Young doctors struggle to learn robotic surgery – so they are practicing in the shadows
Posted by admin on 9th January 2018
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Artificial intelligence and robotics spell massive changes to the world of work. These technologies can automate new tasks, and we are making more of them, faster, better and cheaper than ever before.

Surgery was early to the robotics party: Over a third of U.S. hospitals have at least one surgical robot. Such robots have been in widespread use by a growing variety of surgical disciplines, including urology and gynecology, for over a decade. That means the technology has been around for least two generations of surgeons and surgical staff.

I studied robotic surgery for over two years to understand how surgeons are adapting. I observed hundreds of robotic and “traditional” procedures at five hospitals and interviewed surgeons and surgical trainees at another 13 hospitals around the country. I found that robotic surgery disrupted approved approaches surgical training. Only a minority of residents found effective alternatives.

Like the surgeons I studied, we’re all going to have to adapt to AI and robotics. Old hands and new recruits will have to learn new ways to do their jobs, whether in construction, lawyering, retail, finance, warfare or childcare – no one is immune. How will we do this? And what will happen when we try?

A shift in surgery

The da Vinci Surgical Robot at a hospital in Pittsburgh.
AP Photo/Keith Srakocic

In my new paper, published January 8, I specifically focus on how surgical trainees, known as residents, learned to use the 800-pound gorilla: Intuitive Surgical’s da Vinci surgical system. This is a four-armed robot that holds sticklike surgical instruments, controlled by a surgeon sitting at a console 15 or so feet away from the patient.

Robotic surgery presented a radically different work scenario for residents. In traditional (open) surgery, the senior surgeon literally couldn’t do most of the work without constant hands-in-the-patient cooperation from the resident. So residents could learn by sticking to strong “see one, do one, teach one” norms for surgical training.

This broke down in robotic surgery. Residents were stuck either “sucking” at the bedside – using a laparoscopic tool to remove smoke and fluids from the patient – or sitting in a second trainee console, watching the surgical action and waiting for a chance to operate.

In either case, surgeons didn’t need residents’ help, so they granted residents a lot less practice operating than they did in open procedures. The practice residents did get was lower-quality because surgeons “helicopter taught” – giving frequent and very public feedback to residents at the console and intermittently taking control of the robot away from them.

As one resident said: “If you’re on the robot and [control is] taken away, it’s completely taken away and you’re just left to think about exactly what you did wrong, like a kid sitting in the corner with a dunce cap. Whereas in open surgery, you’re still working.”

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