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Research

We have multiple projects that seek to improve surgical safety through education. Not only can we do this through innovation, as in our MUS Errors work, but also through looking back, as in our Health Facts studies. Feel free to browse and learn.

Lab Activities

Image of Dr. Lee, Dr Stylianou, and Duy Ho
Improving Education and Safety through Simulation
Dr. Lee, Dr Stylianou, and Duy Ho with our Pelvic model
Student testing our pelvic model
Improving Education and Safety through Simulation
Testing for error detection
Students testing VR instrument
Improving Education and Safety Through Simulation
A medical student prepares to test our motion tracking trocar
woman standing at white board
Speech Communication Interference in the OR
Lauren Roberts, Medical Student standing at our white board mock-up of the robotic OR -
Man and woman in scrubs
Speech Communication Interference in the OR
Ray Chan explains the rating process to study participants
group of people in a meeting
Speech Communication Interference in the OR
Examining different placement of machinery in the robotic OR
Image of Surgilab team members
Surgical Simulator testing time!
It takes a village to test a simulator!

Interprofessional Communication in the OR

Speech Communication Interference

We use video ethnography to study inter-professional communication in the Operating Room. Our methodology is speech communication interference, when a loud OR interferes with one team member communicating a message to another. The OR contains loud machines and multiple overlapping conversations, and speech communication interference occurs 2-3 times per hour.  We work with OR staff to not only study miscommunication in the OR, but to improve it.

Our interdisciplinary team includes Human Factors experts and works with hospital OR team members to generate and study novel interventions to improve communication in the OR and reduce surgical errors.

We have funding from the Agency for Healthcare Research and Quality (AHRQ).

As we collect data on this research, it often spawns even more research studies in related areas. For example, currently in the data collection stage, "Music in the OR: Let Someone else be the DJ" examines the individual preferences of OR personnel.

"Follow it Up Until You Come to the Nose of the Thing!' Ambiguous Verbal Instruction in Robotic Surgery" was presented at the 2024 Association for Medical Education in Europe Annual meeting by our collaborator Dr. Emily Huang:

  • Huang E, Yanamala S, Steele S, Bacon D, McKenzie A, Sutkin G. “Follow it Up Until You Come to the Nose of the Thing!” Ambiguous Verbal Instruction in Robotic Surgery. Short communication at the Association for Medical Education in Europe 2024 Conference, Aug 24-28, 2024. Basel, Switzerland.
  •        Bachar A, Brommelsiek M, Simonson RJ, Chan YR, Davies A, Catchpole K, Sutkin G. Speech Communication Interference in the OR. J Surg Res. 2023. doi: 10.1016/j.jss.2023.11.064. PMID: 38142575.
  •        Krishnan T, Rudy P, Viswanathan N, Brommelsiek M, Bachar A, Sutkin G. The Impact of Facial Personal Protective Equipment on Speech Intensity. Urogynecology  2023;29(4):422-429. doi:10.1097/spv.0000000000001282. PMID: 36730870.
  •      Brommelsiek M, Krishnan T, Rudy P, Viswanathan N, Sutkin G. Human-Caused Sound Distractors and their Impact on Operating Room Team Function. World J Surg, March 2022. 46;1376-1382
  •        Sutkin G, Brommelsiek M, Bachar A, Simonson RJ, Chan YR, Davies A, Catchpole K. Speech Communication Interference: Surgical Team Requests and Impact on Patient Safety. Oral Presentation at the 2023 American College of Surgeons Clinical Congress, October 22-25, 2023, Boston, MA.
  •        Sutkin G, Bachar A, Brommelsiek M, Simonson R, Chan YR, Davies A, Catchpole K. Understanding Causes of Miscommunication in the Operating Room. Poster presentation at the 2024 HFES International Symposium on Human Factors and Ergonomics in Health Care, March 24-27, 2024, Chicago, IL.
  • Sutkin G, Steele C, Brommelsiek M, Simonson R, Chan YR, Davies A, Catchpole K. Human Factors Approach to Improving Communication between Console Surgeon and Bedside Assistant. Oral presentation at the 2024 International Symposium on Human Factors and Ergonomics in Health Care Robotics Summit, March 24, 2024, Chicago, IL.

Improving Education and Safety through Simulation

Midurethral Sling Surgery Errors

We hypothesize that surgical error related to sub-optimal surgeon bio-mechanics can be quantified, predicted, and avoided by discrete changes in the kinematics of the surgeon’s shoulder, elbow, and wrist, and the surgical instrument’s spatio-temporal characteristics. 

Publications resulting from this research are

 

Cognitive Strategies in High Risk Surgical Steps: The Role of Coping and Resilience

Qualitative study that explores the mental responses of surgeons during high risk surgical steps, how they develop strategies to alleviate stress and perform under pressure, how they perform under pressure without choking, and how performance under pressure is related to cognitive map formation and manipulation. We explore these themes through semi-structured interview in order to identify trends in strategies for coping and resilience that surgeons use to improve their performance.

This research was selected for a short communication and presented virtually at the Association for Medical Education in Europe 2021, as well as at our Vijay Rayadu Babu Quality Patient Safety Day. Cognitive mapping and its role in surgical resilience

Mueller F, Brommelsiek M, Sutkin G. Mental 3D Visualization: Building Surgical Resilience for Performing High-Risk Procedures. J Surg Educ. 2022 May-Jun;79(3):809-817. doi: 10.1016/j.jsurg.2022.01.007. PMID: 35123912

 

Health Outcome Research using Electronic Health Record Databases

This research has been presented at the Society of Gynecologic Surgeons 2023 Annual Meeting in Tucson, AZ.  

 

A qualitative analysis of health data in different areas as they relate to surgical procedures and their outcomes. Some of the articles below are results of this research, including, “The Risk of Primary Uterine and Cervical Cancer After Hysteropexy” and  “Risk Factors for Returning to the OR for a Second Surgery After Midurethral Sling for Stress Urinary Incontinence”, as well as, "The Impact of Preoperative HbA1c on reoperation rates in Women undergoing Surgery for Stress Urinary Incontinence and Pelvic Organ Prolapse", pictured here.

Some studies resulting in publications are

1. Ohene-Agyei J, Wang X, Sahil S, Cheng AL, Shepherd JP, G. S. Prophylactic Vancomycin Leads to Fewer Device Removals in Sacral Neuromodulation. Urogynecology. Published online Forthcoming.

2. Bachar A, Wang X, Herzog K, Sahil S, Cheng AL, Ohene-Agyei J, Shepherd JP, Sutkin G. Hemoglobin A1c and Reoperation After Surgery for Stress Incontinence or Prolapse. Urogynecology. Published online December 1, 2023. doi:10.1097/SPV.0000000000001438. PMID: 38113124

3. Balasubramanian S, Wang X, Sahil S, Cheng AL, Sutkin G, Shepherd JP. Risk factors for development of acute pyelonephritis in women with a positive urine culture. Neurourol Urodyn. 2022; 1- 8. doi:10.1002/nau.25005. PMID: 35788978

4. Ablatt S, Wang X, Sahil S, Cheng AL, Shepherd JP, Sutkin G. Reoperation rates of stress incontinence surgery in rural vs urban hospitals. AJOG Global Reports, 2(3). Aug 2022 doi:10.1016/j.xagr.2022.100059. PMID: 36276800.

5. Kurian R, Kirchhoff-Rowald A, Sahil S, Cheng A-L, Wang X, Shepherd J, Sutkin G. The Risk of Primary Uterine and Cervical Cancer After Hysteropexy, Female Pelvic Medicine & Reconstructive Surgery: March 2021(27)3:e493-e496. doi: 10.1097/SPV.0000000000001030. PMID: 33620910

6. Sharif F, Mahmud F, Suman S, Cheng, A-L, Shepherd J, Sutkin G Risk Factors for Returning to the OR for a Second Surgery After Midurethral Sling for Stress Urinary Incontinence. Female Pelvic Med Reconstr Surg. 2020 Jul;26(7):443-446. doi:10.1097/SPV.0000000000000804. PMID: 32217917

 

Scoping Review

Scoping review of studies that use video-recording as a methodology to conduct Health Professions Education research. This research is a collaborative effort with external researchers Elizabeth Littleton, PhD,  Emily Huang, MD, Da Yeon Roo, MD and Patricia O’Sullivan, EdD.

Dr. Emily Huang, MD presents our research at the 2023 ASE/SEW meeting in San Diego, CA.

 

 

 

Education through Ethnography

By observing and analyzing the lived experience of medical professionals and trainees, we can identify weaknesses and strengthen teaching.

 Some of our recent publications and posters resulting from this include:
Movement analysis studies the granular movements and non-verbal cues of surgeons in the teaching OR
  • Rose C, Gangireddy S, Kirchhoff A, Gray M, Martin J, Brommelsiek M, Arnold L, Ye S, Sutkin G. Non-Verbal Patterns of Communication in the Operating Room. Poster Showcase at The University of Missouri Kansas City 7th Annual Vijay Babu Rayudu Quality & Patient Safety Day, May 29, 2020. Kansas City, MO. (No Link Available)

1.       Rose C, Bachar A, Martin J, Cheng AL, Sutkin G. Non-verbal Patterns of Teaching Communication in the Operating Room. Accepted Poster Presentation at the 2024 Association for Surgical Education Surgical Education Week. April 23-27, 2024. Orlando, FL.

Gender Differences in learning, teaching and communication are studied
  • Casubhoy I, Ramprasad A, Meister MR, Bethman BL, Sutkin G. How teaching surgeons communicate: An analysis of intraoperative discourse among male and female surgeons. Accepted for Publication. The American Journal of Surgery. Published online Forthcoming.
  • Ramprasad A, Casubhoy I, Meister M, Bachar A, Bethman B, Sutkin G. Language in the teaching OR: Expressing Confidence Versus Community. Trainee Quickshot Podium presentation at the 2023 Association for Surgical Education Annual Meeting, April 13-15, 2023, San Diego, CA
  • Ramprasad A, Casubhoy I, Bachar A, Meister M, Bethman B, Sutkin G. Communal Versus Agentic Spoken Language Among Surgeons in the Operating Room. Poster Presentation at The University of Missouri Kansas City Health Sciences Student Research Summit, March 2, 2022. Kansas City, MO.
  • Ramprasad A,  Casubhoy I, Meister M, Bethman B, Bachar A, Sutkin G. Communal Versus Agentic Spoken Language Among Surgeons in the Operating Room. Poster presentation at the 9th Annual Vijay Babu Rayudu Quality & Patient Safety Day, May 6, 2022. Kansas City, MO.
Deixis delves deeper into communication, identifying unclear communication and its consequences
  • Mahadev A, Bachar A, McKenzie A, Sutkin G. “Take a bit off the top here”: Ambiguity and vagueness in the operating room. Accepted for live presentation in the 5 Minute Linguist Event at the Linguistic Society of America 98th Annual Meeting, Jan 5-8, 2023, Denver, CO.
  • Mahadev A, Bachar A, Karmarkar T, McKenzie A, Sutkin G. Implicit Communication and Miscommunication in Surgical Instruction. Podium presentation at the 2023 Association for Surgical Education Annual Meeting, April 13-15, 2023, San Diego, CA.
Silence studies non-verbal communication, as well as wondering when to speak up