PROFILE: Dr Peter Weinstock, Global Surgical Training Challenge Judging Panelist

Twenty years ago, when Dr Peter Weinstock initially started implementing surgical simulation training at Boston Children’s Hospital, where he is a pediatric critical care physician, it was to enhance surgeons’ techniques for rare, but very high stakes, interventions. 

“We were trying to address the well-known relationship between volume and quality,” says Dr Weinstock, referring to studies that suggest that the more cases a physician treats, the better the patient outcomes. In other words, practice makes excellence. They developed simulation models to teach and maintain surgical skills in cases such as hydrocephalus, a build-up of fluid in and around an infant’s brain, which is relatively rare but a significant risk to the child.

“We needed to ensure that surgeons were game-ready when those rare cases presented in the hospital,” he says. Over the last 20 years, he and his team have established and grown a world-recognized surgical simulation lab called Immersive Design Systems at Boston Children’s Hospital. It is a full-scale human-centered design lab for training, systems engineering, and rapid prototyping. 

“We have come a long way from using moulage on mannequins,” he says. That being said, he has grown increasingly interested in simulation training in low and middle income countries (LMICs) and with understanding how to design and create models for low resource settings. 

While the initial premise at Boston Children’s Hospital was to train and maintain skills for less common surgical interventions, the Global Surgical Training Challenge has focused on some of the most common needs. From ectopic pregnancy to the most common long bone fractures, the finalist teams are addressing challenges that impact millions of people each year.

“The Global Surgical Training Challenge resonated with me on so many levels,” he says. “It is an exciting opportunity to explore how to bring these training models closer to the practitioners.” 

That question of “bringing the training to the practitioners” has been a driving philosophy in his work in Boston. “Everywhere, clinicians are very busy and it can be a challenge to get them to come to a centralized lab or training environment. We believe it’s important that the simulation training be easily accessible. In LMICs, we are trying to address a similar need — how do we bring surgical training models to the practitioners in more remote or rural settings, rather than their needing to travel to a large urban center?” The need to have on-demand training that is convenient and accessible to clinicians is a universal challenge.

He adds that another critical challenge in designing simulators for low resource settings — ones that use inexpensive local materials — is in deciding how high and how much fidelity is essential to learning specific  procedures. “Many ‘high-fidelity’ mannequins and trainers contain a lot of bells and whistles, some of which may not be necessary for the training at hand. The designers and innovators in LMICs need to focus on the critical features and decide on both what and what not to include.”

One of the less frequently addressed benefits of the open source “build it yourself” training modules is that learners can practice privately and freely, in their own time. They can make as many mistakes as they need to as they develop competence and confidence. 

“The ability to do this without the pressure of someone watching over you, particularly in those early attempts, creates  so-called psychological safety – an environmental factor that we’re finding is really important in successful surgical training,” says Dr Weinstock. 

Although that has not been an explicit objective of the Global Surgical Training Challenge, it is something that some learners have mentioned. They can practice repeatedly until they feel ready to demonstrate to a mentor or even a peer. “This model of putting control of training in the learner’s hand can really optimize the training from the start.”

Dr Weinstock, along with the other Global Surgical Training Challenge judges, will conduct the final review of the finalists’ modules in December. The Grand Prize winner will be announced in January 2023.

(Image courtesy of Dr Weinstock)