Surgical Education Learners Forum (SELF)
After the Global Surgical Training Challenge completed in December 2022, the team took the learnings and evolved the program into a forum for developing self-administered skills assessment.
This Surgical Education Learners Forum (SELF) develops and evaluates training modules for clinicians in low-resource settings. SELF training modules enable clinicians to independently learn and self-assess specific skills. Modules are free-to-use and publicly available.
Mohr has been engaging in conversations at major conferences on the future of surgical education, and has now expanded those conversations to include emergency and critical care.
“It’s a huge cultural change, a huge endeavor in a methodical, ethical, and rigorous way—to show that this is safe and ethical, and that people can train themselves with confidence and competence.”
By regulation, Intuitive does not provide instruction on the practice of medicine; the introduction of new technology requires careful management, and hospitals, medical institutions, and medical boards have responsibility and discretion over surgeon credentialing and hospital privileges.
“There is real soul searching around how do we make these things available in low resource environments?” Mohr said. “How do we keep them maintained? All of that. It’s a wicked problem, because it’s got so many moving parts, and so many different places where different systems that have different value structures need to interact.”
Quality: it’s about systems
Mohr visited many operating rooms to see the places where care was delivered, and the visit to Sudan brought home the message that quality is about systems.
“It’s not necessarily about the availability of resources,” said Mohr. “People took huge pride in the care they were delivering and clearly took a lot of care to keep things clean and to keep things stocked. It wasn’t fancy stuff, it was the basics.
“We saw desperately poor places where I wouldn’t be worried about getting an operation in their OR. And we saw other places where they had higher resources, but things were a mess; you just sort of looked at it and you thought people have given up. Quality is about systems, not about resources.”
Tools for the future—including the future of surgical robotics
Sharing knowledge—and tools—empowers facilities to formulate their own systems.
“It’s respectful of the people to whom you are giving these tools,” said Mohr. “You are saying ‘this is for you to do with as you want to solve your problems,’ as opposed to ‘I’m going to come in and reserve the use of these tools for people that have been trained in my Western medical world.’ You’re enabling people to build their own systems and trusting them to build quality systems if they have the right materials to do so.”
With the groundwork in place, surgical robotics becomes an increasing possibility.
“Surgical care is about well-trained clinicians and a well-trained team having access to tools, and being able to be there when the patient needs them.”
In the long run, building excellent systems of training means that when the physical plant infrastructure is ready, it can support robotic surgery systems.
“The poor need minimally invasive surgery even more than the wealthy do because there’s no social safety net,” Mohr said. “More often when someone is having surgery, they’re needing to return to a job and they don’t have the leisure of recuperating for weeks.
“So first, you’ve got to build these robust systems. Once you’ve got the systems, you start to bring the more sophisticated tools that allow people to give their patients better outcomes. So robotics fits in down the road,” she said.
“But robotics really is just a tool. The fundamentals are education and practice and teamwork.”
SELF is an evolution of the Global Surgical Training Challenge, a $5 million global competition that funded the development of surgical training modules. These modules empower surgical practitioners to learn, practice, and self-assess specific surgical skills without direct supervision from a more experienced surgeon.The training modules are freely available on Appropedia.
For more information, visit www.self.surgery.
