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Hospitals should address physician knowledge gaps to improve quality of care, outcomes, and patient safety, says a surgeon who has searched Google mid-surgery to help a fellow physician determine how to proceed.
The knowledge gaps are an offshoot of the rapid advances being made in medicine, says Justin Barad, MD, an orthopedic surgeon at Mee Memorial Hospital in King City, CA. He also is co-founder and CEO of Osso VR, a virtual reality surgical training platform. (Other virtual reality platforms for surgeons include Surgical Theater and Medical Realities.)
Medical advances are being made so rapidly that physicians are hard-pressed to stay current, he says.
“The foundation of this problem is very simple math. There is too much to learn and too little time to learn it,” he says. “New knowledge, new procedures, and new technology are being developed every day, so learning new things and relearning old things is becoming the norm.”
In a recent survey conducted by the online medical video education network VuMedi, 87% of the more than 500 surveyed practicing physicians said they could provide better treatment if they had more immediate access to in-depth information on medical breakthroughs. In addition, 74% percent said patient outcomes are lower in certain parts of the country because surgeons have slower access to medical breakthroughs.
Studies have shown that it can take years for a medical breakthrough to reach clinical practice and affect patient outcomes, Barad says.
The pressure to keep up with clinical advances and the difficulty in obtaining experience in new techniques could play roles in physician burnout, Barad says. Surgical trainees also can be frustrated by their limited ability to learn new procedures due to work hour restrictions and technological advances that mean surgeons need less help from trainees.
Trainee surgeons also can spend a significant amount of time, sometimes as much as half of their work hours, entering data into electronic health records, Barad says. Research has indicated that a substantial portion of residents could not operate independently after graduation, he notes.
Evolving technology also means that surgeons need more practice to become proficient than they did in years past with simpler techniques, he says.
A surgeon used to achieve proficiency in many procedures after about 25 cases, but now that number might be closer to 75 because of the increased complexity of some procedures, he says.
“Newer technologies are leading to increased complications as surgeons work their way up the learning curve because they’re typically practicing on patients,” Barad says. “With minimally invasive hip replacement, the complication rate can be 300% higher in your first 15 to 20 cases, and you have to do about 100 cases before you can do the case proficiently at a safe complication rate. People are just working their way up the learning curve.”
Hospitals also find it difficult to adequately assess surgical skills, Barad notes. Knowledge can be assessed objectively, but assessing technical skills is more challenging, he says.
The knowledge gap can involve even the most experienced surgeons when they are using newly developed techniques or technology, Barad notes. Quality improvement leaders may be unaware of how much the knowledge gap can affect patient outcomes, he says.
“I can attest personally that I was in many surgeries where I was scrubbed in and helping and I was told to scrub out, jump on the computer, and Google either a YouTube video or an instruction manual to figure out what to do next,” Barad says. “I can say this is a very serious problem that I saw with alarming frequency.”
Quality improvement and patient safety leaders probably would blanch at the thought of a surgeon consulting YouTube during a procedure, but surgeons may see that as the only option when they are unable to keep up with evolving technology and techniques, Barad says.
Hospitals can try to keep surgeons out of that situation by acknowledging the learning gap as an unavoidable offshoot of medical advances rather than any shortcoming of the physician, he says. Simulations and advanced training opportunities can help keep surgeons current, he says.
“Once you’ve identified the problem, you can intervene,” Barad says. “This is very doable today, and forward-thinking hospital leaders will provide surgeons with the time and the resources to improve their skills in ways that don’t involve practicing on patients until they reach proficiency.”
Much of the data on the learning curve for new technology is relatively recent and has not been considered in terms of its effects on quality and patient outcomes, Barad says. Hospitals with less-than-optimal quality and safety scores should consider the knowledge and training gap as a potential explanation for some of the problem.
“Often, it’s not what we’re doing to patients that is the problem but how we’re doing it. The implants and medications may be amazing, but the outcome may be determined by how you’re doing the surgery and the qualifications of the people involved,” Barad says.
“Decision support is also becoming more important as we learn to use artificial intelligence and physician augmentation to help us make better decisions for the patient.”
Barad notes that the Association of American Medical Colleges has predicted the United States could see a shortage of up to 120,000 physicians by 2030. (The report is available online at: https://bit.ly/2FLgzIL.) That will only increase the chance of poor outcomes, he says.
“Not only will they face these outcome challenges, but every physician will be overloaded,” Barad says.
“There is no way we’re going to be able to treat them using current methodology. We will have to depend on technology to make these procedures more efficient and something that can be done on such a scale with fewer physicians, and that will only put more pressure on them to stay current.”
Financial Disclosure: Author Greg Freeman, Editor Jesse Saffron, Editor Jill Drachenberg, Nurse Planner Amy M. Johnson, Editorial Group Manager Terrey L. Hatcher, and Consulting Editor Patrice Spath report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.