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  5. Turning a rusty surgeon into a well-oiled machine

Turning a rusty surgeon into a well-oiled machine

Doug Wiegmann

Surgeons who serve in the armed forces might spend years working in a military hospital before they are deployed to trauma-heavy combat zones. Such situations likely will require those surgeons to draw on seldom-used skills—and a University of Wisconsin-Madison industrial engineer is studying ways to keep those skills sharp.

With a $2 million grant from the U.S. Department of Defense, Doug Wiegmann, a UW-Madison associate professor of industrial and systems engineering, is working with principal investigator Carla Pugh, a UW-Madison associate professor of surgery, to investigate how people forget a skill. Pugh, Wiegmann, and their collaborators are following surgeons who are in a non-practicing portion of their residencies to map how their performance in both basic and complex surgical procedures might deteriorate over time.

The knowledge could benefit military or reservist surgeons who will face a shifting landscape of skill needs and demands over the course of their careers. For example, they might perform administrative duties during their deployment—then return to the operating room after a lengthy absence. Or, as they use different types of surgical skills—trauma care versus specialty work such as cardiac or eye surgery—they risk forgetting aspects of procedures they're not actively performing.

"The question is, how do we help surgeons maintain their ability to be deployed quickly and to be able to perform those procedures they haven't had to do in their non-combat situations or in civilian practice?" Wiegmann says.

Wiegmann hopes to learn which parts of surgical skill decay quickly and how different pieces of a skill interact and affect that decay. The team will map that process of forgetting and ultimately, find ways to help surgeons retain the skills they're not using.

Each skill has three components: basic knowledge (for example, names of instruments and anatomy), procedural knowledge (which steps are involved and in what order to perform them), and technical knowledge (for example, how to move the body to perform the skill).

Although each of those components interacts and influences the other, they might decay at different rates, says Wiegmann. "If you haven't driven a car or ridden a bike for 10 years, you're probably not going to forget the names of things too much," he says. "But, for example, if you're a musician and you haven't played in years, you might remember the names of the notes, and you might remember how to produce them, but you pick up the instrument now and your fingers don't know where to go." The researchers will evaluate how surgeons perform all aspects of a skill after varying periods of inactivity. Understanding how rapidly skill decays, and how each component decays differently, will help them develop simulations or techniques that help surgeons learn, maintain or improve a skill they are not currently using.

For example, surgeons could use a specialized mannequin to practice different surgeries. Or, they could use mental rehearsal, a successful technique popular in athlete game-day preparation in which a surgeon imagines himself or herself performing surgery at a high level, confronting errors and difficulties successfully. "We don't know yet if mental rehearsal would work for surgery," says Wiegmann. "But if it does, it's a low-cost and easily deployable methodology that can be scaled up relatively quickly across all surgical specialties."

The researchers also will study how skill decay occurs differently in experts with years of surgical practice under their belts versus surgeons who recently completed their residencies. Wiegmann expects the former group will experience slow decay: "If you've done something for several years, presumably the impact of not doing it for six months would be less than if you'd just gotten out of school and now haven't done something for six months."

Surgical training reinforcement methods could have broader applications in medicine, says Wiegmann. For example, surgeons in nonacademic and rural settings have far lower case volumes than those in urban and university centers, and thus, fewer opportunities to practice particular procedures. Training reinforcement methods also could help surgeons return to practice after temporary absences—for example, medical or family leave.

Additionally, the results of the study could apply well beyond surgery. "There's been much more research of skill development than there has been on skill decay," says Wiegmann. "We don't know as much about decay. So this project could apply also to any other type of skilled behavior or performance, including music or athletics."

Wiegmann and Pugh's collaborators include Caprice Greenberg and Eugene Foley, associate professors of surgery; and Robert Radwin, a professor of industrial and systems engineering.

Christie Taylor