Monday, January 3, 2011

Surgeons Are Not Pilots

I am sick of hearing that surgeons can be compared to pilots. Yes, there are some similarities and some things can be learned from the aviation industry. For example, I am a big fan of checklists, having used them in both the operating room and intensive care settings. Both a GS and an FP will have occasion to multitask and both need to have what is termed “situational awareness” or an understanding of where he is and what is going on around him. But let’s look at some of the differences between specifically, general surgeons (GS) and fighter pilots (FP).

The training of surgeons and pilots is remarkably different. This table illustrates some of the differences.

Total hours of training for a GS after medical school can be broken down as follows. Five years of residency training at 80 hours/week equals 20,800 hours. Allowing for 6 hours of sleep/night (Ha!) over five years would reduce the actual training time to 15,600 hours of which some 2000 hours would be spent in the operating room (about 1000 cases performed by the average graduating chief resident at about 2 hours/case).

Total hours of training for an FP entering the US Air Force are as follows. (Note: data are from a paper by a USAF colonel who is also a surgeon.) Once accepted to flight school, the neophyte first takes 50 hours of civilian flight training and becomes certified as a private pilot. Then he goes to Phase I or preflight training which apparently involves ground training, survival, navigation etc and no actual flying. Phase II is six months of flight training with 90 hours of flight time in a jet trainer. Phase III is another 6 months of training with 120 hours of flying in the aircraft to which they have been assigned. The entire package takes about two years at let’s say 10 hours per day or 5200 hours (50 hours/week x 52 weeks x 2years) of which some 260 hours is actually spent in the air.

To illustrate this point more clearly, someone once said, “I know a lot of doctors who became recreational pilots, but I don’t know one pilot who became a recreational doctor.”

If what Malcolm Gladwell says is true that one needs to spend 10,000 hours at a task before one can be considered an “expert”, I leave it to you to decide whether surgeons and pilots are experts.

Some thoughts on this from surgeons in the UK:

“If a pilot were to undertake all the roles required by a consultant surgeon, he/she would interview separately every potential passenger for every flight that he/she was responsible for. He would then have to determine for each passenger the optimum way of reaching their destination; it may well be that rail, road or sea travel would be better for that particular individual than air travel. [T]he captain would need to obtain informed consent from every passenger to ensure that they understood what flying involved, including the risk of infection in aircraft, the risks related to the type of ventilation being used for that particular flight, the risks of deep vein thrombosis and pulmonary embolism, the risks of a major air disaster, the risks of air turbulence, etc.” It goes on.

“When was the last time you talked to your pilot? Please let the analogy end.”

Coming soon: “Patients Are Not Airplanes”


Fruttel said...

Very well written, I couldn't agree móre!

Mind you, I guess that in general many people compare a pilot to a physician along this line: "They both hold your life in their hands for a period of time".

Koopy said...

Just as there are proficient pilots and incompetent pilots, so too are there doctors. The true purpose of the checklist is stop the latter group of both vocations from making fatal mistakes.

You talk of flawed analogy yet, to "illustrate your point" you make mention of recreational pilots. That means you either denigrate the aviation profession or lessen yours, as a real comparison would probably show that no doctors become 'professional' pilots. Is the USAF colonel/surgeon also a pilot, and if so, what came first - the chicken or the egg?

But enough. I believe the checklist will promote better safety procedures and ultimately save lives. My only source is from Canadian CBC Radio One, yet if accurate, the minority of surgeons approved of using the checklists but 95 percent would want it implemented if they themselves were going under the knife. It appears you have spoken for yourselves.

Skeptical Scalpel said...

I appreciate your comment but I never said I didn't like checklists. Here is what I did say in the first paragraph of this post "For example, I am a big fan of checklists, having used them in both the operating room and intensive care settings." I'd like to see the link from CBC Radio One with the study you cite.

Koopy said...

Then I apologize, and should of read your initial paragraph more closely. I am neither a surgeon or a pilot so I won't wade into the debate over differences. Here is the CBC radio show link that has an recorded audio link:

BobbyG said...

Yeah, this is nice. All very nice. I know the bloom is way off that aviation analogy.

But, as George Will once observed, "the reason air travel is so safe is that the pilot is the first one to the scene of the crash."

Skeptical Scalpel said...

It's true. They have an extra incentive to get it right.

Anonymous said...

You forgot the 3 years of training after a fighter pilot gets to his squadron.

Skeptical Scalpel said...

I didn't do the pilot calculation. An Air Force colonel did. You are right. Fighter pilots train a lot. Unless there's a war going on and they're in it, all they do is train.

But, one could say the same about surgeons. I continue to learn from every case I do.

Anonymous said...

It's a comparison between apples and oranges. Both have to memorize about the same amount of information. Most of the time, surgeons just have to be able to think. Pilots have to be able to think and physically perform a task simultaneously. Imagine taking the MCAT while operating a vehicle. This is what a military checkride is like. Plus during flight training, the pilot is always 2 days away from being removed and sent home ending his flying career. You also forget to talk about the qualification upgrades. Let's compare a GS to a FP who has upgraded to Evaluator Pilot (the guys who give the checkrides) and the YEARS of training and memorization THAT guy has under his belt. I talked to a guy once who did both and asked which was harder, One year of Undergraduate Pilot Training or four years of medical school. He answered UPT.

Skeptical Scalpel said...

Anonymous, thanks for commenting. Are you serious? All surgeons have to do is think? Surgery is a hands-on occupation. We have to think and operate at the same time. This would go on during an entire 4-hour procedure unlike what a pilot does which involves thinking only at take off and landing. There is no autopilot in surgery.

I agree that comparing surgeons to pilots is not a good thing to do, but lots of people do it. That's why I have written so many posts on the subject.

Graybill said...

I think anonymous is referring to orthopedic surgeons in his comment.

Skeptical Scalpel said...

Graybill, I think you are on to something.

Anonymous said...

Completely agree. The analogy has always annoyed me. To compare the controlled conditions of a domestic commercial flight to acute care surgery is ludicrous. If the analogy were accurate, sleep deprived pilots would be flying out dated, poorly maintained planes, low on fuel, through lightning storms, or worse. The flip side of that analogy would be that as surgeons, we would only perform elective cholecystectomy, after a full night sleep, with only thin, fit, elite endurance athletes a patients, and we would never have an annoying pager or phone bothering us while in the OR

Anonymous said...

You are spot on in some respects, but a little of the mark as well. You mention the training to become a FP, however freqeuently reference the airline pilot (I have previous posts you've written on my mind here). This oversimplifies the role of an aviator, since there are many type of aviators; since my specific experience is in military tactical aviation (jet aircraft), I will reference this.

Regarding the UK surgeons statement. What he said is exactly what happens in Tactical Aviation. To even be allowed to ride in an ejection seat aircraft the passenger must be medically screened, trained for a mishap (two days of aviation physiology, survival swimming, and protective equipment), as well as gain any authorization to fly. The risk is not taken lightly... my point: There is some truth in the comparison. It is not perfect, but no comparison is.

Skeptical Scalpel said...

I appreciate the comments. I confess I exaggerated a bit to make a point. In reference to the degree of difficulty, I was referring more to commercial pilots.

I am aware of ejection seat training since I did it many years ago. However, I think you'll agree that most fighter pilots don't have a chance to engage with passengers very often.

kornprom saengaram said...

Surgeon's skill eg. anastomose the LIMA to LAD in CABG is more difficult than flying the aircraft with one engine failure
wet rwy & low visibility at max crosswind limit.On the other hand decision making what how when and where we have to make a diversion to alternate airport is more difficult than choosing between explore-lap or just NPO & observation.
So I mean in terms of skill .....surgeon > pilot
In terms of decision making ...... pilot> surgeon
but both they have many similar things those can be applied for each other.

Skeptical Scalpel said...

I disagree that pilots have harder decisions to make than surgeons. Deciding whether to operate or not can be extremely difficult.

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