A Look Inside Your Surgeon’s Brain, Before the Surgeon Looks Inside You

(Bloomberg Opinion) -- It was one of those findings that brings on thoughts of the future — both scary and exciting: Scientists showed they could use brain imaging to sort out experienced surgeons from novice students. There’s been a history of extraordinary, often dubious, claims involving brain-imaging studies — everything from finding the seat of love to religion to attachment to one’s iPhone — but this claim looks plausible and potentially useful.

Studying expertise this way became possible once there were imaging devices portable enough to monitor peoples’ brain activity while engaged in complex tasks. And so a team of doctors and engineers set up an experiment to monitor the brains of medical students and doctors performing in a simulator developed to test surgical skills.

What they found, published in last week’s Science Advances, was that the brain scans could not only differentiate trained surgeons from students, but could also reflect progress over the course of 11 days as students learned surgical skills.

The technique used is called functional near-infrared spectroscopy, and it measures where blood is flowing in the brain. In novices, there’s lots of exercise going on in the prefrontal cortex, where people think things through and strategize. That was less pronounced in more experienced surgeons or students after a training period, replaced by coordinated activity in several other areas.

I chatted with two engineers involved in the study. Suvranu De and Xavier Intes, both of Rensselaer Polytechnic Institute, said they are not trying to create the brain police. The goal is not to decide who should be allowed to become a surgeon, but to improve the way surgeons are trained and evaluated, so we can better determine whether they are ready to practice on patients.

De said that he’s previously worked on designing simulators to help surgeons develop skills. What he learned was that there’s a lot of emphasis on the cognitive skills needed for surgery, but a real gap in addressing the motor skills — the hand-eye coordination that we all want in our surgeons.

Many specialties don’t require any tests of motor skills to become certified to perform surgery, he said. There is one test, called the Fundamentals of Laparoscopic Surgery, which evaluates such skills for general surgeons, but he said it’s subjective and has not been very strongly tied to reduction in patient injuries.

He and Intes both expressed some distress about a string of negative comments following a news story about them in the Wall Street Journal that ran under the headline “Brain Scans Can Detect Who Has Better Skills.” They say the point isn’t to replace skills tests with brain scans, but to use the scans to improve the current training methods and tests. 

Perhaps people are sensitive about brain technology given fantastical visions like Mark Zuckerberg’s idea that a future Facebook could mine our thoughts. And people often feel disproportionate fears over new technology. And yet, some studies have suggested that medical errors rank as the third-leading cause of death in the U.S. That’s what we should be more afraid of.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Faye Flam is a Bloomberg Opinion columnist. She has written for the Economist, the New York Times, the Washington Post, Psychology Today, Science and other publications. She has a degree in geophysics from the California Institute of Technology.

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