Cannulation Skill Assessment Using Functional Data Analysis

Objective:
A clinician's operative skill—the ability to safely and effectively perform a procedure—directly impacts patient outcomes and well-being. Therefore, it is necessary to accurately assess skill progression during medical training as well as develop methods to most efficiently train healthcare professionals.
Methods:
In this study, we explore whether time-series needle angle data recorded during cannulation on a simulator can be analyzed using functional data analysis methods to (1) identify skilled versus unskilled performance and (2) relate angle profiles to degree of success of the procedure.
Results:
Our methods successfully differentiated between types of needle angle profiles. In addition, the identified profile types were associated with degrees of skilled and unskilled behavior of subjects. Furthermore, the types of variability in the dataset were analyzed, providing particular insight into the overall range of needle angles used as well as the rate of change of angle as cannulation progressed in time. Finally, cannulation angle profiles also demonstrated an observable correlation with degree of cannulation success, a metric that is closely related to clinical outcome.
Conclusion:
In summary, the methods presented here enable rich assessment of clinical skill since the functional (i.e., dynamic) nature of the data is duly considered.