Surgeons as Educators A Guide for Academic Development and Teaching Excellence

99

task, they remain imperfect. The resources required to record trainees’ task perfor-
mances, as well as the time investment and associated cost required on the part of
each surgeon to watch and assess each task performance, limit the scalability of this
means of evaluation across a large cohort of residents [ 26 , 27 ]. Indeed, the limita-
tions of our current surgical feedback mechanisms have become so significant that
a recent consensus of the Association for Surgical Education has prioritized the
determination of the best methods and metrics for assessment of technical and non-
technical surgical performances as a top ten research priority for twenty-first-
century surgical simulation research [ 28 ].
One proposed means to better foster mastery of surgical skills is the use of surgi-
cal coaches. Work by Greenberg and colleagues from the University of Wisconsin
has provided a framework by which peer-based surgical coaching might be inte-
grated into a program for surgical skills development, both for surgeons in training
and experienced surgeons in practice. Surgical coaches are poised to optimize
“deliberate practice” by setting goals, providing motivation and encouragement,
and providing guidance within the context of a collegial relationship [ 29 ]. Such an
approach could address not only the technical aspects of surgical skills development
but also cognitive and nontechnical areas as well. With the increasing volume of
laparoscopic and minimally invasive approaches in surgery, video-based peer surgi-
cal coaching has also been introduced as a potential alternative to traditional feed-
back mechanisms [ 30 ]. However, even with such innovative approaches, the
challenges of scalability and time investment remain, as these frameworks continue
to rely on the expertise of a limited number of expert surgeons to advance the skills
of numerous residents and peer surgeons.

Table 6.2 (continued)

Force

sensitivity

1

Rough moves, tears

tissue, injures nearby

structures, poor

control, frequent

suture breakage

2 3

Handles tissues

reasonably well,

minor trauma to

adjacent tissue, rare

suture breakage

4 5

Applies appropriate

tension, negligible

injury to adjacent

structures, no suture

breakage

Autonomy 1

Unable to complete

entire task, even with

verbal guidance

2 3

Able to complete

task safely with

moderate guidance

4 5

Able to complete task

independently

without prompting

Robotic

control

1

Consistently does

not optimize view,

hand position, or

repeated collisions

even with guidance

2 3

View is sometimes

not optimal.

Occasionally needs

to relocate arms.

Occasional collisions

and obstruction of

assistant

4 5

Controls camera and

hand position

optimally and

independently.

Minimal collisions or

obstruction of

assistant

6 Crowdsourcing and Large-Scale Evaluation