Should Surgeons Have Coaches Evaluate Their Performances?Mar 14, 2014
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Interviewer: Sports teams have them to help improve their performance. Individual athletes a lot of times have them as well. Should surgeons have them, too? Dr. Sam Finlayson, chair of the Department of Surgery at the University of Utah Hospital, tell me why coaches for surgeons might be a good idea.
Dr. Sam Finlayson: Just about any profession that requires high performance and consistently delivering high quality results would benefit from consistent observation and the opinion and advice of somebody who's an expert. We see that, as you mentioned, in the sports industry. It's a very public performance. Everybody has access to the statistics. Everybody has somebody who's telling them how to do things better.
This somewhat relates to a recent study that came out of Michigan that looked at a bunch of surgeons doing the same procedure. They videotaped their performance and then took those videotapes and had them looked at by a number of independent observers. Those observers then rated the surgical skill of each one of those surgeons and found huge disparities.
I was talking to the author of the paper a few weeks ago. He actually does that operation he was observing. He said he was just blown away by at the one end of the spectrum people who were doing things he thought just made him cringe. I mean he couldn't believe that people were operating that way. At the other end of the spectrum he saw people operating so smoothly and so expertly that he thought wow, I could never be that good. The range was tremendous.
We've allowed a disparity to exist because we don't have transparency. Because once somebody finishes their training they don't have a lot of input with regard to how they're doing other than complication rates which, in general, are low. It's hard to really differentiate one surgeon from the other.
Interviewer: In this videotaped study did they find that there are some real easy basic things that, if those were fixed, it would improve things quite a bit?
Dr. Sam Finlayson: This study didn't go so far as to identify specific factors that can be improved or specific techniques, but I think that's really where this is going. I think it's going to draw a lot of attention to our performance as surgeons, hopefully in a constructive way.
Interviewer: What would this look like, then, implemented to have maybe some critiquing of performances?
Dr. Sam Finlayson: One thing that could improve the way we go about ensuring that our performance is uniformly high is to develop more of a sense of teamwork in surgery, make it less of an individual practice. The group of surgeons comes together, works together, and is invested in other people's outcomes and their success.
Interviewer: Do you think it's going to be kind of like the study where videotapes will be made, maybe there will be a pile on your desk you'll have to look at, or maybe like in football, they're reviewing tape?
Dr. Sam Finlayson: Yeah, that's an interesting thought. I know a number of researchers who have tried to put videotapes into operating rooms to observe what was going on, and it is extraordinarily difficult. Surgeons don't like their performance being videotaped.
I think part of that comes out of this defensiveness. We're an extraordinarily litigious society. Every surgeon is worried about being sued. If you've got taped documentation of your performance you worry that's going to show up in a courtroom.
Interviewer: Do you feel having a performance taped and then critiqued would be important enough that those types of laws should be enacted? Do you think that is a really good way of doing it, or maybe not?
Dr. Sam Finlayson: I think at least at the start there need to be some assurances. I think that surgeons are too nervous right now to have their performance so closely observed and recorded.
Interviewer: Well, nobody would like that, really. Like, to be sitting in my cube doing my job, would I want somebody to videotape everything I did?
Dr. Sam Finlayson: That's right, that's right.
Interviewer: Probably not.
Dr. Sam Finlayson: Probably not.
Interviewer: What would you implement here at the University of Utah to help improve surgeons' performance?
Dr. Sam Finlayson: I think that, as I said before, this is really going to require a culture change. Surgeons have to feel safe. They have to feel like they're not going to be devalued because they need help. All surgeons need to recognize at some level that they need help, that everybody can do better.
Interviewer: Just with a second set of eyes watching you, giving you some feedback, things you don't even realize.
Dr. Sam Finlayson: Sure, yeah. Right. Nadal, Djokovic, the best tennis players, they all have coaches. Everybody can do better. That's a culture change. Most surgeons think they're better than average surgeons. There's probably a substantial core of surgeons who think that they're the best, but that doesn't mean that they can't be better. Everybody can be better.
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