The evidence that simulation and proficiency-based training produce better, safer surgeons has been settled for over two decades. So why has surgery been so slow to take it up?

Professor Tony Gallagher talks to surgical simulation pioneer Dr Richard "Rick" Satava, Professor Emeritus of Surgery at the University of Washington and a former DARPA programme manager, about the study they ran together at Yale, why the operating room is the wrong place to learn basic skills, and why the real barriers to change are time, leadership and money rather than the science. They close on the limits of what AI can assess today, and what comes next, from telesurgery to surgery in space.

(0:00) Thirty years, and one seminal study

(2:07) Simulation as a revolution, transposed from the military

(3:23) Why the operating room is the wrong place to learn basic skills

(6:30) Treating surgical education as a science is disruptive

(9:39) The 2002 Yale study, and the end of "see one, do one"

(11:58) Disruption keeps coming: telesurgery, space and directed energy

(13:01) The barrier is not the evidence, it is selling it

(16:21) Leadership: the skills lab before theatre

(18:06) Who should own the standards and credentialing

(21:00) Twenty-five years on: training hours and fellowships

(25:52) You cannot compress the time, people learn at different rates

(32:26) Why proficiency-based progression is demanding to deliver

(35:07) Protected time in practice: the Wednesday afternoon model

(44:18) Why proficiency-based progression has not gained traction

(45:08) Formative feedback and the meaning of progression

(50:28) Where AI actually is today

(52:02) Convincing the establishment that simulation is patient care

(58:49) Service over training, and the business of medicine

Studies mentioned:

Seymour, Gallagher, Satava et al. Virtual reality training improves operating room performance. Annals of Surgery, 2002. https://journals.lww.com/annalsofsurgery/abstract/2002/10000/virtual_reality_training_improves_operating_room.8.aspx

Satava, Stefanidis, Levy et al. Fundamentals of Robotic Surgery (FRS) skills curriculum trial. Annals of Surgery, 2020. https://pubmed.ncbi.nlm.nih.gov/30720503

Gallagher, Ritter, Satava et al. Proficiency-based training as a paradigm shift. Annals of Surgery, 2005. https://pubmed.ncbi.nlm.nih.gov/15650649

Satava and Gallagher. Proficiency-based progression for FRS curriculum development. Annals of Laparoscopic and Endoscopic Surgery, 2020. https://ales.amegroups.org/article/view/5782/html

Guest: Dr Richard M. Satava

Host: Professor Anthony G. Gallagher. LinkedIn: https://www.linkedin.com/in/anthony-g-gallagher/