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

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.

The Social Cost of an AI Teammate: How an Artificial Teammate Reshapes Human-Human Communication in Small-Team Decision-Making

Conversational AI is increasingly positioned as a teammate rather than a tool, yet we know little about how its presence reshapes communication among the humans on the team. We examined sociocognitive communication dynamics in team decision-making using Group Communication Analysis (GCA), team surveys, and lexical analyses of team discourse. Teams completed a high-stakes moral-dilemma decision task in a randomized controlled study: 16 teams of two students plus an AI teammate, and 17 all-human teams of three. Across six GCA dimensions and survey outcomes, we find that the AI teammate was the single most talkative and self-cohesive member of every treatment team, yet its contributions carried the least new information and the lowest density. The presence of AI also reshaped communication amongst humans. In AI-human teams, human teammates showed lower responsivity and social impact toward one another and reported lower levels of belonging and status. Greater AI dominance in the conversation was associated with students feeling less valued as team members. Additionally, this social cost is immediate and present at baseline; it does not emerge over the course of the conversation. Drawing on these results, we discuss a research agenda extending to voice-based and longitudinal settings.