From Multimodal Observation to Interpretable Suggestions: Counterfactual Time-Expanded Relational Modeling of Surgical Teams

Abstract

In surgery, patient safety is threatened not only by technical issues but also by poor teamwork. However, existing surgical AI-based solutions focus mainly on visual workflow and technical execution, neglecting the modeling of team interactions and missing opportunities to actively support clinicians in improving their teamwork skills. To address this gap, we propose a tempo-relational framework for modeling surgical team dynamics from multimodal observations. By leveraging Time-Expanded graphs, the approach captures both relational structure and temporal evolution, achieving strong expressivity while remaining robust in the low-data regime typical of surgical settings. Beyond prediction, such modeling enables the generation of efficient, interpretable, and actionable suggestions for clinicians. More specifically, we generate suggestions via a counterfactual procedure that identifies minimal yet structured changes in individual behaviors and interaction patterns associated with improvements in team performance. Experiments with simulated surgical procedures show that our approach improves predictive performance in diverse behavioral and interaction goals while offering meaningful insights into team dynamics. This work advances surgical AI beyond outcome-driven prediction towards a socially grounded, team-centric, and actionable paradigm to better understand and support the development of team skills in surgical settings.

Accepted at ACM Multimedia 2026