Practice makes perfect … except for doctors?

Should patients be the 'testing ground' to train medical personnel on procedures they are not familiar with? Or are there better ways?
Illustrative. Doctors perform surgery on a patient at the Wolfson Medical Center in Holon. (Nati Shohat/Flash90)
Illustrative. Doctors perform surgery on a patient at the Wolfson Medical Center in Holon. (Nati Shohat/Flash90)

Imagine someone that you care about deeply [that includes yourself] who requires a complicated procedure in order to regain a healthy status. This individual gets admitted to the hospital, undergoes a series of tests and is finally deemed ready for actual surgery. A group of ladies and gentlemen enter the patient’s room and at some point, after muttering a litany of medical terminology, turn to the patient and, with a smile, announce the time of the upcoming operation.

Perhaps because of the sedative that was given the previous night, the patient dares to ask the following question: Who will be doing surgery? Sometimes, there is a moment of silence as the leader of the medical team looks back and forth and finally seems to decide on the spot that “Dr. Jones will be doing the procedure”. Dr. Jones may very well appear to be far too young to drive, and even after a search on the Internet, does not seem to have any published experience with your upcoming surgery. But the dye has been cast and you will entrust your welfare to an individual who is not only a total stranger, but is also someone who has quite a racy Facebook page

Doctors practice on their patients. This has been the standard approach in medicine from time immemorial. Admittedly, for a very long time, the concept was that the apprentice would follow the tutor and slowly but surely osmose the necessary knowledge and skill to perform a given procedure. But in this day and age things work differently, and it could very well be that a physician with very limited experience is ultimately the one who will be responsible for your outcome.

You might ask the totally reasonable and logical question, why don’t doctors practice on some form of simulation?

I actually find it fascinating that simulating real-life crises, and allowing trainees to practice in these controlled environments, has been a part of many other fields for a very long time. Pilots develop experience primarily in simulators simply because there isn’t enough real-world experience to train them. This is true both in the military and in civil circumstances.

Police officers and fire services also train in simulated fields for a whole variety of tasks. The last place you want to be learning basic skills is on the job when other people are depending on you, and of course your own life is on the line.

Quite frankly, it seems that the world of medicine has considered itself above everyone else and has felt it legitimate to allow physicians to practice on patients who are frightened, in pain and desperate for assistance. As far as I’m concerned, even after a doctor has completed his formal training, he should continue to be mentored by a senior physician in the same field.

This is especially true in surgery. As I have pointed out in previous blog posts, simulator options are now available for physicians, but they still are not part of standard medical school education and residency training. In my opinion, there is absolutely no reason why a doctor should not be able to practice something as basic as taking blood on a practice dummy, before beginning to poke a real person.

There were things I did as a young doctor that I was not qualified to do yet was expected to perform. I hurt people unnecessarily and one day, whether on this world or the world to come, I will have to answer for that. And I accept that without question.

In this day and age, medical schools must universally implement simulation training for everything. Yes, it will require a significant investment in time and resources and money. Who cares? By the time a young physician is expected to perform a procedure, it should be second nature to him or her, based on training in a simulation lab.

It is not necessarily required that all training be in such a lab. I recently downloaded an app from the Android store called “Touch Surgery”. I have absolutely no connection to the company. This unit of software is amazing. I personally haven’t held a scalpel in an operating theater for 25 years. But with the assistance of this app, I could even imagine myself performing at least basic surgical procedures.

This app visually displays each and every step in a whole variety of procedures. There is absolutely no question that a medical student or resident should be using such an app to effectively memorize all of the steps for the procedure they are about to perform. I personally would love to see this app extended to basically every possible medical and surgical procedure that is done. Then, you could take the student or resident who has studied up, using such an app, and run them through a simulation lab to see if they have truly internalized the information.

Of course, you could easily argue why the physician must memorize every step. Imagine a future version of smart glasses, or a Microsoft 3-D hologram, calling out the step-by-step instructions as the physician works. If you are in the midst of the surgery and there is a complication, the surgeon could call out “show me how to repair the aorta” and lo and behold, a virtual surgeon would appear before the operator’s eyes, and guide him or her through the repair. If this sounds very much like a copy of the famous scene in the movie “The Matrix”, where the character Trinity learns how to fly a helicopter in seconds, then I would agree.

I can easily see future medical students being taught by virtual mentors. These holographic teachers would constantly observe, test, score and re-teach as necessary,.every single person studying to be a physician. There is absolutely no doubt in my mind that this approach, heavily steeped in advanced technology, will be far more successful than present teaching techniques.

For all of those individuals who smirked when Google announced that it was pulling the consumer version of Google Glasses, they should consider the following: would they want their doctor to be wearing such glasses if he/she encountered a problem during surgery and needed an immediate consult from a remote specialist who could see exactly what was going on. I know that I would want my doctor to be using every available piece of technology to be able to achieve the best possible outcome.

Thanks for listening

My website is at

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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