Skills of the future: training surgeons for a co-pilot OR
- Aug 29
- 3 min read
Aviation figured this out forty years ago, the hard way.
Cockpit automation was getting good enough that a plane could largely fly itself.
Crashes kept happening anyway.
When investigators traced the causes, the pattern was consistent: the majority stemmed from failures in interpersonal communication, decision-making, and leadership, not equipment failure.
The industry's response wasn't to slow down automation. It was to build an entirely new category of training around working alongside it.
That training is called crew resource management. It remade how pilots are taught, decades before surgery will need to answer the same question.
Why automation made teamwork the harder problem
Cockpit resource management started in 1979. It was built to reduce pilot error by making better use of the human resources on the flight deck.
The early goal was narrow: break down cockpit hierarchies rigid enough that a junior officer would stay silent while sensing danger.
The captain outranked him, and that was reason enough to stay quiet.
That single fix took years to spread and decades to formalize. By 1995, the FAA had made it mandatory training for every major carrier.
The core insight has held up. As the aircraft got smarter, the scarce skill wasn't flying it.
It was the humans in the cockpit knowing how to communicate, delegate, and challenge each other under pressure, with a machine doing more of the flying than ever before.
Surgery has an equivalent hierarchy problem and an equivalent automation curve. It hasn't had its own CRM moment yet.
Where the OR is right now
Surgical training still centers almost entirely on solo mastery. A resident's progression is measured by how independently they can execute a procedure.
That model made sense when the alternative to independence was reliance on another surgeon. It makes less sense as the alternative becomes fluent collaboration with an increasingly capable robotic system.
Robotic platforms aren't going to replace the surgeon's judgment any time soon. But they're already changing what a surgeon needs to be good at in the room.
That includes knowing when to trust a system's suggested plan.
It includes knowing how to intervene cleanly when the system is wrong.
And it includes knowing how to communicate a deviation to the rest of the team in real time, the same way a pilot communicates an automation override to a co-pilot.
None of that is technical skill in the traditional sense. It's teamwork skill, aimed at a non-human teammate.
What a curriculum built for this would actually include
Aviation's answer wasn't a single course. It evolved through generations of training.
The first generation targeted individual psychological readiness.
The second moved to group dynamics.
The third explicitly addressed flight deck automation as its own module, once cockpits got smart enough to need it.
Surgery is roughly where aviation was before that third generation.
The technology is arriving. The training hasn't caught up.
A curriculum built for a co-pilot OR would need to teach residents explicitly how to verify and cross-check a system's output rather than accept it passively.
It would need to teach how to communicate an override decision to the room without creating confusion.
And it would need to teach residents to recognize the specific failure mode where a team defers to the machine's confidence instead of its own read of the situation.
Aviation calls this automation complacency. It remains one of the hardest habits to train out of highly skilled people, even with recurrent instruction.
The training that's still missing
None of this exists yet in a formal way inside surgical residency. Robotic platforms are taught as tools: how to operate the console, how to manage the instruments.
Nobody is teaching residents how to be a good teammate to a system that's doing more of the planning than it used to.
That's the gap the next decade of surgical education has to close.
The aviation industry already ran the experiment.
It took a string of preventable accidents and thirty years to get CRM right.
Surgery has the chance to build the equivalent training deliberately, before it needs the same wake-up call.
Source: FAA
