We all read in the newspapers that our hospitals have to cut costs, have not enough trained personnel who also sometimes have to work extreme hours. In Europe we are trying to get working hours down to below 10 hours per day, in the United States residents’ working weeks have to be maximum 80 hours a week! In parallel, medical disciplines are getting more and more advanced with the use of new equipment, new techniques as well as advanced medical devices.
With the amazing development around catheter based interventions we can today treat areas all the way from the brain down to the lower extremities - without open surgery. Procedures can today be made in a fraction of the time with substantially less complications and much faster recovery than after an open operation.
What many patients do not know is that many of these procedures are technically very complex and require a lot of practice and experience by the doctors. Otherwise it can lead to devastating complications.
Studies show that physicians with experience of six (or less) cases of a certain procedure have an almost doubled risk of causing complications leading to death, compared to physicians with >24 cases experience. And yet for the Carotid procedure references, in the US 50% of all procedures were done by physicians with <6 cases (Carotid Artery Stenting learning curve JAMA Sept 2011, USA, published in Interventional News Nov-2011).
Doctors also need to maintain proficiency in many standard procedures. Typically, doctors would need about 25-30 cases with a difficult procedure per year to maintain their skill levels to avoid obvious mistakes and prevent errors.
So what does this mean to you, the patient? What can be done to help doctors stay on top of their game?
Medical simulation has been around since the early 1990s, initially used for key-hole surgery, anesthesia training and similar. Numerous scientific studies prove that simulation improves skills of doctors operating on a real patient. We should expect doctors to do what aircraft pilots must do regularly, which is to practice on simulators to proactively improve their skills in order to prevent errors.
There are very few today that argue against the use of simulators for medical training, however, it is still not integrated into daily hospital routine! You, the patient should be asking your doctor and your hospital if they use simulators to improve your safety.
Simulation is used at university hospitals and skills centers around the world for basic education but still just in a fraction of the world’s university institutes. More importantly: simulation very rarely is used for continuous improvement and maintaining skills in daily hospital operations.
So, as a patient your first question should be
(i) how many procedures have you as “my doctor” done in total,
(ii) how many in the last 12 months,
(iii) how efficient is this hospital with respect to this procedure and do you use simulation to train and maintain expertise.
Note added April 12-2012:
I have received some comments that my text above is perceived as criticism towards physicians. I want clarify this is not in any way my intention, I have an enormous respect for physicians work and under what conditions and pressure they are continuing performing.
My intention was to highlight the need for a change in the system where structured training and continuous improvement is implemented for entire teams to improve safety, outcomes as well as productivity. This topic has been discussed during Mentice entire existence and even before this, however even if a lot of positive improvement has occurred, still a lot need to happen. This discussion and debate will be continued…
I welcome comments from both physicians, hospital management and everyone else involved in the pursuit of improving patient safety. Please join me in this important debate so that together we can have an open and collective exchange of ideas and solutions on how to best use medical simulation technology.