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Ali JT, Yang G, Green CA, Reed BL, Madani A, Ponsky TA, Hazey J, Rothenberg SS, Schlachta CM, Oleynikov D, Szoka N. Defining digital surgery: a SAGES white paper. Surg Endosc 2024; 38:475-487. [PMID: 38180541 DOI: 10.1007/s00464-023-10551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Digital surgery is a new paradigm within the surgical innovation space that is rapidly advancing and encompasses multiple areas. METHODS This white paper from the SAGES Digital Surgery Working Group outlines the scope of digital surgery, defines key terms, and analyzes the challenges and opportunities surrounding this disruptive technology. RESULTS In its simplest form, digital surgery inserts a computer interface between surgeon and patient. We divide the digital surgery space into the following elements: advanced visualization, enhanced instrumentation, data capture, data analytics with artificial intelligence/machine learning, connectivity via telepresence, and robotic surgical platforms. We will define each area, describe specific terminology, review current advances as well as discuss limitations and opportunities for future growth. CONCLUSION Digital Surgery will continue to evolve and has great potential to bring value to all levels of the healthcare system. The surgical community has an essential role in understanding, developing, and guiding this emerging field.
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Affiliation(s)
- Jawad T Ali
- University of Texas at Austin, Austin, TX, USA
| | - Gene Yang
- University at Buffalo, Buffalo, NY, USA
| | | | | | - Amin Madani
- University of Toronto, Toronto, ON, Canada
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
| | - Todd A Ponsky
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Dmitry Oleynikov
- Monmouth Medical Center, Robert Wood Johnson Barnabas Health, Rutgers School of Medicine, Long Branch, NJ, USA
| | - Nova Szoka
- Department of Surgery, West Virginia University, Suite 7500 HSS, PO Box 9238, Morgantown, WV, 26506-9238, USA.
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Wiegmann DA, Wood LJ, Cohen TN, Shappell SA. Understanding the "Swiss Cheese Model" and Its Application to Patient Safety. J Patient Saf 2022; 18:119-123. [PMID: 33852542 PMCID: PMC8514562 DOI: 10.1097/pts.0000000000000810] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This article reviews several key aspects of the Theory of Active and Latent Failures, typically referred to as the Swiss cheese model of human error and accident causation. Although the Swiss cheese model has become well known in most safety circles, there are several aspects of its underlying theory that are often misunderstood. Some authors have dismissed the Swiss cheese model as an oversimplification of how accidents occur, whereas others have attempted to modify the model to make it better equipped to deal with the complexity of human error in health care. This narrative review aims to provide readers with a better understanding and greater appreciation of the Theory of Active and Latent Failures upon which the Swiss cheese model is based. The goal is to help patient safety professionals fully leverage the model and its associated tools when performing a root cause analysis as well as other patient safety activities.
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Affiliation(s)
- Douglas A Wiegmann
- From the Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Laura J Wood
- From the Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Tara N Cohen
- Department of Surgery, Cedars-Sinai, Los Angeles, California
| | - Scott A Shappell
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, Florida
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Mohamadipanah H, Wise B, Witt A, Goll C, Yang S, Perumalla C, Huemer K, Kearse L, Pugh C. Performance assessment using sensor technology. J Surg Oncol 2021; 124:200-215. [PMID: 34245582 PMCID: PMC8855881 DOI: 10.1002/jso.26519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/10/2022]
Abstract
Over the past 30 years, there have been numerous, noteworthy successes in the development, validation, and implementation of clinical skills assessments. Despite this progress, the medical profession has barely scratched the surface towards developing assessments that capture the true complexity of hands-on skills in procedural medicine. This paper highlights the development implementation and new discoveries in performance metrics when using sensor technology to assess cognitive and technical aspects of hands-on skills.
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Affiliation(s)
- Hossein Mohamadipanah
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Brett Wise
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Anna Witt
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Cassidi Goll
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Su Yang
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Calvin Perumalla
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kayla Huemer
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - LaDonna Kearse
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Carla Pugh
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
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Salloum NL, Copley PC, Kaliaperumal C. Letter: Video Documentation of Operative Note in Neurosurgery-Old Wine in a New Bottle! Neurosurgery 2021; 88:E467-E468. [PMID: 33555028 DOI: 10.1093/neuros/nyab015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nadia Liber Salloum
- Department of Clinical Neurosciences Royal Infirmary of Edinburgh Edinburgh, United Kingdom
| | - Phillip Correia Copley
- Department of Clinical Neurosciences Royal Infirmary of Edinburgh Edinburgh, United Kingdom
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Gabrysz-Forget F, Young M, Zahabi S, Nepomnayshy D, Nguyen LHP. Surgical Errors Happen, but Are Learners Trained to Recover from Them? A Survey of North American Surgical Residents and Fellows. JOURNAL OF SURGICAL EDUCATION 2020; 77:1552-1561. [PMID: 32694084 DOI: 10.1016/j.jsurg.2020.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Surgical training necessitates graded supervision and supported independence in order to reach competence. In developing surgical skills, trainees can, and will, make mistakes. A key skill required for independent practice is the ability to recover from an error or unexpected complication. Error recovery includes recognizing and managing a technical error in order to ensure patient safety and may be underrepresented in current educational approaches. OBJECTIVE The purpose of this study is to explore residents' experiences and perceptions of error recovery training in surgical procedures. METHOD An online survey was sent to surgical program directors in the United States and Canada using the Accreditation Council for Graduate Medical Education and the Royal College of Physicians and Surgeons of Canada distribution lists. Participating programs distributed the survey to their residents and fellows. The survey was composed of Likert-scale items, yes/no questions as well as open-ended questions focused on perceptions, experiences, and factors that influence to error recovery training in the operating room. RESULTS A total of 206 surveys were completed. Overall, 99% (n = 203) agreed or strongly agreed that error recovery is an important competency for future practice. This was reflected in free-text response: "Errors can be minimized but they are inevitable, so certainly believe a surgical curriculum that addresses error recovery is of paramount importance." While 83% (n = 170) feel confident recovering from minor errors, only 34% (n = 68) feel confident that they could recover from major errors that are likely to have serious consequences on patient safety. Overall, residents do not consider that they have adequate training in error recovery, with only 37% (n = 72) felt they were adequately trained to recover from major errors. It was also mentioned "The quality of learning regarding error recovery depends entirely on the attending." CONCLUSIONS Opportunities to learn to recover from technical errors in the operating room are valued by surgical trainees, but they perceive their training to be both inadequate and variable. This contributes to a lack of confidence in error recovery skills throughout their surgical training. There is a need to explore how best to integrate error recovery into more formal surgical curricula in order to better support learners and, ultimately, contribute to increased surgical safety.
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Affiliation(s)
- Fanny Gabrysz-Forget
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Center for Professional Development and Simulation, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Meredith Young
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sarah Zahabi
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Dmitry Nepomnayshy
- Center for Professional Development and Simulation, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts; Department of Surgery, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Lily H P Nguyen
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada; Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada.
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Pugh CM, Law KE, Cohen ER, D’Angelo ALD, Greenberg JA, Greenberg CC, Wiegmann DA. Use of error management theory to quantify and characterize residents’ error recovery strategies. Am J Surg 2020; 219:214-220. [DOI: 10.1016/j.amjsurg.2019.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/10/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022]
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D'Angelo J, Snyder M, Bleedorn J, Hardie R, Foley E, Greenberg JA. An Interdisciplinary Approach to Surgical Skills Training Decreases Programmatic Costs. J Surg Res 2019; 235:600-606. [PMID: 30691848 DOI: 10.1016/j.jss.2018.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 10/04/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgical resident duty hour limitations have necessitated operative skill training outside of the operating room. Although wet-lab skills training is ideal, materials and human resource requirements make wet labs-utilizing biologic samples cost prohibitive for many residency programs. To resolve this problem, our general surgery residency program collaborated with the Institution's School of Veterinary Medicine Surgery Residency program to pilot a cost-effective interdisciplinary surgical skills curriculum. MATERIALS AND METHODS The general surgery residency program manager and program director initiated a collaboration with the Veterinary Surgery Residency. Postgraduate year (PGY) 2 general surgery residents and PGY 1-3 veterinary surgery residents participated in monthly joint surgical skills practice sessions. A novel interdisciplinary surgical skills curriculum was implemented that incorporated skills beneficial to both sets of trainees utilizing donated canine cadavers. RESULTS A total of nine joint skills sessions were conducted for nine general surgery residents and five veterinary surgery residents. A cost analysis was conducted for a surgical skills curriculum servicing both programs independently and compared to the actual costs of the collaborative curriculum. The cost analysis estimated total savings generated by the collaborative to be $27,323.79. Review of initial feedback from trainees suggest that skill sessions reinforce knowledge, and that the collaborative skills sessions were an enjoyable and valuable learning activity. CONCLUSIONS The skills curriculum collaborative has proven to be a cost-effective and high quality interdisciplinary pedagogic tool. The partnership allowed for mutually beneficial resource sharing and allowed for the initiation of a surgical skills wet lab that had previously been unavailable to both groups.
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Affiliation(s)
- Jonathan D'Angelo
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Mara Snyder
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jason Bleedorn
- University of Wisconsin School of Veterinary Medicine, Madison Wisconsin
| | - Robert Hardie
- University of Wisconsin School of Veterinary Medicine, Madison Wisconsin
| | - Eugene Foley
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jacob A Greenberg
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Ruis A, Rosser AA, Quandt-Walle C, Nathwani JN, Shaffer DW, Pugh CM. The hands and head of a surgeon: Modeling operative competency with multimodal epistemic network analysis. Am J Surg 2018; 216:835-840. [DOI: 10.1016/j.amjsurg.2017.11.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
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E-learning teaches attendings "how to" objectively assess pediatric urology trainees' surgery skills for orchiopexy. J Pediatr Urol 2018; 14:132.e1-132.e6. [PMID: 29162327 DOI: 10.1016/j.jpurol.2017.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 09/18/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Established methods to train pediatric urology surgery by residency training programs require updating in response to administrative changes such as new, reduced trainee duty hours. Therefore, new objective methods must be developed to teach trainees. We approached this need by creating e-learning to teach attendings objective assessment of trainee skills using the Zwisch scale, an established assessment tool. The aim of this study was to identify whether or not e-learning is an appropriate platform for effective teaching of this assessment tool, by assessing inter-rater correlation of assessments made by the attendings after participation in the e-learning. Pediatric orchiopexy was used as the index case. METHODS An e-learning tool was created to teach attending surgeons objective assessment of trainees' surgical skills. First, e-learning content was created which showed the assessment method videotape of resident surgery done in the operating room. Next, attendings were enrolled to e-learn this method. Finally, the ability of enrollees to assess resident surgery skill performance was tested. Namely, test video was made showing a trainee performing inguinal orchiopexy. All enrollees viewed the same online videos. Assessments of surgical skills (Zwisch scale) were entered into an online survey. Data were analyzed by intercorrelation coefficient kappa analysis (strong correlation was ICC ≥ 0.7). RESULTS A total of 11 attendings were enrolled. All accessed the online learning and then made assessments of surgical skills trainees showed on videotapes. The e-learning comprised three modules: 1. "Core concepts," in which users learned the assessment tool methods; 2. "Learn to assess," in which users learned how to assess by watching video clips, explaining the assessment method; and 3. "Test," in which users tested their skill at making assessments by watching video clips and then actively inputting their ratings of surgical and global skills as viewed in the video clips (Figure). A total of 89 surgical skill ratings were performed with 56 (65%) exact matches between raters and 89 (100%) matched within one rank. Interclass correlation coefficient (ANOVA) showed statistically significant correlation. (r = 0.725, 95% CI 0.571-0.837, F = 3.976, p ≤ 0.00001). Kappa analysis of inter-rater reliability showed strong consensus between attendings for average measures with ICC = 0.71, 95% CI 0.46-0.95 (p = 0.03). CONCLUSION We launched e-learning to teach pediatric urology attendings "how to" assess trainee surgical skills objectively (Zwisch scale). After e-learning, there was strong inter-rater correlation in assessments made. We plan to extend such e-learning to pediatric urology surgical training programs.
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Law KE, Gwillim EC, Ray RD, D'Angelo ALD, Cohen ER, Fiers RM, Rutherford DN, Pugh CM. Error tolerance: an evaluation of residents' repeated motor coordination errors. Am J Surg 2016; 212:609-614. [PMID: 27586850 DOI: 10.1016/j.amjsurg.2016.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/30/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The study investigates the relationship between motor coordination errors and total errors using a human factors framework. We hypothesize motor coordination errors will correlate with total errors and provide validity evidence for error tolerance as a performance metric. METHODS Residents' laparoscopic skills were evaluated during a simulated laparoscopic ventral hernia repair for motor coordination errors when grasping for intra-abdominal mesh or suture. Tolerance was defined as repeated, failed attempts to correct an error and the time required to recover. RESULTS Residents (N = 20) committed an average of 15.45 (standard deviation [SD] = 4.61) errors and 1.70 (SD = 2.25) motor coordination errors during mesh placement. Total errors correlated with motor coordination errors (r[18] = .572, P = .008). On average, residents required 5.09 recovery attempts for 1 motor coordination error (SD = 3.15). Recovery approaches correlated to total error load (r[13] = .592, P = .02). CONCLUSIONS Residents' motor coordination errors and recovery approaches predict total error load. Error tolerance proved to be a valid assessment metric relating to overall performance.
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Affiliation(s)
- Katherine E Law
- Department of Industrial and Systems Engineering, School of Engineering, University of Wisconsin-Madison, 3214 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, USA
| | - Eran C Gwillim
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA
| | - Rebecca D Ray
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA
| | - Anne-Lise D D'Angelo
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA
| | - Elaine R Cohen
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA
| | - Rebekah M Fiers
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA
| | - Drew N Rutherford
- Department of Health Professions, University of Wisconsin-La Crosse, 3062 Health Science Center, La Crosse, WI, USA
| | - Carla M Pugh
- Department of Industrial and Systems Engineering, School of Engineering, University of Wisconsin-Madison, 3214 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, USA; Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA.
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