower tier performers (14.5 ± 9.8 seconds vs 34.0 ± 52.0 seconds, respectively P < .01). Likewise, top performers showed less Idle Time when intubating the burnt airway compared to lower tier performers (18.6 ± 15.2 seconds vs 63.4 ± 59.11 seconds; P < .01). Comparing performance on the burnt airway to the normal airway, there was a difference for lower tier performers (63.4 ± 59.1 seconds vs 34.0 ± 52.0 seconds; P < .01) but not for top tier performers (18.6 ± 15.2 seconds vs 14.5 ± 9.8 seconds; P= .07).CONCLUSION: Similar to our previous findings with other procedures, Idle Time was shown to have known group validity evidence when comparing top performers with lower tier performers. Further, Idle Time was correlated with procedure difficulty in our prior work. We observed statistically significant differences in Idle Times for lower tier performers when comparing the normal airway to the burnt airway but not for top tier performers. Our findings support the continued exploration of Idle Time for development of objective assessment and curricula.

  View details for DOI 10.1016/j.surg.2019.09.016

  View details for PubMedID 31708084

• Screening surgical residents' laparoscopic skills using virtual realitytasks: Who needs more time in the sim lab? Surgery Mohamadipanah, H., Perrone, K. H., Nathwani, J., Parthiban, C., Peterson, K., Wise, B., Garren, A., Pugh, C. 2019

  Abstract

  BACKGROUND: This study investigated the possibility of using virtual reality perceptual-motor tasks as a screening tool for laparoscopic ability. We hypothesized that perceptual-motor skills assessed using virtual reality will correlate with the quality of simulated laparoscopic ventral hernia repair.MATERIALS AND METHODS: Surgical residents (N= 37), performed 2 virtual reality perceptual-motor tasks: (1) force matching and (2) target tracking. Participants also performed a laparoscopic ventral hernia repair on a simulator and final product quality score, and endoscopic visualization errors were calculated. Correlational analysis was performed to assess the relationship between performance on virtual reality tasks and laparoscopic ventral hernia repair.RESULTS: Residents with poor performance on force matching in virtual reality-"peak deflection" (r= -0.34, P < .05) and "summation distance" (r= -0.36, P < .05)-had lower final product quality scores. Likewise, poor performance in virtual reality-based target tracking-"path length" (r= -0.49, P < .05) and "maximum distance" (r= -0.37, P < .05)-correlated with a lower final product quality score.CONCLUSION: Our findings support the notion that virtual reality could be used as a screening tool for perceptual-motor skill. Trainees identified as having poor perceptual-motor skill can benefit from focused curricula, allowing them to hone personal areas of weakness and maximize technical skill.

  View details for DOI 10.1016/j.surg.2019.04.013

  View details for PubMedID 31229312

• Can VR Be Used to Track Skills Decay During the Research Years? The Journal of surgical research Mohamadipanah, H. n., Perrone, K. n., Peterson, K. n., Garren, M. n., Parthiban, C. n., Sunkara, A. n., Zinn, M. n., Pugh, C. n. 2019

  Abstract

  Time away from surgical practice can lead to skills decay. Research residents are thought to be prone to skills decay, given their limited experience and reduced exposure to clinical activities during their research training years. This study takes a cross-sectional approach to assess differences in residents' skills at the beginning and end of their research years using virtual reality. We hypothesized that research residents will have measurable decay in psychomotor skills when evaluated using virtual reality.Surgical residents (n = 28) were divided into two groups; the first group was just beginning their research time (clinical residents: n = 19) and the second group (research residents: n = 9) had just finished at least 2 y of research. All participants were asked to perform a target-tracking task using a haptic device, and their performance was compared using Welch's t-test.Research residents showed a higher level of "tracking error" (1.69 ± 0.44 cm versus 1.40 ± 0.19 cm; P = 0.04) and a similar level of "path length" (62.5 ± 10.5 cm versus 62.1 ± 5.2 cm; P = 0.92) when compared with clinical residents.The increased "tracking error" among residents at the end of their research time suggests fine psychomotor skills decay in residents who spend time away from clinical duties during laboratory time. This decay demonstrates the need for research residents to regularly participate in clinical activities, simulation, or assessments to minimize and monitor skills decay while away from clinical practice. Additional longitudinal studies may help better map learning and decay curves for residents who spend time away from clinical practice.

  View details for DOI 10.1016/j.jss.2019.10.030

  View details for PubMedID 31776024