Bio

Bio


Carla Pugh is Professor of Surgery at Stanford University School of Medicine. She is also the Director of the Technology Enabled Clinical Improvement (T.E.C.I.) Center. Her clinical area of expertise is Acute Care Surgery. Dr. Pugh obtained her undergraduate degree at U.C. Berkeley in Neurobiology and her medical degree at Howard University School of Medicine. Upon completion of her surgical training at Howard University Hospital, she went to Stanford University and obtained a PhD in Education. She is the first surgeon in the United States to obtain a PhD in Education. Her goal is to use technology to change the face of medical and surgical education.

Her research involves the use of simulation and advanced engineering technologies to develop new approaches for assessing and defining competency in clinical procedural skills. Dr. Pugh holds three patents on the use of sensor and data acquisition technology to measure and characterize hands-on clinical skills. Currently, over two hundred medical and nursing schools are using one of her sensor enabled training tools for their students and trainees. Her work has received numerous awards from medical and engineering organizations. In 2011 Dr. Pugh received the Presidential Early Career Award for Scientists and Engineers from President Barak Obama at the White House. She is considered to be a lead, international expert on the use of sensors and motion tracking technology for performance measurement. In 2014 she was invited to give a TEDMED talk on the potential uses of technology to transform how we measure clinical skills in medicine. In April 2018, Dr. Pugh was inducted into the American Institute for Medical and Biological Engineering.

Clinical Focus


  • General Surgery

Academic Appointments


Professional Education


  • Fellowship:University of Michigan Medical School (2009) MI
  • PhD, Stanford University Graduate School of Education, Education & Technology (2001)
  • Board Certification: General Surgery, American Board of Surgery (1999)
  • Residency:Howard University Hospital General Surgery Residency (1997) DC
  • Medical Education:Howard University College of Medicine (1992) DC

Research & Scholarship

Current Research and Scholarly Interests


The Technology Enabled Clinical Improvement (T.E.C.I.) Center is a multidisciplinary team of researchers dedicated to the design and implementation of advanced engineering technologies that facilitate data acquisition relating to clinical performance.

The T.E.C.I. team has had great success in quantifying physicians’ clinical experiences using sensor, video, and motion tracking technologies. This work has resulted in an information rich database that enables empirical evaluation of clinical excellence and medical decision making.

By leveraging highly specific and objective clinical performance metrics, the T.E.C.I. Center is harnessing the unique opportunity to support peer to peer data sharing and clinical collaborations that can transform the clinical workflow and ultimately benefit healthcare providers.

The T.E.C.I. Center aims to transform human health and welfare through advances in data science and personalized, technology-based performance metrics for healthcare providers.

Publications

All Publications


  • Surgical procedural map scoring for decision-making in laparoscopic cholecystectomy. American journal of surgery Hashimoto, D. A., Axelsson, C. G., Jones, C. B., Phitayakorn, R., Petrusa, E., McKinley, S. K., Gee, D., Pugh, C. 2018

    Abstract

    INTRODUCTION: The objective of this study was to determine whether decision-based procedural mapping demonstrates differences in attendings versus residents.METHODS: Attendings and residents were interviewed about operative decision-making in laparoscopic cholecystectomy (LC) using a cognitive task analysis framework. Interviews were converted into procedural maps. Operative steps, patient factors, and surgeon factors noted by attendings and residents were compared. Two scoring methods were used to compare map structures of attendings versus residents.RESULTS: Six attendings and six residents were interviewed. There were no significant differences in the number of patient or surgeon factors identified. Attendings had significantly more operative steps (29.67 ± 1.9 vs. 23.3 ± 1.9, p = 0.04) and crosslinks (3.2 ± 0.5 vs. 1 ± 0.4, p = 0.005) in their maps and a higher total score (90.2 ± 8.4 vs. 63.2 ± 3.8, p = 0.015) than residents.CONCLUSION: LC procedural map scoring for attendings and residents demonstrated significant differences in structural complexity and may provide a useful framework for assessing decision making.

    View details for DOI 10.1016/j.amjsurg.2018.11.011

    View details for PubMedID 30470551

  • Shortcut assessment: Can residents' operative performance be determined in the first five minutes of an operative task? Surgery Mohamadipanah, H., Nathwani, J., Peterson, K., Forsyth, K., Maulson, L., DiMarco, S., Pugh, C. 2018; 163 (6): 1207–12

    Abstract

    BACKGROUND: The aim was to validate the potential use of a single, early procedure, operative task as a predictive metric for overall performance. The authors hypothesized that a shortcut psychomotor assessment would be as informative as a total procedural psychomotor assessment when evaluating laparoscopic ventral hernia repair performance on a simulator.METHODS: Using electromagnetic sensors, hand motion data were collected from 38 surgery residents during a simulated laparoscopic ventral hernia repair procedure. Three time-based phases of the procedure were defined: Early Phase (start time through completion of first anchoring suture), Mid Phase (start time through completion of second anchoring suture), and Total Operative Time. Correlations were calculated comparing time and motion metrics for each phase with the final laparoscopic ventral hernia repair score.RESULTS: Analyses revealed that execution time and motion, for the first anchoring suture, predicted procedural outcomes. Greater execution times and path lengths correlated to lesser laparoscopic ventral hernia repair scores (r = -0.56, P = .0008 and r = -0.51, P = .0025, respectively). Greater bimanual dexterity measures correlated to Greater LVH repair scores (r = + 0.47, P = .0058).CONCLUSIONS: This study provides validity evidence for use of a single, early operative task as a shortcut assessment to predict resident performance during a simulated laparoscopic ventral hernia repair procedure. With the continued development and decreasing costs of motion technology, faculty should be well-versed in the use of motion metrics for performance measurements. The results strongly support the use of dexterity and economy of motion (path length + execution time) metrics as early predictors of operative performance.

    View details for DOI 10.1016/j.surg.2018.02.012

    View details for PubMedID 29728259

  • Dynamic Visual Feedback During Junctional Tourniquet Training. The Journal of surgical research Xu, J., Kwan, C., Sunkara, A., Mohamadipanah, H., Bell, K., Tizale, M., Pugh, C. M. 2019; 233: 444–52

    Abstract

    BACKGROUND: This project involved the development and evaluation of a new visual bleeding feedback (VBF) system for tourniquet training. We hypothesized that dynamic VBF during junctional tourniquet training would be helpful and well received by trainees.MATERIALS AND METHODS: We designed the VBF to simulate femoral bleeding. Medical students (n=15) and emergency medical service (EMS) members (n=4) were randomized in a single-blind, crossover study to the VBF or without feedback groups. Poststudy surveys assessing VBF usefulness and recommendations were conducted along with participants' reported confidence using a 7-point Likert scale. Data from the different groups were compared using Wilcoxon signed-rank and rank-sum tests.RESULTS: Participants rated the helpfulness of the VBF highly (6.53/7.00) and indicated they were very likely to recommend the VBF simulator to others (6.80/7.00). Pre- and post-VBF confidence were not statistically different (P=0.59). Likewise, tourniquet application times for VBF and without feedback before crossover were not statistically different (P=0.63). Although participant confidence did not change significantly from beginning to end of the study (P=0.46), application time was significantly reduced (P=0.001).CONCLUSIONS: New tourniquet learners liked our VBF prototype and found it useful. Although confidence did not change over the course of the study for any group, application times improved. Future studies using outcomes of this study will allow us to continue VBF development as well as incorporate other quantitative measures of task performance to elucidate VBF's true benefit and help trainees achieve mastery in junctional tourniquet skills.

    View details for DOI 10.1016/j.jss.2018.08.044

    View details for PubMedID 30502284

  • What do you want to know? Operative experience predicts the type of questions practicing surgeons ask during a CME laparoscopic hernia repair course. American journal of surgery Godfrey, M., Rosser, A. A., Pugh, C. M., Sachdeva, A. K., Sullivan, S. 2018

    Abstract

    BACKGROUND: Given their variegated backgrounds, surgeons taking continuing medical education (CME) courses possess different learning needs. This study examines the relationship between surgeons' levels of experience and the questions they asked in a simulation-based CME course.METHODS: We analyzed transcribed audio-video data collected from surgeons participating in a simulated laparoscopic hernia repair CME course and identified four types of questions learners posed to their instructors. Linear regressions compared how often these questions were asked versus self-reported operative experience.RESULTS: Both Requesting Guidance and Requesting Confirmation were inversely proportional to experience, whereas Asking About a Specific Case was directly proportional to experience. Requesting Instructor Preference exhibited no significant correlation with experience.CONCLUSION: Practicing surgeons with relatively less experience tend to ask for confirmation and guidance, whereas those with greater experience tend to focus on specific hypothetical scenarios. This data can be used to tailor instruction based on learners' self-reported experience level.

    View details for DOI 10.1016/j.amjsurg.2018.11.027

    View details for PubMedID 30527925

  • Characterizing Touch Using Pressure Data and Auto Regressive Models Laufer, S., Pugh, C. M., Van Veen, B. D., IEEE IEEE. 2014: 1839–42

    Abstract

    Palpation plays a critical role in medical physical exams. Despite the wide range of exams, there are several reproducible and subconscious sets of maneuvers that are common to examination by palpation. Previous studies by our group demonstrated the use of manikins and pressure sensors for measuring and quantifying how physicians palpate during different physical exams. In this study we develop mathematical models that describe some of these common maneuvers. Dynamic pressure data was measured using a simplified testbed and different autoregressive models were used to describe the motion of interest. The frequency, direction and type of motion used were identified from the models. We believe these models can a provide better understanding of how humans explore objects in general and more specifically give insights to understand medical physical exams.

    View details for Web of Science ID 000350044701204

    View details for PubMedID 25570335

    View details for PubMedCentralID PMC4288476