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Peer Review of Surgeons' Skills Carries 'Threatening Undertones'

Cheryl Clark, for HealthLeaders Media, October 17, 2013

HLM: Has any other research project rated surgeons' skill and then paired it with patient outcomes like yours?

JB: To my knowledge, no. There's a large body of attempts to rate surgical residents' skill, but I'm not aware of any systematic attempt to peer-rate the technical skill of mature practicing surgeons, much less link those ratings to objective measures of surgeons' outcomes.

HLM: Might this prompt surgeons to be defensive and to object to such a process?

JB: Yes, there certainly is a threatening undertone to this.

HLM: The obvious question is whether this technique might be used to score surgical skill for procedures other than gastric bypass. Is it ready for prime time?

JB: There's no doubt in my mind we have a reproducible, reliable, and highly informative way of judging the comparative quality of practicing bariatric surgeons…although it will have to be confirmed by others.

And I believe it would likely extrapolate to other procedures such as robotic radical prostatectomy and robotic hysterectomy. And eventually, not just complex videoscopic surgery but other types of complex, complicated, surgery where how well the procedure is done bears on the outcome: Neurosurgery, spine, cardiac, vascular surgery and major orthopedics. I think scientific research will bear out this approach for a broad swath of surgeries.

HLM: What should you do with the poor performers? Now you'll have knowledge those folks aren't up to par, and you've now actually linked this to patient harm in higher complication rates. That's real.

JB: You have to ask who is the "you" in that sentence. Is it hospitals credentialing their own surgeons? The American Board of Surgery charged with certification of those surgeons? Regardless who the decision maker is, it's important to recognize there's a bell-shaped distribution. There will always be variation.

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2 comments on "Peer Review of Surgeons' Skills Carries 'Threatening Undertones'"


Rosemary Gibson (10/21/2013 at 7:53 AM)
Too bad that the title chosen for this article suggests the author and editors are concerned more about the surgeons than the patients. Patients want a competent surgeon. How is that threatening? Rosemary Gibson Senior Advisor, The Hastings Center

S.Noel,M.D. (10/18/2013 at 9:46 PM)
This study provides objective documentation of facts well known to those of us who have done agonizingly difficult surgical peer review for decades. Unfortunately, Medical Staff peer review bodies have little ability or authority to assist or force poor performers to improve their skills, if their outcomes are "acceptable", but not "optimal". Who is to define what is "acceptable"?