Surgeon’s performance: analogy with aircraft pilot’s challenges
Authors: Suhir Ephraim , Bedny Inna 
Published: June 2022

There is an obvious analogy between the challenges that an aircraft pilot has to cope with when fulfilling his/her long-term mission or when encountering a short-term abnormal situation, and the challenges that a surgeon faces during his/her "mission", a surgical operation, which is always a highly challenging and sometimes unpredictable effort. Kao and Thomas seem to be the first ones who paid attention to this analogy that could be viewed today as a part of what is identified as human-system-integration/interaction (HSI) field. This extraordinarily broad field includes the role of human performance in various psychological and ergonomics tasks in general and critical aspects of human interactions with an intelligent system in particular: predictive modeling (PM), both computer simulations based and analytical; vehicular engineering, such as aerospace, automotive, railway, and maritime; medical electronics; and, of course, all kind of the human-in-the loop (HITL) and human factor (HF) related activities, attributes and challenges. The outcome of these activities is highly dependent on the mental (cognitive) workload (MWL) and, mostly long-term, human capacity factor (HCF). Probabilistic predictive modeling (PPM) enables evaluating, improving, assuring and ultimately, if possible and appropriate, even specifying the acceptable (adequate and never-zero) probability of failure of a HITL mission or a situation, when the reliability of the equipment/instrumentation, the performance of the human-in-control (the pilot or the surgeon) and the response of the object-of-control (the air or spacecraft, not to mention the patient undergoing surgery), and the interfaces of these and other uncertainties contribute jointly to the importance of the outcome of the undertaking. Systemic-Structural Activity Theory (SSAT) is applicable to the analysis and improvement of the efficiency and reliability of the highly challenging types of human activity. The objective of this paper is to indicate the need for quantifying the role of the HF in making a surgical operation less risky and to indicate that the consideration of the analogy of this effort with the aircraft pilot challenges, which have been addressed and modeled in a number of recent publications, could be helpful. The paper uses a simplified double-exponential-probability-distribution function (DEPDF) to make our point and to "bring down to earth" the more general model for the probability of the human-non-failure (HnF). By predicting this probability and making it adequate for a particular surgical application, one could put various "educated guesses" and "gut feelings" about the instrumentation and human reliability during the fulfillment of the surgical mission on a really "reliable" quantified foundation. Plenty of additional, both analytical and computer simulation-based modeling, as well as experimental and clinical and statistical work should be done to “reduce to practice” the general idea of the need for quantifying, in one way or another, the numerous challenges that a surgeon faces in his/hers never-routine activity, in which the analogy with the pilot's performance might be helpful.