Medical Training in the Fitbit, Google Glass and Personal Information Era Carla M

DEAN’S CORNER

Medical Training in the Fitbit, Google Glass and Personal Information Era Carla M. Pugh, MD, PhD Robert N. Golden, MD Carla M. Pugh, MD, PhD; Robert N. Golden, MD

to provide detailed performance metrics for Will advanced technologies change the way hands-on clinical skills. we learn and practice medicine? Doctors go through many years of training to become top-notch professionals, but the intensity of their ongoing training and here’s no question that we are in the operating room and training environments. assessment often subsides after the comple- midst of an ever-expanding journey Many of the currently available technologies tion of their residency and fellowship years. of information access. While Google have the potential to dramatically change the In contrast, other types of professionals often Tand Wikipedia have changed the landscape way educators teach and measure learners’ use performance data to refine their psycho- of searchable, worldwide information on expertise. The big question is: How far is the motor skills on a regular basis throughout their a variety of topics, Facebook, Fitbit, and medical profession ready to go? careers. Google Glass have taken things to the next Recent research published in the New For example, athletes rely heavily on level—from storage and access of informa- England Journal of Medicine (NEJM) noted instant replays, video reviews, and cumulative tion to up-close-and-personal data. that clinicians who use less than 10 Newtons of metrics to improve their performance. In some The medical profession has not been distributed palpation force during a simulated settings, their personal performance records shy about joining the craze of information breast examination were 7 times more likely are public knowledge. This information allows exchange. Most medical schools and national to miss a 2-centimeter lesion. This research individuals to set personal goals. Athletes medical organizations have Facebook and project—which calls upon haptics, or the sci- know where they stand compared to their Twitter accounts, and numerous academic ence of touch—involved the use of silicone peers. Coaches use the information to design medical centers use Google Glass in the breast molds combined with layers of simu- training programs to maximize performance. lated breast tissue, skin, and various masses These information resources promote continu- in different locations. The breast molds incor- ous quality and performance improvement at porated sensor technology to capture data the individual and team levels. regarding where the clinician was palpating • • • In the medical field, specialty board exami- and the amount of palpation force he or she nations are the most comprehensive compe- Doctor Pugh is a professor and vice chair of applied during the examination. Researchers education and patient safety in the University tency assessments that are widely available. of Wisconsin School of Medicine and Public tested more than 500 surgeons, OB/GYN phy- We don’t have an objective test for “hands- Health’s (UWSMPH) Department of Surgery, and sicians and family medicine physicians. on skills,” which would be extremely helpful, clinical director of the UW Health Simulation While more work is necessary to under- especially in procedural areas of practice. It’s Center; Doctor Golden is the dean of the stand fully how this data relates to real-life one thing to get feedback about performance UWSMPH, Robert Turell Professor in Medical Leadership, and vice chancellor for medical af- clinical breast examinations, the implications from a faculty member or peer, and another fairs, UW-Madison. are clear: Advanced technologies are available thing altogether to receive a detailed computer

168 WMJ • AUGUST 2015 readout. To that end, we envision a time when staff from the University of Wisconsin School physicians receive daily computerized feed- of Medicine and Public Health (UWSMPH), UW back about their work that will allow them to Hospital and Clinics, UW Medical Foundation, improve their proficiency in areas such as pal- and many practitioners throughout the state pation, instrument selection, operative time, and region. Capable of conducting interdisci- and blood loss. Further, this type of data could plinary health care scenarios, the center was be incorporated into recertification and main- designed to serve myriad health care fields, tenance of certification processes. from surgery and respiratory therapy to envi- However, this scenario raises many ques- ronmental services and nursing. It incorporates tions. How will the data be used? Are medical best practices, integrates Centers for Disease professionals ready for this type of feedback? Control and Prevention protocols, and pro- The Achilles heel of the medical profession vides critical feedback. Wapiti is that physician performance data often has We have taken steps to make sure the been used in a punitive fashion—the opposite Simulation Center’s policies and personnel are of how it’s used with professional athletics. sensitive to everybody’s fears and concerns. Medical Many physicians have an understandable fear For those who question whether objective that performance data could be used against assessments of psychomotor performance are Group them, thus creating resistance to the idea of related to clinical outcomes, a well-designed collecting such data and dampening our hopes study has addressed that issue. In 2013, a for its availability as a strategic guide through NEJM article showed that a simple Likert scale Opportunity for the stages of mastery en route to performance rating of surgeons’ operative skills correlated excellence. significantly with patient outcomes. Using Family Practice/ While it’s unclear what needs to happen to blinded ratings, surgeons who scored the low- ER Trained change physicians’ culture and outlook about est on psychomotor skills had higher patient personal performance data, history suggests readmission and re-operation rates. Physicians that eventually we will adopt the technologies Examples of technology in action at the and communication venues of the general pub- UWSMPH include: • Spooner lic. Then, rather than only asking if a physician •• A US Department of Defense-funded proj- • Ashland is board certified, a patient will want to know ect is using motion-tracking technology his or her doctor’s haptics scores. After all, to model and understand skills decay that’s what matters in the operating room. among physicians who rarely perform cer- Getting the medical profession to take full tain procedures or who endure prolonged • Full or Part Time advantage of technological tools for assess- absences from practice—such as those ment and performance improvement will who become ill or take maternity or pater- Shifts Available require expanding the use of existing tech- nity leave. Its goal is to understand ways in nologies for medical purposes; increasing the which military doctors can more smoothly • No Need number of researchers, designers, and inno- make the transition back into practice after to Relocate vators who have a passion for health care; deployment. and finding a way to address the delicate •• A National Institutes of Health-funded • Paid Malpractice legal issues that accompany the use of video study is examining surgeons’ decision- review and assessment in health care settings. making skills during critical intra-opera- Meanwhile, sensor technology, simulators, and tive moments. For example, as a surgical other forms of high-tech training methods have trainee performs a generic task—such as come a long way. Medical and nursing schools dissecting a pelvic tumor—sensor technol- Contact Mindy Peters around the United States are embracing the ogy can capture and measure his or her concepts, with many investing in multimillion- movements, reaction times and decisions. Physician Recruiter dollar training programs and simulation cen- We have already embarked on the informa- 888.733.4428 ters that employ state-of-the-art technologies. tion age. Data exists, it’s meaningful, and it will [email protected] The UW Health Simulation Center offers edu- not go away. In fact, we believe our patients www.erstaff.com cational opportunities for students, faculty, and will begin to demand it.

VOLUME 114 • NO. 4 169 WMJ (ISSN 1098-1861) is published through a collaboration between The Medical College of Wisconsin and The University of Wisconsin School of Medicine and Public Health. The mission of WMJ is to provide an opportunity to publish original research, case reports, review articles, and essays about current medical and public health issues.

Visit www.wmjonline.org to learn more.