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From the cockpit to the OR: safety and simulation in surgery

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.
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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.
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