Sensing Success in Clinical Exams

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Carla Pugh, MD, may be changing the way doctors diagnose breast cancer and the accuracy of the diagnosis during a clinical office exam.

Pugh, a researcher and surgeon at Northwestern University’s Feinberg School of Medicine, just earned the Presidential Early Career Award for Scientists and Engineers for research in using her patented technology to set standards for clinical performance. The award is the highest honor bestowed by the United States government for science and engineering professionals.

She successfully developed a breast simulator and simulation technology to physically measure the ability of medical students and physicians to detect breast cancer during clinical exams. Clinical exams back up mammograms and are the only screening many women receive.

Pugh and her team are building 100 sensor-enabled breast examination simulators, complete with simulated abnormalities, with a grant from the National Institutes of Health. Students and doctors can train with these and get immediate feedback on the accuracy of a diagnosis.

She also invented a simulator and applied her patented sensor technology to teach students about properly completing prostate and pelvic exams. With the sensor-enabled simulations, Pugh said she believes it's possible to identify proper and improper techniques that result in cancer diagnoses. She spoke with us about her passion for medicine and education that could lead to major changes in how medicine is practiced.

Carla Pugh, associate professor of surgery at Northwestern, works with her simulation technology to help medical students better diagnose breast cancer. (Photo: Carolyn Silva, Northwestern University)Carla Pugh, associate professor of surgery at Northwestern, works with her simulation technology to help medical students better diagnose breast cancer. (Photo: Carolyn Silva, Northwestern University)Tell us about the simulators. What drew you to this kind of technology, as opposed to other kinds of research?

A big problem in the whole medical field is that we don't have widely used objective measures of hands-on performance. So, when doctors get credentialed to practice medicine or get their license or board certification, it has always been a board-certified test. It's a written test. We have hoards and hoards of pencil and paper tests. But the reality is, medicine is a hands-on field. And we just don't have the tests yet to assess whether you can do a surgical procedure to a certain standard, or even a physical exam. The quirkiness about it is that it's subjective. We use our hands a lot. I can use my hands and touch someone to try and feel a tumor, and my interpretation of that can be completely different from someone else's.

Do you hope to expand your research with sensor technologies? If so, in which fields, and how?
Right now, Northwestern already has a curriculum on the teaching side for medical students for these sensitive examinations. For teaching at Northwestern and at Stanford and many other programs, they use both my simulator as well as [volunteer] patients.

I've done other things with sensor technologies [for] surgical procedures. I partner with specialists, like thoracic surgeons, who need help. There are new doctors that need to be trained on a new procedure, and an older doctor [who] needs to learn how to do it. With the technology, we can go into so many fields. I helped test a new treatment procedure for deploying a stint in a cancer in the esophagus. We made a simulator for that. All it takes is a little creativity. Now that I have the sensor technology, I can build a lot of things. I put on my education hat and figure it out.

What does this mean for breast cancer research? Are people recognizing its importance?
It's slow. Breast cancer research is a huge industry and an old dinosaur of sorts. There are protocols and common areas of research that are currently popular, and mine is not a popular area yet. It's not mainstream. It would take several other researchers to gain more attention. It's just the natural wave of how science progresses. It has the potential to become mainstream if other scientists find the same findings. A few people are working on it in different venues. There's really a small group of us.

Do you think your research could help decrease the occurrence of medical malpractice?
I think that it definitely will help doctors. I think it will also help patients understand what I now understand about the human body. We don't know everything. Medicine is a partnership. Yes, you might be the unique person who has a case that no one else has; that's fair and okay. Somehow, we have to trust each other and try to do the best thing. Doctors are human. Doctors get sued because patients believe the doctors didn't do their best. Hopefully, these simulators will ensure that doctors can detect that one-centimeter tumor. I think it will help doctors. I think it will help patients. It goes both ways. It will help science. There's a whole world out there with unanswered questions.

What was your motivation for this research?
My motivation was the surgical field. I started this when I was a graduate student getting a PhD in education at Stanford University. This has been a 12-year project. I'm a very visual and hands-on person. After I finished my surgical residency at Howard University Hospital, I was very frustrated that there were these elements in the medical field. You learn science differently as a first and second-year medical student and as an undergraduate. It's by the book, and there's one right answer. Then, you get into the medical field, and patients have these things that are not by the book. There are so many different interpretations. This research was very meaningful to me, because, as a surgeon, I would say, “Wow, I feel good about my answer, but there's no way to be 100 percent correct.” In the whole profession of medicine, you're going to give a drug, you're going to subject [your patients] to tests; there's this loosey goosey area. We've done pretty well with this area in medicine, but I believe we can do better.

What is your ultimate career goal?
I would really like this technology to go to the next level of really helping patient understanding. I want just a better understanding of medicine and to affect patient care outcomes on both sides. I really think it can affect the amount of money we spend on healthcare. I want this technology to have a positive effect on the patient and to ensure competency and efficiency on the part of the physician to practice medicine.

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