An Integrated Video-AI Platform for Action-Level Microanastomosis Training and Performance Feedback

Verbal feedback delivered by attending surgeons in the operating room plays a critical formative role in resident trainee skill acquisition. Yet, assessing the quality of trainer feedback and its effectiveness in influencing trainee behavior during live surgery remains a challenge. Prior studies assessed feedback content relying on extensive manual annotation by expert human raters and focused on developing broad taxonomies that overlook the qualitative aspects of feedback delivery such as clarity or urgency. Limited existing automated methods, including keyword analysis and topic modeling, also fail to capture these nuanced aspects. We introduce a two-stage LLM-based framework that discovers interpretable feedback quality criteria grounded in the context of surgical training. Our method uses multi-agent prompting and surgical domain knowledge injection to discover a small set of human interpretable scoring criteria (e.g., Encouraging, Urgent, Clear). These criteria are then used to automatically score live surgical feedback via an LLM-as-a-judge approach. Evaluation on 4.2k trainer feedback instances demonstrates that our AI-discovered criteria outperform prior content-based frameworks in predicting feedback effectiveness, including observed trainee behavioral adjustments and trainer approval. This work advances scalable, human-aligned assessment of communication quality in the operating room and provides a foundation for improving surgical teaching practices.

Persistent shortages in the surgical workforce and inherent limitations of traditional training methods highlight the necessity of automated, data-driven approaches in surgical education. This study addresses these challenges by introducing a novel, explainable AI-powered framework for automated skill assessment, specifically focusing on cataract surgery. We present the world's largest dataset of cataract surgery videos, comprising 2,000 recordings. Additionally, we propose an AI-powered analytical framework that employs advanced computer vision and signal-processing techniques to automatically evaluate surgical videos to derive objective, quantitative performance indicators that complement or potentially replace subjective scoring methods. A significant advantage of our framework over previous methods lies precisely in its explainability of outputs, elevating it beyond merely an opaque skill classification tool. Through experimental analysis of 83 cataract surgery videos, we demonstrate that the automatically computed metrics exhibit strong correlations with expert-based subjective evaluations, achieving up to 87% accuracy in surgical skill assessment. Each metric was individually examined, and expert surgeons provided subjective ratings using the newly introduced Capsulorhexis Skill Assessment System (CSAS). These subjective assessments were compared with ten objective motion-based metrics extracted through our framework. The results indicated a robust correlation between subjective ratings and automated indicators, underscoring the framework's capacity to accurately model surgical expertise.

Current video benchmarks for multimodal large language models (MLLMs) focus on event recognition, temporal ordering, and long-context recall, but overlook a harder capability required for expert procedural judgment: tracking how ongoing interactions update the procedural state and thereby determine the correctness of later actions. We introduce SiMing-Bench, the first benchmark for evaluating this capability from full-length clinical skill videos. It targets rubric-grounded process-level judgment of whether interaction-driven state updates preserve procedural correctness across an entire workflow. SiMing-Bench is instantiated with SiMing-Score, a physician-annotated dataset of real clinical skill examination videos spanning cardiopulmonary resuscitation, automated external defibrillator operation, and bag-mask ventilation, each paired with a standardized step-wise rubric and dual-expert labels. Across diverse open- and closed-source MLLMs, we observe consistently weak agreement with physician judgments. Moreover, weak performance on rubric-defined intermediate steps persists even when overall procedure-level correlation appears acceptable, suggesting that coarse global assessment substantially overestimates current models' procedural judgment ability. Additional analyses with binary step judgment and step-aligned clips indicate that the bottleneck is not merely fine-grained scoring or temporal localization, but modeling how continuous interactions update procedural state over time.