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How 'Practice Makes Perfect' Applies to Surgery

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As humans, we make decisions based on the tools, resources, and skills available to us. As surgeons, we must often make decisions quickly and in the face of uncertainty. Training, preparation, and heuristics can certainly help position us for success in those moments.

Continued learning through the evaluation of surgical case footage is another powerful tool for learning new techniques, assessing performance, and analyzing in-the-moment perceptual experiences. Ultimately, it can help us improve upon the quality of care that we provide. In my own practice, I have experienced improved dexterity and predictive physiological anticipation through repetition and film review. 

Recent advances in medical equipment have greatly reduced the need for open surgeries, allowing minimally invasive procedures to become the standard of care for many benign interventions. One of the benefits of minimally invasive surgery is the built-in ability to record full procedures from start to finish and to quickly transfer the surgical video to a device for further review. 

To follow are four reasons why I believe studying recorded videos of procedures should be encouraged among trainees and seasoned physicians.

1 It shows us exactly what happened.

Human memory is fallible. How many of you have written an operative report after a three- or four-hour case only to realize well after the fact that the narrative is missing an essential piece of information? We are only human, and recalling the exact steps of oft-complex procedures is a process fraught with errors. 

It’s certainly not best practice, but there were instances when several days (or even weeks) went by before I was able to complete reporting for a case. I admit that I have had to add addendums to case documentation after realizing that I left out important steps in initial drafts. Unlike the human brain, video captures all of the intraoperative steps and allows us to objectively assess the choices that we made.

2 People have different learning styles.

Behavioralists have identified a myriad of different learning styles. All of us have utilized different learning techniques to get through medical school and training — not-safe-for-work mnemonics, anyone? Some of us learn best by reading text; others, myself included, are kinesthetic learners and find seeing something firsthand helpful in order to internalize information effectively. Video technology is one more tool in our arsenal to address cognitive limitations, and it should play a more significant role in surgical education and training.

3 It allows us to strategize and improve our technique.

Many other professionals use video playback as an aid for reviewing and critiquing performance. Sports organizations, for example, spend hours reviewing plays to analyze the strengths and weaknesses of their opponents and develop strategies to maximize the potential of their players. Commercial and recreational pilots utilize video technology in flight simulators to practice difficult maneuvers and polish their skills. If the multibillion-dollar sports and aviation industries rely on video to review and improve their work, then surgeons and hospitals should be able to find some benefit from doing the same. 

4 It makes space for growth and collaboration.

Training does not stop after residency or fellowship. We are accountable to our patients and must continually educate ourselves by reviewing evidence-based research and analyzing our own performances in the OR. In addition, we can share what we have learned in order to help others become better surgeons. Medicine is, by nature, a competitive field, but if we share and collaborate with others, we can learn better techniques, improve efficiency, and strive to achieve better overall patient outcomes. 

Finally, there are valid arguments both for and against postoperative video review. I’ve encountered senior attendings in residency and fellowship who are hesitant due to privacy issues and have even heard a colleague remark, “I don’t want proof that lawyers can use against me.” We all make choices as to how we live our lives, and I do not believe that surgeons should be forced to produce a video for every procedure. 

That said, I believe that defensive medicine is one of the most dangerous ways to practice. Fear of legal repercussions can decelerate innovation and cause us to deviate from evidence-based medicine and provide less-than-ideal care. We should be protected and even rewarded for taking steps to critique our work, improve our skills, and ultimately move our field toward safer outcomes.

What do you believe are the pros and cons of rewatching recordings of your past procedures? Share your thoughts in the comment section below.

Courtney Fox is a minimally invasive gynecology fellow and women’s health care advocate. She is passionate about making sure patients are educated on their bodies and understand their treatment options. You can follow her on Twitter @CourtneyFoxMD and Instagram @courtneyfoxmd. 

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