Monday, September 17, 2007

First Annual W.W. Krippaehne Lecture

This morning's surgical grand rounds saw the presentation of the first annual William Krippaehne Lecture in Surgical Education delivered by guest speakers Gunnar Ahlberg, M.D., and Stig Ramel, M.D., of the Karolinska Institute.

Kicking off the event, Dr. Richard Mullins began with a short biographical sketch of William Wonn Krippaehne, M.D., alumnus and former chair of surgery here at the Medical School. Krippaehne was born in Douglas, AK, to a mining engineer and a nurse. Shortly after the mine flooded four years later, the family relocated to Puyallup, WA, and the young William rarely strayed far from the Pacific Northwest after that. As the lecture brochure concludes, "Teaching was an integral part of Dr. Krippaehne's entire professional life. His life long vocation was to provide the best environment possible at Oregon's Medical School for education." To honor and recognize Krippaehne's contributions to surgical education at the school, the Dept. of Surgery has created this yearly lecture on the topic of surgical education.

The inaugural lecture speakers, Ahlberg and Ramel, both hail from Sweden, recognized as the birthplace of virtual reality simulation and its use in surgical education. Their talk, "Integrating Skills Training in Formal Surgical Education," discussed their research on the use of simulation programs in training surgeons to perform common, but challenging, surgical procedures. Replacing the century-old Halsted model of surgical education (See one, do one, teach one), training programs predicated on the achievement of proficiency levels in simulated programs do seem to affect the learning curve for some procedures. After conducting controlled studies with students in Sweden, Ahlberg and his colleagues still came to the conclusion the teaching surgeon has the greatest impact on student proficiency. It still matters what your teacher is like--whether s/he is technically proficient, whether s/he can convey key points, whether s/he can connect with students in the learning environment. That is, we still need our William Krippaehnes.

In the Q&A following the talk, a few of the surgeons in the audience brought up issues concerning the intangible aspects of surgery: surgical decision-making, gut feeling, patient-specific complications. When residents are trained on idealized patients in a virtual environment, where do those issues fit in? How can we pass on the knowledge that goes with the skill? Again, Krippaehne had it right: he expected students to know what was in the textbooks; he wanted to teach them how to reason, how to solve problems. The trainer remains the critical source of this education in analysis and synthesis.

I was put in mind of the new book Super Crunchers: Why Thinking-By-Numbers is the New Way to be Smart, by Ian Ayres. A review of it that I recently glanced at noted the coming divide between "super crunchers" and "intuitivists," those who make decisions based not on raw data but on a gut feeling. Will we ever have enough data to model all possible factors affecting any given outcome? Will computers ever be smart enough to teach us wisdom and restraint? Only time will tell. In the meanwhile, make sure your surgeon has done at least 200 colonoscopies before you go in for yours. Trust me--you'll thank yourself later.

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