TEDMED: Sensor technology helps test hands-on skills

After witnessing a colleague miss a blood clot in a patient with acute coronary syndrome, Carla M. Pugh, MD, PhD, FACS, recognized the need for a tool to measure the quality of a physician’s sensory perceptions, or their ability to touch and locate abnormalities.

As a child, Pugh enjoyed taking apart and reassembling household items to learn how the items worked. She said those interests and skills translated into her work on the development of tools to measure and teach haptics, the study of tactile feedback.

“When I was 11 years old, I was the director of a transplant clinic. I was very adept at fixing stuffed animals that were injured during the course of play. I also fixed Barbie dolls, bikes, electronics and other things,” Pugh, who is the education and patient safety clinical director at the University of Wisconsin’s Health Clinical Simulation Program, said during her talk. “It’s very clear that these events shaped my life and who I am today and what I’m doing, and obviously this is one of the reasons I became a surgeon.”

Importance of haptics

As a surgeon, disappointment over the lack of tools to teach tactile skills led Pugh to change career paths. She began a quest to develop solutions to teach and evaluate haptic medical skills, such as effective techniques for locating a breast tumor or the blood clot her colleague missed but she was able to feel.

“For my resident, this is a case of haptics, the art and science of touch — knowing how to touch something, knowing how things are supposed to feel, being able to discern the difference between something that’s normal and abnormal,” she said. “And the tricky thing about haptics is, we don’t have a surefire way of teaching it, we don’t have a way of measuring it and, therefore, we don’t have a way of ensuring competency. So how are doctors supposed to learn?”

Physicians receive extensive training, but Pugh said there is no access to technology like the instant replay videos athletes are able to review in order to improve their performance.

“The best we have in the medical field is the tried and true board examination, but this is a pencil and paper test, a test of cognitive and declarative knowledge. We don’t have a test for hands-on skills, and we desperately need one.”

While in college on her new career path, Pugh began developing anatomical prototypes out of anything she could find, including badminton birdies.

“I thought, huh, this could serve as a great tumor or internal organ that may help me to explain to my classmates some of the nuances and difficulties of teaching certain medical exams and procedures,” she said. “And once I thought more about it, I then began to gather some other items: an empty roll of toilet paper, some saran wrap and a can of play dough, and these four items would seal the deal for me to build the perfect prototype.”

‘Instant replay’ for physicians

After these humble beginnings, Pugh worked with engineers, designers and developers of technology, and announced at TEDMED that she was able to develop and research sensor-based breast models designed for competency testing.

While testing the devices, Pugh learned that about 15% of experienced clinicians were using ineffective techniques, but with her model, they were able to review their method and improve their skills.

“I have the instant replay,” she said. “What’s exciting about this is we were able to discover this faulty technique with sensor technology that’s readily available today. What’s also exciting about it is that this ineffective haptic technique can be remediated.”

Pugh said that sensors and applications in phones and wearable devices fall short of their potential.

“Most of this technology is not built with medical training in mind, or human performance measurement,” she said. “All that means to me is that there are incredible opportunities to repurpose currently available technologies and expand their use, and that’s good business.”

However, legal challenges may hinder the adoption of devices that can record results.

“It’s not common for doctors to have access to instant replays and video reviews of what they do because it’s actually discoverable from a legal perspective and can be used against us,” she explained. “When we solve that problem, then we’ll really be able to take education and assessment to a new level. That’s the final frontier.”

For more information:

Pugh CM. Presented at: TEDMED 2014; Sept. 10-12, San Francisco.