By Dr. Justin Barad
The aviation industry and healthcare industry have been compared for a long time, most often on the topic of safety.
Both fields carry an immense responsibility to protect the public and eliminate human error as much as possible. Numerous studies and reports showcase how much traction the aviation industry has made compared to healthcare in lowering the number of fatalities, in light of increased risk as the aviation industry has grown. A 2016 study from researchers in the U.K., notes that though the number of worldwide flight hours has doubled over the past 20 years, airline fatalities have fallen nearly 45 percent. However, in the U.S. alone, 200,000 preventable medical deaths happen every year – the equivalent of three fatal airline crashes per day.
The similarities and differences in the two industries is a hot debate. The comparison of training and assessment required for pilots and surgeons is an important area to consider when human factors greatly impact safety in both industries. It is also interesting to look at the rate of new knowledge entering each industry compared to the requirements for assessment and reassessment of that knowledge throughout a pilot or surgeon’s career.
Initial pilot training normally takes around 250 hours of flight time. Every six months, pilots must go into a simulator where they practice and are assessed on standard and emergency procedures. While surgeons undergo a significantly longer initial training period in medical school and residency, there is no assessment (or reassessment) requirement for surgeons. Our current approach to surgical training is time-based, not competency-based; a fact that greatly sets healthcare apart from aviation in its approach to training.
Why is this important? Healthcare knowledge is becoming increasingly difficult for practitioners to keep up with. New studies show that, by 2020, medical knowledge will double every 73 days compared to doubling every 50 years in the 1950s. The innovation and complexity of medical device technology is particularly challenging for surgeons. Increasingly complex technology means an increasing number of cases need to be practiced, but learning it is not as simple. Numbers vary between studies, but in general, a surgeon used to need to perform at least 25 cases to obtain a basic level of safety. Now, the number is around 75-80 (and in some cases more than 100) to achieve optimal proficiency. On the other hand, the cockpit has been simplified for pilots with the advent and adoption of new technology, yet their time spent in simulators nativigating emergency scenarios and ensuring preparedness for those events is greater than surgeons.
Southwest flight 1380 is the aviation industry’s latest example of pilot preparedness. The pilot’s ability to not only safely but calmly navigate the tragic and dangerous event can be somewhat attributed to the industry’s stringent simulation and assessment requirements. Unexpected emergency events happen far more often in medicine, and “standard” operations are arguably more complex, yet assessing for the ability to handle “low frequency, high urgency” situations is not performed.
Throughout a surgeon’s career, many new techniques and procedures will be introduced. In recent years, studies have begun to increasingly look at misuse and adverse events associated with medical devices. While these new advances typically allow for less invasive procedures or the ability to treat conditions that previously had limited options, these modern procedures are dependent on a technically competent surgeon that is dedicated to learning and mastering them. One qualitative study assessing device use errors and the prevention of adverse events found “the top three reported factors leading to the adverse event were the user, design problems, and lack of training.” A report from the World Health Organization analyzing the challenges of increased complexity of technology notes primary reasons for adverse events with these new technologies are the result of improper training and longer learning curves. It also highlights an important implication of this challenge: medical devices are prevented from achieving their “full public health potential.” In other words, providers continue to use older technologies simply because they don’t have the time and opportunity to properly train on the newer products.
Traditional training scenarios for complex medical devices involve the surgeon traveling to a one- to two-day training workshop, typically sponsored by the medical device company. This off-site training is time consuming for all parties, and costly. Following these courses, it could be four to six months between the time one learns a procedure and the time the doctor gets to perform the procedure on a patient.
Surgical simulation seems like an optimal solution to the above challenge, which should provide the opportunity to practice and assess oneself repeatedly over time. Unfortunately the prior generation of simulation technology has not adequately addressed these training gaps. Thankfully, the field of simulation is evolving due to recent breakthroughs in immersive technologies, such as augmented and virtual reality, which increase the accessibility and effectiveness of surgical simulation for all members of the surgical team. The immersive nature and portability of these technologies open the door for the regular practice of procedures before treating patients, offering a safe place to make mistakes and work up the learning curve at one’s own speed. Simulation also has the ability to standardize training, so that we can quickly disseminate best practices and techniques from experts and governing professional bodies through the cloud. Finally, the next generation of simulators can accurately assess a surgeon’s objective technical skill. Virtual reality, like the system we have created at Osso VR, gives surgeons device- and procedure-specific training opportunities, and the ability to train with multiple users for team and leadership skills.
If the healthcare industry can standardize the adoption and implementation of simulation technologies, in addition to instituting regular assessment requirements, we might be able to catch up to aviation’s impressive safety record. When high-stress, emergency situations arise, the public is trusting that both doctors and pilots are ready, and able, to keep them safe.
About the author: Justin Barad, M.D. is the co-founder and CEO of Osso VR, a clinically validated and award-winning surgical training platform. Dr. Barad is also an orthopaedic surgeon with a Bioengineering degree from UC Berkeley, and an M.D. from UCLA. He completed his residency at UCLA, and his fellowship was in pediatric orthopaedics at Harvard and Boston Children’s Hospital. With a background in game development and a firsthand understanding of the challenges facing residents and experienced doctors, he co-founded Osso VR with a mission to democratize access to modern surgical techniques and improve patient safety. In addition, Dr. Barad has also written for Medgadget, a popular medical technology site, for more than a decade, and has spoken at multiple conferences including TEDMED, CES, Exponential Medicine, and Health 2.0.