Hands on

When describing the inspiration for her life’s work, Carla Pugh, MD, PhD, recalled her time as a medical student and surgical resident. “Before I could operate on a tumor, I needed to know how densely it was attached. A CT scan couldn’t tell me — the only way I’d know was through my hands,” said Pugh. “I realized I wouldn’t truly learn how to diagnose just by watching my instructors, and I wanted to find a better way.” 

Today, Pugh is an international expert in the science of touch. She has created sensor technologies to quantify clinicians’ hands-on skills and has combined those tools with educational concepts; together, they help medical students and residents learn how to more effectively use touch when treating their patients.

After completing her surgical residency at Howard University, Pugh enrolled as a doctoral student in the Stanford Graduate School of Education, where she began to explore optimal training methods in the medical environment and to develop the sophisticated sensor, video and motion-tracking technologies that would be key to capturing haptic — or touch-sensing — information.

“It really all started at Stanford 17 years ago,” said Pugh, who received a PhD in education in 2001 and now holds three patents on the use of sensor and data-acquisition technology to measure and characterize hands-on clinical skills.

Since returning in December 2017 — to take a dual role at Stanford Medicine as professor of general surgery and director of the Technology Enabled Clinical Improvement Center — Pugh has created collaborations across campus and beyond that are bringing the new field of touch technology and training to the next level.

On the technology side, for example, the Pugh lab has partnered with Technion Israel Institute of Technology to develop a fabric force-sensor bra that captures clinical data during a breast examination. Pugh is also exploring the creation of new touch-sensing tools with Stanford faculty members Allison Okamura, PhD, professor of mechanical engineering, an expert in haptics as well as virtual environments and simulators; and Zhenan Bao, PhD, professor of chemical engineering and of materials science engineering, who builds stretchable flexible sensors. 

Pugh is working with colleagues in the Graduate School of Education, including the school’s dean, Daniel Schwartz, PhD, and lecturer Karin Forssell, PhD, on the training half of the equation. 

“In terms of the best approach to training students to use haptic data,” she explained, “we need to know: How much of this should be learned while using your hands in context, or on a computer? Does this learning objective require a haptic display, or virtual reality? How much data can you collect during the process of care, right in front of the patient, and get real-time feedback that goes directly to a database?” 

Pugh and her colleagues plan to engage industrial and systems engineers, social scientists, and other experts in answering these critical questions about using the growing quantity of haptic data in training.

“Nationwide, trainees are telling us they want this information,” said Pugh. “There’s a lot more work to be done — but the audience is ready.”