Show Me The Evidence copertina

Show Me The Evidence

Show Me The Evidence

Di: Anthony G. Gallagher Flux Learning Ltd
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Most training is sold on confidence. Show Me The Evidence is built on data. In every episode we take a single study, clinical trial, or systematic review and work through what it found, how it was designed, and what it means for the way we teach and assess skill. We focus on metrics-based training and proficiency-based progression, the approach that asks learners to demonstrate measurable competence before moving on, and we trace its results across surgical, medical, and professional education. This is a podcast for learning professionals and medical educators who want more than opinion. Expect plain-language breakdowns of the research, honest discussion of what the evidence does and does not support, and conversations with the people behind the studies. If you make decisions about how people are trained, we think you deserve to see the evidence first.2026 OGC Metrics and Anthony G Gallahger. Scienza Scienze sociali
Episodi
  • From Physics-Based Simulation to Surgical Robots| Show Me The Evidence E8- Dr Dwight Meglan

    From Physics-Based Simulation to Surgical Robots| Show Me The Evidence E8- Dr Dwight Meglan
    Jul 18 2026
    Show Me the Evidence, Episode 8Guest: Dr Dwight Meglan Topic: Physics-Based Simulation, Surgical Robotics and Why Simulators Still Don't Measure What MattersEpisode SummaryIn this episode, Professor Tony Gallagher is joined by Dr Dwight Meglan, the engineer who developed one of the first physics-based virtual reality simulators for endovascular procedures in the late 1990s, and who has spent the last two decades building surgical robots. Together they trace 30 years of simulation-based training and ask why so little has changed: simulators are still not verified against real-world physics, the field still measures process rather than skill, and device manufacturers, not educators, still set the agenda. The conversation ranges from haptics and instrumented torquers to Likert scales, credentialing committees, telesurgery risk, and why autonomous surgical robots are a regulatory and financial impossibility rather than a technical one. It closes with the evidence for Proficiency-Based Progression (PBP) and the leadership needed to adopt it.Key Topics Covered1. Building the first physics-based VR simulators | 0:00Meeting at Medicine Meets Virtual Reality in the late 1990sReal-time physics of tool and tissue interaction, fluoroscopy and haptic feedbackWhy the goal was to replicate reality, not design a user experiencePhysics tests to verify simulator correctness still do not exist, 25 years on2. Who really drives simulation: the device manufacturers | 2:24Manufacturers pay for simulation, so manufacturers shape itTraining to use the device versus training to perform the procedureSimulators in exhibition booths: marketing tools first, training tools second3. Haptics and the sensory threshold problem | 3:55The instrumented torquer: measuring what cardiologists actually feelJust noticeable difference thresholds vary between cliniciansStill no published datasets on the forces a cardiologist feels during catheterisationClinicians praising the haptics on simulators where the haptics were switched off4. Using devices safely: the stapler and the defibrillator | 8:52A stapling device with a 6 to 27 per cent leak rate, where one third of patients who develop a leak dieTraining to the instructions for use is device safety training, not surgical skills trainingCardiac defibrillator implantation: clinicians departing from the instructions for useConstruct validity findings: some very senior clinicians perform worse than the worst trainee when assessed with objective, peer-derived metrics5. What should a simulator measure? | 13:19The original approach: record everything, then find the measures that matterMetrics for mechanical thrombectomy for acute stroke, developed from the human procedure with MenticeHow clinician-led metrics forced a redesign of contrast injection, later patentedIt works when you insist on it, but you must start with the metrics6. The state of simulation metrics today | 17:35At a recent conference, almost none of the exhibited simulators had any metrics at allSome manufacturers avoid measurement deliberately: plausible deniabilityValidated metrics as a purchasing condition: if you cannot build them in, we will not buy7. From simulation to surgical robotics | 21:52Why simulation felt like a capped market and robotics did notThe analogous DNA of simulators and robots as real-time information processing systemsVerification versus validation: robots are bench-tested against dozens of specifications, simulators almost never are8. Measuring process, not skill | 26:49Motion tracking and path length: lessons not learned from laparoscopic surgeryAI-driven pattern hunting as a fishing expedition without a hypothesisSuturing as the test case: the physics of tissue apposition has never been publishedPhysical intelligence and humanoid robotics will improve simulation from the outside in9. Likert scales are not measurement | 36:47Binary, procedure-specific metrics require scoring the entire video, reliably, in pairsOne-to-five ratings after watching a few minutes of video are hand waving, not assessmentRing exercises on robotic simulators have never been verified against real forces10. Whose job is it? Credentialing and privileging | 39:27Manufacturers certify device use; professional societies and hospitals grant privilegesPer-procedure privileging in the United States versus broad qualification in EuropeThe credentialing committee problem: standards set by the least experienced memberCase volume, fellowship length and reputation are social proof, not evidence of competence11. A jumbo jet a day: the human cost | 44:43Deaths from surgical skills deficits estimated as equivalent to a full jumbo jet crashing every day, consistent with evidence that around 4.2 million people die within 30 days of surgery each year (Nepogodiev et al., The Lancet, 2019)Why one death at a time never makes headlines the way one crash doesThe Bristol Royal Infirmary case: peers knew for a decade before the front pages forced action (The ...
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    1 ora e 1 min
  • Dr Ruben DeGroote, From Proficiency to Wisdom in Surgical Training

    Dr Ruben DeGroote, From Proficiency to Wisdom in Surgical Training
    Jul 3 2026
    Show Me the EvidenceGuest: Dr Ruben De Groote Topic: From Time to Competence: Proficiency-Based Progression and the Reinvention of Robotic Surgical TrainingEpisode SummaryIn this episode, Professor Tony Gallagher sits down with Dr Ruben De Groote, consultant urologist at OLV in Aalst, Belgium, CEO of 4Health and its digital learning platform Surgquest, and the researcher behind a recently completed PhD on Proficiency-Based Progression (PBP) robotic surgical training across three surgical disciplines. Ruben and Tony first met in 2019 while developing and validating the metrics for the robot-assisted radical prostatectomy.Together they examine an uncomfortable reality: the century-old Halstedian apprenticeship model can no longer produce surgeons who are ready to operate independently. Reduced theatre exposure, rising bureaucracy, and working-hours legislation have hollowed out the "see one, do one, teach one" paradigm, leaving as many as one in three residents unready for independent practice. Ruben makes the evidence-based case for PBP: a standardised, metric-driven approach that measures what a surgeon actually does, gives explicit formative feedback, and trains to a benchmark rather than to a clock. The conversation moves from the failings of subjective assessment through a multi-specialty randomised controlled trial, and on to the harder question of how surgeons progress from proficiency to genuine wisdom.Key Topics Covered1. Why the apprenticeship model is breaking down (0:50) The Halstedian "see one, do one, teach one" model relied entirely on graded theatre exposure. Over the last 15 to 20 years, bureaucracy and a legal cap on working hours (departments are penalised for exceeding roughly 60 hours a week on average) have eroded that exposure. The result is a vicious circle in which trainees get less time in the operating room, and fellowships originally meant for super-specialisation are being repurposed simply to reach independence.2. Where the bureaucracy came from (6:06) A wider shift in medicine towards risk aversion and defensive practice. Tasks that were once handled verbally now require written orders, increasing the administrative burden for everyone and pulling ambitious residents out of theatre for half a day or more.3. Robotics as both a challenge and an opportunity (7:52) Robotic surgery combines complex procedures with the mastery of technology, which raises the training bar. It also places a computer between the surgeon's eyes and the patient, making it possible to store video and surgical data, review procedures, give formative feedback, and measure kinematics. This makes robotics a powerful tool for objectively measuring and improving surgical quality.4. Exposure is not enough: the case for structure (9:31) Watching a procedure is not the same as being trained to perform it. Ruben and Tony agree that robotics demands the structure the Halstedian approach once imposed, but delivered through universal, evidence-driven standards and benchmarking, rather than the reputation of a single centre or trainer.5. The systemic problem: a lack of standardisation (12:39) Without standardised curricula, trainees are dependent on the goodwill of whichever consultant they are assigned. Ruben describes a fellowship with six fellows and nine consultants, each teaching the same procedure differently, and warns that patients are effectively used as training models for consultants who were not well trained themselves.6. Who should set and police the standards (17:37) Standards should be set by rigorous scientific research, not opinion. Scientific societies should define the benchmark and authorities should make it mandatory, in the same way prescribing rights follow formal qualification. Ruben cautions against a large role for industry, citing the conflict of interest in paid proctoring, where a proctor can be pushed to guide a novice through complex steps they have not earned the right to attempt.7. The multi-specialty randomised controlled trial (23:15) A blinded RCT deliberately included urologists, general surgeons, and gynaecologists to test the belief that some specialties are inherently more skilled. At baseline all three performed equally, and after training all three performed equally well. The methodology, not the specialty, predicted the skill set. As reported in the episode, 67 per cent of PBP trainees reached proficiency by the end of the day, compared with 17 per cent trained by the apprenticeship model. [See PROVESA / De Groote RCT publications below.]8. Quantifying intraoperative performance: why subjective scales fail (28:18) Likert-based tools such as GEARS are subjective and prone to drift, with a trainer's scoring shifting depending on the video seen just before. For validity, inter-reader agreement should be 80 per cent or higher; in Ruben's study GEARS reached only around 30 per cent, which by default makes it invalid for assessing surgical quality. Binary metrics are the ...
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    1 ora
  • Göran Malmberg, Mentice: Why Simulation Without Metrics Falls Short

    Göran Malmberg, Mentice: Why Simulation Without Metrics Falls Short
    Jun 28 2026
    Guest: Göran Malmberg, Group CEO and President of Mentice AB (Gothenburg, Sweden), the world leader in physics-based virtual reality simulation for endovascular therapiesHost: Professor Anthony G GallagherTopic: Why Simulation Without Metrics Falls Short, and the Unsettled Question of Who Owns Medical TrainingEpisode SummaryIn this episode, Professor Tony Gallagher is joined by Göran Malmberg, who has led Mentice since 2008 and built it into the global leader in physics-based VR simulation for endovascular therapies. Drawing on more than two decades at the meeting point of engineering, medical devices and clinical training, Göran and Tony confront an uncomfortable structural problem: training is still treated as a cost item rather than a driver of value, and no one can say clearly who owns the responsibility for proving that a clinician is ready to perform a procedure. They make the case that simulation without validated metrics is a suboptimal tool, that proficiency-based progression (PBP) is the route to structured skill, and that the next move belongs to whoever is willing to lead, whether that is a major device manufacturer, a regulator or a professional society.Key Topics Covered1. From High-Tech to High-Stakes — 0:00Göran's route into medical simulation from automotive and industrial B2B technologyWhy selling advanced technology is broadly similar across sectors, and what was genuinely new about medicineMentice and the early years of VR simulation in medicine2. Training as a Cost, Not a Value — 2:13Why structured training is rarely connected to return on investmentHow it has often depended on the goodwill and personal time of passionate cliniciansThe wider concern about a business ethos moving into academic medical centres, and where training and quality assurance fit3. Why Simulation Needs Metrics — 6:40Göran's agreement with Tony's central conclusion: any simulation without metrics is a suboptimal tool for procedure-based trainingThe difference between general-purpose simulation and structured training to a defined level of skillWhere proficiency-based progression fits4. The Hard Part: Defining and Validating Metrics — 7:26Why the biggest hurdle is getting device companies to define and validate metrics before they engage the simulation providerThe mechanical thrombectomy example, where clinicians pushed Mentice to build and subsequently patent a new deviceWho should own the metrics: industry, professional medicine, or departments of healthThe evidence that PBP-trained operators perform around 60% better in the clinical environmentPublication: Seymour NE, Gallagher AG, Roman SA, O'Brien MK, Bansal VK, Andersen DK, Satava RM. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Annals of Surgery. 2002;236(4):458-464. doi:10.1097/00000658-200210000-000085. The Misunderstood Cost of Physics-Based Simulation — 11:12Why a physics-based VR simulation is not a video gameThe months of programming, engineering and validation behind a credible simulatorHow to weigh that cost against the alternative cost of proctored real cases over three to six monthsEvidence that PBP simulation training can cost roughly a third of conventional training, and the question of why medicine has not collated thisPublication: Puliatti S, Rodriguez Peñaranda N, Amato M, De Groote R, Farinha R, Bunting B, van Cleynenbreugel B, Mottrie A, Gallagher AG. Randomised trial on the economic impact of proficiency-based progression versus conventional robotic surgical training. BJU International. 2026;137(3):493-501. doi:10.1111/bju.701306. The Evidence Industry Finds Hard to Hear — 18:00The Birkmeyer finding that suboptimal performance in experienced clinicians leads to worse outcomes, with a difference of roughly 50 to 80 per centThe Mascheroni IMPROF trial, run with Medtronic in Switzerland, where metrics-based training to proficiency produced markedly fewer intraoperative errors than traditional simulation training, and where Tony notes that none of the standard-trained group reached the proficiency benchmarkA Leuven PhD viva on a circular stapler, where PBP training removed the leak rate seen with standard instructions-for-use trainingPublication: Birkmeyer JD, Finks JF, O'Reilly A, Oerline M, Carlin AM, Nunn AR, Dimick J, Banerjee M, Birkmeyer NJO. Surgical skill and complication rates after bariatric surgery. New England Journal of Medicine. 2013;369(15):1434-1442. doi:10.1056/NEJMsa1300625Publication: Mascheroni J, Stockburger M, Patwala A, Mont L, Rao A, Retzlaff H, Garweg C, Verbelen T, Gallagher AG. Effect of Metrics-Based Simulation Training to Proficiency on Procedure Quality and Errors Among Novice Cardiac Device Implanters: The IMPROF Randomized Trial. JAMA Network Open. 2023;6(8):e2322750. doi:10.1001/jamanetworkopen.2023.227507. Whose Job Is It Anyway? — 22:40The sensitivity of telling a clinician they are not ready yet, and why the metrics come ...
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    1 ora e 3 min
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