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Practice does not always make perfect – what surgeons can learn from other industries

Toronto, April 15, 2016

By Marc Dodsworth

Dr. Teodor Grantcharov performs surgery in the OR with the black box recording
Dr. Teodor Grantcharov performs surgery in the OR with the black box recording.

Surgeons can learn much from other high-risk industries, especially aviation and professional sports, says Dr. Teodor Grantcharov, a staff surgeon at St. Michael’s and a Li Ka Shing Knowledge Institute scientist.

“The future of medical and surgical evaluation is competency-based education,” Dr. Grantcharov said Thursday at a lecture held at the Keenan Research Centre of St. Michael’s Hospital. “We need to continually assess and reassess our skills to ensure that only the best are going to work in the OR. But we can only do that by looking beyond the contemporary selection processes and education models.”

A study published in The Annals of Surgery found that a significant number of general surgery residents had difficulties achieving technical competence at the end of their training. Dr. Grantcharov said he thinks this contributes to billions of dollars spent in preventable adverse events, as found in a study published in the journal Inquiry.

Dr. Grantcharov has already begun to change that.

Borrowing from the airline industry, Dr. Grantcharov and his team developed a black box for the OR that records much of what transpires during laparoscopic, or minimally invasive, surgeries including video, audio, room temperature and decibel levels.

“By analyzing the footage, we can identify what errors occurred during surgery, why they occurred, and what we can do to make sure they don’t occur again,” he said. “When we identify these preventable adverse events, we can create targeted education interventions and policy changes that ultimately improve patient outcomes.”

Dr. Grantcharov said medicine could also learn three key lessons from professional sports.

Firstly, by engaging in deliberate practice – a training method that involves review of past performance and tailored feedback, similar to when football coaches review video footage with their teams – surgeons can analyze where they might have made an error to ensure they do not make a similar one in future.

A study by the Society of American Gastrointestinal and Endoscopic Surgeons found that residents practicing a laparoscopic gallbladder removal in virtual reality using deliberate practice had higher ratings for quality of surgical performance than those who underwent the “one-size-fits-all” conventional training.

“Every surgeon is different,” said Dr. Grantcharov. “We all have our different strengths and weaknesses. We need to recognize our deficiencies and focus on improving them.”

Secondly, the idea of warming up before the game can be useful to surgeons as well. A study published in the journal Surgical Endoscopy found that surgeons who practiced before a surgery outperformed those who didn’t.

“I feel much more confident entering the OR when I practice beforehand,” said Dr. Grantcharov. “This is a simple intervention that leads to dramatic improvement in patient outcomes.”

Finally, Dr. Grantcharov is an advocate for mental practice – the same way athletes visualize what they’re going to do before they do it. A study by Dr. Chris Hicks, an emergency physician at St. Michael’s, found that surgeons who visualized their performance beforehand – including the steps they were going to take and what they would do should an error occur – worked better as a team than those who underwent technical trauma training.

“We need to veer away from this idea that we’re infallible,” said Dr. Grantcharov. “Instead of practicing under the illusion of perfection, we, as surgeons, need to recognize, tolerate and learn from human error.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.