Self assessment provides guidance where words fall short in surgical training

If you were to monitor and map the movements and gestures of a group of master surgeons performing a surgical technique — from the sequence to timing to sweep of the hand — you would notice a remarkably similar choreography among them. “But if you ask them to explain, step by step, the process, they all say different things,” says Dr. Carla Pugh, Professor of Surgery at Stanford University School of Medicine, and part of the judging panel for the Global Surgical Training Challenge.

The Global Surgical Training Challenge has been designed to stimulate the creation of novel, low-cost surgical training modules, which will help surgical practitioners to learn and assess new skills to improve the health of their communities. Self-assessment is one of the foundational principles of the Challenge. Although the training modules and accompanying self-assessment could be used in medical schools or other traditional surgical training environments, they should enable surgical practitioners and trainees to learn and assess their psycho-motor skills without the presence of a teacher.

Beyond becoming board-certified, which measures minimum competency, physicians seek to perfect their craft. “We see this around the world,” says Dr. Pugh. “Surgeons video record their cases and review them afterwards, or they share them with colleagues. No one wants to be minimally competent; they want mastery.”

”No one wants to be minimally competent; they want mastery.”

Dr. Carla Pugh

Professor of Surgery at Stanford University School of Medicine

What physicians and other surgical providers in both high and low resource settings have in common is the desire to master surgical skills. They want to share information and learn from each other in a way that is safe. In traditional settings, training can rely on cadavers, classrooms and supervising instructors, or other expensive resources. Accessing these resources can be a challenge for practitioners in low-resource settings.

Dr. Pugh’s approach focuses on the use of wearable technology as a mechanism for self-assessment of surgical skills. “Wearable technology allows us to quantify individual performance in ways that are difficult, if not impossible, with verbal descriptions.” These technologies allow the movements and gestures to be recorded and digitized, thus capturing their technique and even their thought process. This, in turn, can improve surgeons’ decision-making.

The self-assessment requirement of the Global Surgical Training Challenge asks innovators to consider ways for surgical practitioners to evaluate their own skills, without the direct observation of an instructor. The goal is to allow surgical practitioners the ability to learn and test new skills outside a traditional classroom environment. This is particularly critical for technically challenging procedures, or those that are less frequently experienced in the clinician’s practice. These are the types of procedures that are correlated with poor patient outcomes.

The Challenge’s self assessment should include a mechanism for targeted feedback, which enables the trainee to ensure they are practicing the appropriate skills. They can then modify their performance to improve competence, and determine when they have practiced to a sufficient level of mastery to perform the procedure in a patient. 

“When you look at it, the point of self-assessment is the improvement of patient outcomes,” says Dr. Pugh. “Even though we all think we do it differently, we can see there is a remarkable similarity among the master surgeons. So it is possible to standardize the assessment.”

Carla Pugh, MD, PhD, FACS, is Director of the Technology Enabled Clinical Improvement (T.E.C.I.) Center. The T.E.C.I. Center is a multidisciplinary team of researchers dedicated to the design and implementation of advanced engineering technologies that facilitate data acquisition relating to clinical performance.