Looking forward – September 2019

David B. Hoyt, MD, FACS

Since its establishment in 1913, the American College of Surgeons (ACS) has continuously sought to help surgeons at all stages of their careers improve their cognitive and technical skills through leading-edge didactic and skills educational programming with the goal of ensuring that patients receive care from surgeons who are highly proficient in providing care. As technology has advanced, Ajit K. Sachdeva, MD, FACS, FACS, FRCSC, FASCME, Director, ACS Division of Education; his team; and other ACS leaders have developed an expanding array of educational programs designed to help surgeons master and retool the skills they need to provide safe, high-quality care. One exciting and innovative opportunity for surgeons to test their skills and ultimately learn from each other will be offered at Clinical Congress 2019 in San Francisco, CA.

Building on an important tradition

This program, The Surgical Metrics Project, builds upon and incorporates the concepts that ACS Past-Presidents Barbara Lee Bass, MD, FACS, FRCSEng(Hon) FRCSI(Hon), FCOSESCA(Hon), and Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCSEng(Hon),  FRCSEd(Hon), and the ACS Division of Education applied in developing and implementing Surgeon Retooling Reimagined: Achieving and Maintaining Lifelong Excellence. Through that program, our profession and other stakeholders have been able to establish a surgeon and health care facility verification program based on new standards to support proficiency and evidence-based best practices.

Similarly, the ACS Targeted Training Opportunities for Practicing Surgeons program is designed to provide individualized educational experiences that help practicing surgeons acquire skills in new procedures and technologies, enhance skills with infrequently performed procedures, and assist surgeons with reentry into surgical practice.

And the annual ACS Surgical Simulation Summit brings together surgeons, academic engineers, medical students, residents, and simulation center directors, educators, administrators, technicians, and researchers to learn about the latest advances and cutting-edge initiatives in simulation-based surgical education and training.

The Surgical Metrics Project

New this year is The Surgical Metrics Project. Leading the effort is Carla M. Pugh, MD, PhD, FACS, professor of surgery and director, Technology Enabled Clinical Improvement (TECI) Center, Stanford University, CA. Clinical Congress 2019 participants will have the opportunity to join Dr. Pugh and her colleagues in an exploration of the use of wearable technologies to measure surgical decision making and technique. Resident, active practice, and retired surgeons all are encouraged to participate.

Figure 1. Data collection set-up: Department of Defense study

Figure 1. Data collection set-up: Department of Defense study

Layton F. Rikkers, MD, FACS, professor emeritus, department of surgery, University of Wisconsin School of Medicine and Public Health, Madison, using wearable data-capture technologies while participating in a simulated surgical task

Figure 2. Magnetic motion tracking

Figure 2. Magnetic motion tracking

Figure 2. Magnetic motion tracking

Wearable technologies will be used to build a database of surgical decision making and technical approaches during a pilot task, repairing a small bowel enterotomy. A total of 10 procedure stations will be available October 28−30 in the Exhibit Hall of the Moscone Center. The exercise will take less than 30 minutes, so all interested parties should be able to participate. The program is sponsored by the ACS Committee on Surgical Skills Training for Practicing Surgeons, with support from Dr. Sachdeva and the Division of Education; Dr. Bass; Dr. Pellegrini; American Board of Surgery Executive Director Jo Buyske, MD, FACS; and other ACS leaders.

Here’s how it works. Before performing the open suture repair of a small bowel enterotomy using porcine intestines, each participant will be equipped with magnetic motion tracking technology that is small enough to fit under surgical gloves without hindering movement. The motion-tracking data will be synchronized with headgear that will capture video and audio data. The video gives a moment-to-moment account of each step and decision that a surgeon makes while operating, and the magnetic motion-tracking technology measures time and flow efficiency. Dr. Pugh said the motion data can give us an efficient and accurate assessment of the surgical process.

With the video application, the researchers will be able to measure common factors that we as surgeons may do as second nature but that have a real impact on efficiency and efficacy, such as how people set up their instrument tray. Because small leaks are not uncommon with open suture repair of a small bowel enterotomy, a leak test will be performed and the researchers will be able to see which leak prevention and recovery techniques surgeons use and measure their effectiveness.

Each participant will get a short report on his or her digital performance. Then, Dr. Pugh and her colleagues will do a large-scale deep dive after the Clinical Congress and draw some conclusions that can be used for data sharing and quality improvement. The purpose is really to start the conversation about what steps surgeons can take to improve outcomes and help surgeons learn from each other. The larger the pool of participants from different institutions and with different levels of expertise, the more useful the findings will be.

The database will be used to answer a variety of questions, including the following:

  • What decisions do surgeons make when faced with a surgical task?
  • How do their decisions and technical approaches affect outcomes/bowel repair quality?
  • Can this database serve as a benchmarking resource for trainees?
  • Is there an expert strategy or evidence-based approach that can be discovered in the data and shared with participants?
  • Can this database serve as a platform to discuss the possibility of longitudinal, personal assessment where participants track their own performance throughout their career?

Dr. Pugh and her research team have an extensive history of successful, simulation-based data collection in the exhibit halls of major medical meetings and will work closely with ACS conference leadership to ensure a successful, professional interaction with the ACS Fellows who volunteer to participate in this program. You will be able to follow and provide feedback on the project via Twitter using #surgicalmetrics.

Other professions that require a high level of mental and physical acuity, such as aviation and sports, have a rich history of collecting, documenting, and sharing quality metrics. Each year, the organizations that represent these professions host major data analytics conferences to review data capture technology, mathematical algorithms, and artificial intelligence approaches to quantifying team and individual outcomes. The College is proud to offer a similar opportunity to Clinical Congress attendees and strongly encourages everyone to participate in this experience that embodies the spirit of Inspiring Quality: Higher Standards, Better Outcomes.


If you have comments or suggestions about this or other issues, please send them to Dr. Hoyt at lookingforward@facs.org.

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Elliott Brender MD
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I find this fascinating & would love to participate. I do have a few questions, though. Will we have an assistant? In dong small bowel enterotomy repairs I have the assistant actively assist. I put inverting stitches in each corner and then have the assistant put gentle reaction on either end. This sets the wound out in a linear fashion making it very easy to put in my subesequent stiches. Without an assistant this is much more difficult. Also I like to invert the edges. I usually do this with interrupted stitches rather than a running stitch with the idea… Read more »

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