James Lee, MD, presents “Innovations in Surgical Education: Metacognition and Technology in Surgical Training” at the 2021 Kui and Wai Fong Lectureship.
How can we train medical students, residents, and faculty better? James Lee, MD, the chief of Endocrine Surgery and the Edwin K. and Anne C. Weisskopf Associate Professor of Surgical Oncology at Columbia University, shared his vision of the future of surgical education at this year’s Kui and Wai Fong Lectureship. While modern medicine, in theory, has led to the death of the Halstedian Model – which is characterized by “see one, do one, teach one,” by learning through practicing on patients, and by volume and repetition in the OR – Dr. Lee argued that surgical education still has room to improve.
Dr. Lee shared three evidence-based approaches that he is applying to surgical education: cognitive pre-training, deliberate practice, and mental models. Cognitive pre-training, an approached pioneered by NASA and adopted by many fields, provides trainees with all the information they need ahead of time. He noted that mental practice achieves about two-thirds of the benefits of physical practice and showed how surgery-specific tools, such as COACH (an online wiki knowledge base) and simulation, can surpass existing tools, such as textbooks, in providing detailed surgeon-specific education on preparing for operations.
Deliberate practice involves measurable performance, pushing beyond comfort zones, and having an expert coach who knows how to perform at the highest level. In Dr. Lee’s own training experience, he went to Europe to train with a world expert in adrenal surgery, but Dr. Lee noted this is not a scalable approach to surgical education. Comparing surgery to professional golf, he explained how even the highest-level performers, like Tiger Woods, still have coaches. He showed the work that his own group has been doing to develop a comprehensive, decision-based model for complex surgery, such as a laparoscopic adrenalectomy, and how an upcoming tool from the American Association of Endocrine Surgery could allow learners to step in to the minds of expert surgeons.
Dr. Lee further described how mental models can be critical for surgeons and that they require four discrete skills: creating an image of the surgical field, maintaining the image over time, inspecting the objects in the image, and transforming the image. He showed how technology could supplement or further train surgeons’ mental modeling skills (e.g., 3D reconstruction and printed models or video games).
