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The findings of this study suggest that there is wide variation in technical skill among practicing surgeons, accounting for more than 25% of the variation in patient outcomes. Higher colectomy technical skill scores appear to be associated with lower complication rates for colectomy and for all other procedures performed by a surgeon. Efforts to improve surgeon technical skills may result in better patient outcomes.
Stulberg, J., et al. Association Between Surgeon Technical Skills and Patient Outcomes JAMA Surg. Published online August 19, 2020. doi:10.1001/jamasurg.2020.3007
This study demonstrates comprehensively that prolonged operative time can increase the likelihood of developing SSI across a broad array of surgical procedures and surgical specialties. Overall, pooled analyses demonstrated that patients with extended operative times across a wide range of procedures had approximately twice the likelihood of developing SSI, and on overage, the mean operative time was approximately 30 min longer in patients with SSIs compared with those patients without SSIs. Nevertheless, given the importance of SSIs on patient outcome and health care economics including hospital reimbursement penalties, hospitals should focus efforts to reduce operative time. This may include strategies such as the adoption of new technologies that can help improve operative efficiency, utilization of specialized care teams, ensuring that operating staff are not overworked or fatigued, and better preoperative planning. These strategies should be considered in light of other possible risk factors for SSI.
Cheng, H., et al. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surgical Infections. Aug 2017.722-735. http://doi.org/10.1089/sur.2017.089
This article highlights novel strategies that may assist surgeons and hospitals in addressing the challenges associated with incorporating emerging procedures and technology with safe patient care. Peer coaching by experienced surgeons has been proposed to assist with safe surgical skill acquisition in practice. Hospital credentialing committees may better utilize expert surgeons as proctors for less-experienced surgeons who apply for privileges to perform new procedures. Furthermore, opportunities exist in leveraging industry's financial incentives with surgeons’ drive for clinical advancements. The strategies described in this article offer ways to ensure procedural competency to benefit and protect patients when surgical innovations enter practice.
Pradarelli, J.C., et al. Facilitating the Safe Diffusion of Surgical Innovations Annals of Surgery: April 2019 - Volume 269 - Issue 4 - p 610–611. DOI: 10.1097/SLA.0000000000003134.
Surgery already takes lessons from the airline industry and can take similar lessons from professional sport with regards to training. The relationship of a coach and elite sportsman is similar in many respects to that of trainer and trainee. As surgical technology advances, so must the teaching tools and strategies to train the next generation of surgeon.
Chand, M., et al. Evolution in surgical training: what can we learn from professional coaches and elite athletes? J R Soc Med. 2014 Jul; 107(7): 290–292. doi: 10.1177/0141076814532395
Kowalewski T, Comstock B, Sweet R, Schaffhausen C, Menhadji A, Averch T, Box G, Brand T, Ferrandino M, Kaouk J, Knudsen B, Landman J, Lee B, Schwartz B, McDougall E, Lendvay TS. Correlation of High-Volume Crowdsourced Evaluation and Tool Motion Metrics for Surgical Skills Assessment: The Basic Laparoscopic Urologic Skills (BLUS) Validation Project. Journal of Endourology [in Review, 2016].
Validity, scalability and discoverability are current but removable barriers to video-based assessment.
Pugh, C., et al. The what? How? And Who? of video-based assessment (VBA). Am J Surg. 2021 Jan;221(1):13-18. doi: 10.1016/j.amjsurg.2020.06.027. Epub 2020 Jun 23.
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