A Surgeon’s Touch: Q&A with Carla Pugh

Carla Pugh spent her childhood tinkering with appliances and electrical outlets. Quite fittingly, she spoke in TEDMED 2014’s “Play Is Not a Waste of Time” session. Now a surgeon and the Clinical Director of University of Wisconsin’s Health Clinical Simulation Program, Carla shared why haptic skills training matters so much in medicine. Eager to learn more about what she sees for the future of medical education, we reached out to her for a Q&A session.

Carla on the TEDMED 2014 stage. [Photo credit: Jerod Harris, TEDMED].
Carla on the TEDMED 2014 stage. [Photo credit: Jerod Harris, TEDMED].

What impact do you hope your talk will have?

I want to spark a serious conversation about need for elite, high-end, mastery training in the healthcare profession. Healthcare is at a critical juncture where there are huge opportunities for major information exchanges that can empower physicians and patients. Both patients and physicians will benefit from clinical skills performance data. For example, what if we all knew which haptic techniques place physicians at risk of conducting poor clinical examinations?

Outside the measurement of haptic skills, are there other gaps that you believe exist in medical education?

I think the future of medical education is about the global improvement of all skills. The soft skills – like interpersonal communications, and the promotion of tolerance – are definitely the most difficult to achieve. As educators, I think there are gaps in knowing how to be the best teachers we can be, and understanding the limitations of observational learning. When my students walk away from watching a video, I have no idea who’s learned what and who hasn’t. Traditional learning hasn’t fully recognized that, and still hasn’t made strategic efforts to change. Watching videos is helpful because it does give students a certain level of instruction, but at some point it’s important to have that team conversation where you face your colleagues. Also, if you are doing a procedure, at some point you have to pick up an instrument and use it. Videos and observation can only get you so far. Applied learning doesn’t take place until action happens.

Could you paint us a picture of your dream patient simulation lab?

Integration is key. Our whole education system isn’t where it could be; I still dream of something that’s full service. The dream simulation lab would have a central facility, where people come to train and discuss a wide variety of clinical skills. It wouldn’t only be about haptics – it would include communication across professions, and improving patients’ communication with their healthcare providers. Beyond that, it would also be a place where patients could come to learn important techniques – like how to give themselves a shot, take care of a wound, or think of creative ways to remember to take their medication. We would educate using broad, hands-on heuristic techniques.

Standard measurement of a physician’s skill is through the board exam. If you were designing the board exam for surgeons, using all of your haptic technology, what would it be like?

The way that the board exam is administered is highly centralized – we have to go to a board designated location to get tested. Ideally, there would be maintenance of professional certifications, where doctors are given relevant lifelong learning opportunities that are ongoing and well integrated into their daily clinical practice. This is something that the board is working on.

I would like to see decentralized opportunities where doctors are able to practice clinically relevant scenarios.   As doctors, we need to maximize our use of local social capital. For example, I have a few experts working down the hall from me, but I don’t have access to their knowledge, their haptic and communication skills for example. We need more information sharing, and the opportunity for shared practice. I want to compare their performance to my performance, and the ability to choose a training paradigm that directly matches the mastery level that I want to achieve. It’s about mastery, not skills – when we talk about skills, we tend to think of them in terms of “you either have them or you don’t.” Mastery is about constantly improving and working towards better performance. That’s what we should focus on.

Are there any actions items you want your viewers to take?

Make sure to read my research article about using sensor technology to assess clinical skills, which will be published in the New England Journal of Medicine on February 19!