Reducing medical errors through Video Based Assessment (VBA)

Surgical errors happen. They are one driver of thousands of deaths and millions of unwanted complications worldwide. But as explored in a previous article, we can significantly reduce these errors through technology, by building a digital safety net. This does not only provide support and guidance throughout surgeries. It also helps to train surgeons and systematically learn from surgical mistakes – for example through Video Based Assessment (VBA), one of the most promising tools for learning.

In the field of surgery, high-performance skills are closely intertwined with patient safety and better clinical outcomes. Yet, as I have previously explored, surgical errors occur much more frequently than we want to believe… and we can only learn from them and, more importantly, reduce them by accepting and better understanding them.

Let’s start by looking at how humans learn. The Dales Pyramid of Learning shows that only 5% of what we are told and 10% of what we read contribute to our knowledge growth. Through audio-visuals and demonstrations, we can retain about 20 to 30% of the content. Yet alone the practice of doing something or even teaching others to fully absorb those new skills, can increase our knowledge retention rate to 75 – 90%. 

Using digital tools to practice certain skills and learn from past performances, especially through Video Based Assessment with which individuals can critically revisit their performance on video to improve skills, we can accelerate the road to mastery.

How athletes benefit from deliberate, goal-oriented VBA

To see the benefits of digital tools for learning we do not need to look far – sports is a strong example of a field where VBA solutions have revolutionized quality of performance. The usage of VBA is widely spread among athletes, coaches, and trainers. This is because:

• Firstly, the visualization within re-playable video recordings facilitates an overall better understanding of the biomechanical principles of movements and resulting performances. Let’s take the example of professional football: Players may replay and analyse as much as they want to get a more objective view on how they hit the ball, how they interact with the team and with what result. In consequence, they can perform “deliberate practice”. 
• Secondly, VBA provides feedback about improvements over time and practice: seeing past performances compared to their latest ones keeps players motivated during the process. Errors and “weak spots” can easily be identified and visually dissected. Furthermore, the digital record does not only enable athletes to compare their own performances but also how they perform as compared to other top athletes.
• Thirdly, coaching performance, communication, and efficiency are enhanced using VBA software because misunderstandings in the complex communication interplay between athlete and coach can be avoided: the video-based analysis provides a more objective view compared to subjective observation. Instead of verbalising what they think they saw, coaches can rely on the video resource on screen for discussing the motion to be improved. Efficiency comes along as the same video resource can be used for training purposes several times and may be deployed to improve the athlete’s self-analysis.

Surgery is highly specialised and challenging, much like professional sports: VBA can significantly improve surgical skills 

Just as visual feedback in performance-sports helps us understand body position and space, it also supports tracing technical procedures in the operating room: by using Video Based Assessment, surgeons can analyse and understand what happened during a procedure. Surgeons can quickly accelerate their learning curve, identify their weak spots, and increase their skill level in the shortest possible time.

What sounds good in theory, has also been scientifically proven: deliberate practice with VBA tools has been at the centre of analysis in an independent, clinical study (see source 3) conducted at the University of Straßbourg in 2020.  

Researchers compared a group of level 3 (skills for any given technique can range from 1, novice to 5, expert) surgeons’ success rates in learning the so-called MIPO (Minimally Invasive Plate Osteosynthesis) technique for distal radius fractures with the help of mentoring and simple exercises compared to training with deliberate VBA practice.

The studies, led by Prof Philippe Liverneaux and Dr Francois Ducourneau, eventually demonstrated that, with a VBA software platform in use, they could increase the surgeons’ skill level from 3 to 5 and as a result: 

• improve the surgical precision score by 50% compared to only 8% of improvement with experience-based training
• decrease X-ray times by 25% 

These are impressive findings – and show us how technology can help surgeons not just through guidance or streamlined workflows during a surgery, but that it can also enhance human skill and intelligence significantly. This in turn improves patient outcomes. Therefore, video-assisted deliberate practice training deserves to be generalized to other surgical procedures to optimize learning and minimize risk – with many exciting possibilities for significant leaps in surgical precision and quality lying ahead. 

Note: The researchers were using Caresyntax’s platform – which was carefully designed with learnings from performance sports and decades of experience in surgeon training. You can find out more about this VBA solution here - or reach out to me directly!

About Bjoern von Siemens:

Coming from a background of technology and healthcare innovators, Bjoern von Siemens is driven by the vision of creating stronger societies through better human health. Since 2007, Bjoern has been founding, investing and mentoring for the digital healthcare technology space. After working with groups such as Siemens Healthcare and advised health insurance companies through Boston Consulting Group and Bain&Comp, he co-founded surgical.ai in 2011. Surgical.ai is a privately held healthcare investment group with $150m AUM. Bjoern also launched caresyntax, a global leader in surgical analytics and automation. As of 2021, Caresyntax’s technologies are used in 4,000 operating rooms worldwide and improving 3 million surgeries per year. Bjoern was educated at the London School of Economics, EBS Oestrich-Winkel and conducted several years of PhD reseach on behavioral psychology and entrepreneurship at both the University of St. Gallen and Harvard University. He published his research in peer-reviewed and management journals, and authored a study and class on the history of Siemens at Harvard Business School.

Sources:

1. CDC Data 
2. https://www.euro.who.int/en/health-topics/Health-systems/patient-safety/data-and-statistics 
3. Ducourneau et al., Learning a MIPO technique for distal radio fractures: mentoring versus simple experience versus deliberate practive. Orthopaedics & Traumatology: Surgery & Research https://linkinghub.elsevier.com/retrieve/pii/S187705682100164X