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Peer Review of Surgeons' Skills Carries 'Threatening Undertones'

Cheryl Clark, for HealthLeaders Media, October 17, 2013

The challenge is where to draw that dotted line. What types of surgeons need to be targeted for remediation or redirection? The bottom 1%, 10%, or the bottom quarter? I expect there will be a lot of difficult discussions.

HLM: Yes, because you now have evidence of harm that you didn't have before. Surgeons submitted what they thought was their best work.

JB: That's a really important point, and I hadn't thought of it that way. The American Board of Surgery fails about 10% to 15% of surgeons every year, and they have to retake the test, and maybe go through other steps.

But you're right, the difference between those tests and what we're talking about here is, nobody has empirically linked how well you do on those tests to patients' risk of dying or other types of bad outcomes as we have with this study.

The stakes are much higher. That's why there's a threatening undercurrent to these findings as they get extrapolated to other specialties.

HLM: If I were a patient who had had surgery by a surgeon judged to have lower level of technical surgical skill, I would want to know. Did you tell the patients whose videos were used in this study?

JB: The study was monitored by the University of Michigan Institutional Review Board, and these surgeons submitted videos that were completely stripped of patient-identifying information. So we don't know which patients were attached to those videos. And furthermore, there was a blood oath of confidentiality, so even I don't know the identify of the surgeon who was the 2.6 or who was the 4.8. [Scores ranged from 1.0 – 5.0]

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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"?