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The aim was to identify how technical skill during open surgery can be measured unobtrusively by video recording during a surgical procedure. We hypothesized that procedural\u2010step timing, hand movements, instrument use and Shannon entropy differ with expertise and training and are concordant with a performance\u2010based validated individual procedure score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Surgeon and non\u2010surgeon participants with varying training and levels of expertise were video recorded performing axillary artery exposure and control (AA) on un\u2010preserved cadavers. Color\u2010coded gloves permitted motion\u2010tracking and automated extraction of entropy data from recordings. Timing and instrument\u2010use metrics were obtained through observational video reviews. Shannon entropy measured speed, acceleration and direction by computer\u2010vision algorithms. Findings were compared with individual procedure score for AA performance<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Experts had lowest entropy values, idle time, active time and shorter time to divide pectoralis minor, using fewer instruments. Residents improved with training, without reaching expert levels, and showed deterioration 12\u201318\u00a0months later. Individual procedure scores mirrored these results. Non\u2010surgeons differed substantially.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Hand motion entropy and timing metrics discriminate levels of surgical skill and training, and these findings are congruent with individual procedure score evaluations. These measures can be collected using consumer\u2010level cameras and analyzed automatically with free software. Hand motion with video timing data may have widespread application to evaluate resident performance and can contribute to the range of evaluation and testing modalities available to educators, training course designers and surgical quality assurance programs.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-020-05916-1","type":"journal-article","created":{"date-parts":[[2021,1,3]],"date-time":"2021-01-03T22:03:09Z","timestamp":1609711389000},"page":"981-987","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Enhanced Training Benefits of Video Recording Surgery With Automated Hand Motion Analysis"],"prefix":"10.1002","volume":"45","author":[{"given":"Colin F.","family":"Mackenzie","sequence":"first","affiliation":[{"name":"School of Medicine (UMDSOM) Shock Trauma Anesthesiology Research Center University of Maryland 11 S Paca St, Suite LL\u201001 21201 Baltimore MD 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University of Maryland School of Medicine Institutional Review Board approved the recruitment and consent process. Cadaver use was approved by the Maryland State Anatomy Board.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This research and development project was conducted by the University of Maryland, School of Medicine and was made possible by a cooperative agreement which was awarded and administered by the U.S. Army Medical Research & Materiel Command (USAMRMC) and the Telemedicine & Advanced Technology Research Center (TATRC) at Fort Detrick, MD under Contract Number: W81XWH-13\u20132-0028 (Colin F Mackenzie M.D.). The views, opinions and\/or findings contained in this publication are those of the authors and do not necessarily reflect the views of the Department of Defense and should not be construed as an official DoD position, policy or decision unless so designated by other documentation. No official endorsement should be made.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}}]}}