Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Video review of surgeons: Can the logistical issues be overcome?

Skeptical Scalpel, MD
Physician
November 13, 2013
Share
Tweet
Share

Last month, a superb study by the Michigan Bariatric Surgery Collaborative showed that the more skilled surgeons were, the better were their outcomes.

Surgeons submitted a video of their choice depicting their performance of a laparoscopic gastric bypass. Since it was self-selected, it was presumably their best work. At least 10 of their peers, blinded as to the name of the surgeon, rated skills on the video which had been edited to include only the key portions of the case.

Surgeons in the lowest quartile of ratings for surgical skill had significantly more postoperative complications, readmissions, reoperations, and deaths.

A New York Times article about the paper features a couple of short video clips — one from a not-so-skilled and one from a very skilled surgeon. The differences are obvious and dramatic.

According to the discussion section of the paper, the Michigan bariatric surgeons are now watching each other operate and will soon be receiving anonymous feedback about their technique from their peers.

It is not clear whether this will improve the skills of the lower-rated surgeons or have any effect on outcomes.

Many people rightfully praised the research. Some suggested that all surgeons should be scrutinized in this same fashion.

I agree that the study was well-done and shows that technically better surgeons have better outcomes.

But there are some problems with generalizing this to all surgeons.

The American Board of Surgery recently noted that there are almost 30,000 board-certified general surgeons in the US. This raises a number of logistical issues.

Let’s say we focus on the most common major surgical procedure — laparoscopic cholecystectomy. 10 surgeon-raters would have to view at least 15 to 20 minutes of video for each of the 30,000 board-certified general surgeons. How long would that take? Who would collect and edit all the videos? Who would make sure that the ratings were consistent? Who would collate and distribute the results? How would follow-up be done? Who would pay for all of this?

And that is just for the board-certified general surgeons. What about the general surgeons who are not board-certified and all the other surgical specialists? Maybe gastroenterologists should have their endoscopy procedures scrutinized. Maybe primary care docs should have selected office visits recorded too.

This is similar to the enthusiasm which surrounded the concept of using retired surgeons to coach other surgeons. The idea was based on the experience of one surgeon, who had access to an expert coach and wrote about it. I blogged about the logistical difficulties that would preclude coaching from becoming widespread. To my knowledge in the two years since I wrote that post, coaching has not caught on as a performance improvement measure.

ADVERTISEMENT

It’s too bad, because in an ideal world, video evaluation of operative procedures and coaching would be great. Unfortunately, we don’t live in an ideal world.

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

Prev

ACP: Practicing high value care and overcoming patients’ concerns

November 13, 2013 Kevin 2
…
Next

Why the annual physical still has value

November 14, 2013 Kevin 31
…

Tagged as: Surgery

Post navigation

< Previous Post
ACP: Practicing high value care and overcoming patients’ concerns
Next Post >
Why the annual physical still has value

ADVERTISEMENT

More by Skeptical Scalpel, MD

  • The hospital CEO who made a surgical incision. What happened?

    Skeptical Scalpel, MD
  • Medical error is not the third leading cause of death

    Skeptical Scalpel, MD
  • Should speed-eating contests be banned?

    Skeptical Scalpel, MD

More in Physician

  • Collective action as a path to patient-centered care

    American College of Physicians
  • Portraits of strength: Molly Humphreys and the unseen women of health care

    Ryan McCarthy, MD
  • When embarrassment is a teacher in medicine

    Vijay Rajput, MD
  • The crushing bureaucracy that’s driving independent physicians to extinction

    Scott Tzorfas, MD
  • Food is a universal language in medicine

    Diego R. Hijano, MD
  • An IMG’s story of exclusion in U.S. residency

    Fereshteh Kagar Bafrani, MD
  • Most Popular

  • Past Week

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The backbone of health care is breaking

      Grace Yu, MD | Physician
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • Why transplant equity requires more than access

      Zamra Amjid, DHSc, MHA | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Why doctors struggle with family caregiving and how to find grace [PODCAST]

      The Podcast by KevinMD | Podcast
    • Does cycling hurt male fertility?

      Martina Ambardjieva, MD, PhD | Conditions
    • Collective action as a path to patient-centered care

      American College of Physicians | Physician
    • Portraits of strength: Molly Humphreys and the unseen women of health care

      Ryan McCarthy, MD | Physician
    • When embarrassment is a teacher in medicine

      Vijay Rajput, MD | Physician
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 11 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The backbone of health care is breaking

      Grace Yu, MD | Physician
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • Why transplant equity requires more than access

      Zamra Amjid, DHSc, MHA | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Why doctors struggle with family caregiving and how to find grace [PODCAST]

      The Podcast by KevinMD | Podcast
    • Does cycling hurt male fertility?

      Martina Ambardjieva, MD, PhD | Conditions
    • Collective action as a path to patient-centered care

      American College of Physicians | Physician
    • Portraits of strength: Molly Humphreys and the unseen women of health care

      Ryan McCarthy, MD | Physician
    • When embarrassment is a teacher in medicine

      Vijay Rajput, MD | Physician
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Video review of surgeons: Can the logistical issues be overcome?
11 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...