Clicker Training For Dogs Is Adapted To Help Surgeons Learn Quickly

Jun 12, 2018
Originally published on June 12, 2018 9:44 am
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DAVID GREENE, HOST:

If you have ever trained a dog, chances are, you have heard of clicker training. This is a way of shaping a behavior that you want, like getting your dog to sit, by slowing things down into these tiny incremental steps. Each step performed correctly is marked with a click. Well, today, one doctor is asking if the clicker can help train surgeons. Here's NPR's Shankar Vedantam.

SHANKAR VEDANTAM, BYLINE: Martin Levy loves to play Frisbee. He gets a kick out of all the cool, weird moves you can do with a flying disc. But one throw stymied him for 30 years. It's known as the forehand wrist flip.

MARTIN LEVY: I had coaches waving at me, telling me to change the position of my hand, screaming at me while I was throwing, and the disc still failed. It still rolled over. The thing that I knew was that the position of my hand was critical. My thumb had to be lower than my pinky in order for this to work.

VEDANTAM: In 2012, he decided to try something different. He put a net in front of a mirror and watched himself as he threw the Frisbee.

LEVY: And what became immediately evident was my thumb was higher than my pinky. OK. Now what I could do was to walk over to the mirror, and I could put my thumb in a position where it was below my pinky. While I'm doing that, I could feel what my forearm felt. Like, I could feel the stress in my forearm. I could feel how my wrist felt. And now I could throw at the mirror and make sure that my thumb was under the pinky.

VEDANTAM: The feedback from the mirror was allowing him to see what he was doing wrong and to fix it in real time.

LEVY: So here, I'm teaching a skill. I'm teaching it to myself. And by mirroring that, I could feel what it felt like and now execute.

VEDANTAM: Levy decided to take what he'd learned into his day job. He's an orthopedic surgeon who has been fixing broken athletes for more than 40 years. Levy teaches residents the basic skills of orthopedic surgery, which look a lot like carpentry. He felt that if he could provide the same kind of nonjudgemental, instantaneous feedback that the mirror had given him, his residents might learn skills faster. Since a mirror was too bulky to haul around, Levy turned to another tool - a red, plastic clicker. It sounds like this.

(SOUNDBITE OF CLICKER)

VEDANTAM: Clickers have been used for many years to train animals.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: So I'm going to reach up here, give her a little tap on top of her rump. And when she steps that leg in, I'm going to give her the marker signal, and then I'll give her a reward.

VEDANTAM: ...To mark the precise moment a horse or a dog does something that the trainer wants the animal to do.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #2: If you have a treat and you hold it over your dog's head, most likely, as you lift the treat up, the dog's butt will go down.

VEDANTAM: Animals associate clickers with treats. They're a form of motivation.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #2: And the moment you're going to click is when you see the muscle of the back legs moving into the sit.

VEDANTAM: The residents Levy was teaching didn't need motivation. They already had a burning desire to become surgeons. But by marking the precise point a resident positioned a drill properly or tied a knot correctly, Levy felt the clicker could behave like a kind of mirror.

LEVY: Here we have two types of drills - one, a smaller one and...

VEDANTAM: I'm standing in a little workshop Levy has designed at the Bronx Montefiore Medical Center in New York. It's crammed with orange Home Depot buckets, saws, drills, wood and rope. On this day, Levy is teaching resident Zachary Sharfman to tie a slider knot. It's used widely in orthopedic surgery. Levy shows Sharfman how the knot is tied.

LEVY: All right, first, this is what it looks like.

VEDANTAM: He demonstrates on a length of rope.

LEVY: OK. And that's a completed knot. So let's go build that.

VEDANTAM: At the precise moment Sharfman performs each step correctly, Levy marks it with a click.

LEVY: The tag point is over. We're going to do it five times, and each time that you hit the tag point, I'm going to mark with the marker. And if you would say it as you're doing it - one-third over two-thirds.

ZACHARY SHARFMAN: One-third over two-thirds.

(SOUNDBITE OF CLICKER)

LEVY: And if you do it again, please.

VEDANTAM: After five successful clicks, they begin the next step and then the next, until they reach the final step.

SHARFMAN: One-third over two-thirds, over and through, fakey pinch, backside grab, dress the knot, deliver.

(SOUNDBITE OF CLICKER)

LEVY: Bingo. Thank you.

VEDANTAM: What strikes me as I watch this is the complete absence of the kind of feedback you usually get from teachers. There's no great job or well done. There's no, that's wrong, or, what are you doing? Levy thinks that eliminating both praise and criticism can help students focus on the task they're learning rather than on what their teacher thinks of them.

LEVY: This is why I used to clicker. It is baggage-free. It is emotional-free.

VEDANTAM: Levy offers to teach me the same knot. I'm usually all thumbs, but Levy's up for the challenge.

LEVY: One-third over two-thirds. The tag point is over.

(SOUNDBITE OF CLICKER)

VEDANTAM: One-third over two-thirds. One-third over two-thirds.

(SOUNDBITE OF CLICKER)

VEDANTAM: One-third over two-thirds.

(SOUNDBITE OF CLICKER)

VEDANTAM: From time to time, Levy stops to explain what I need to do. There's neither approval nor disapproval on his face and in his voice. I stop paying attention to him. It's just the rope, my hands and the clicker.

(SOUNDBITE OF CLICKER)

VEDANTAM: One-third over two-thirds.

LEVY: Last one.

VEDANTAM: While Levy's use of the clicker makes him an outlier in medicine, the technique is being used in other fields to train people to become better dancers, fishermen and golfers.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #3: So you get to the top of your backswing, hear the click. And then once you hear the click, you're then going to obviously go with your downswing sequence. You want to hear that click again at the impact sign when you hit the ball.

VEDANTAM: Psychologist Barry Schwartz says clickers might not be useful for all kinds of teaching situations, but they may be effective in situations where the emotional crosscurrents of praise and criticism are getting in the way of learning.

BARRY SCHWARTZ: If the student wants the feedback more than the actual skill, well, then you start to see these things go wrong, you know? You have students who do whatever they think it takes to get the approval of their teacher, whether or not it contributes to their mastery of the material. You know, they're not there to get good at math; they're there to get smiles from the teacher. And, you know, if the teacher's less than perfectly calibrated, it's going to turn out that the things that get smiles from the teacher and the things that actually produce understanding of math are not the same things.

VEDANTAM: In those cases, it might be a good idea to get away from both the gold stars and the eye rolls and try a simple...

(SOUNDBITE OF CLICKER)

VEDANTAM: Shankar Vedantam, NPR News.

(SOUNDBITE OF MUSIC)

GREENE: You can hear Shankar on this program, and Shankar is the host of the show Hidden Brain, which you can hear on many public radio stations across the country or wherever you get your podcasts.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.