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.
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0:00) Thirty years, and one seminal study
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2:07) Simulation as a revolution, transposed from the military
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3:23) Why the operating room is the wrong place to learn basic skills
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6:30) Treating surgical education as a science is disruptive
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9:39) The 2002 Yale study, and the end of "see one, do one"
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11:58) Disruption keeps coming: telesurgery, space and directed energy
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13:01) The barrier is not the evidence, it is selling it
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16:21) Leadership: the skills lab before theatre
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18:06) Who should own the standards and credentialing
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21:00) Twenty-five years on: training hours and fellowships
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25:52) You cannot compress the time, people learn at different rates
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32:26) Why proficiency-based progression is demanding to deliver
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35:07) Protected time in practice: the Wednesday afternoon model
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44:18) Why proficiency-based progression has not gained traction
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45:08) Formative feedback and the meaning of progression
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50:28) Where AI actually is today
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52:02) Convincing the establishment that simulation is patient care
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58:49) Service over training, and the business of medicine
Studies mentioned:
Guest: Dr Richard M. Satava
Host: Professor Anthony G. Gallagher. LinkedIn: https://www.linkedin.com/in/anthony-g-gallagher/
What is Show Me The Evidence?
Most training is sold on confidence. Show Me The Evidence is built on data.
In every episode we take a single study, clinical trial, or systematic review and work through what it found, how it was designed, and what it means for the way we teach and assess skill. We focus on metrics-based training and proficiency-based progression, the approach that asks learners to demonstrate measurable competence before moving on, and we trace its results across surgical, medical, and professional education.
This is a podcast for learning professionals and medical educators who want more than opinion. Expect plain-language breakdowns of the research, honest discussion of what the evidence does and does not support, and conversations with the people behind the studies.
If you make decisions about how people are trained, we think you deserve to see the evidence first.