Telementoring: an Overview and Our Preliminary Experience in the Setting Up of a Cost-effective Telementoring Facility

Measuring the Success of a Project ECHO Implementation: Results from an International e-Delphi Study

There is an increasing global need for organisations to utilise high-quality telementoring models to support workforce development and mentorship. Project ECHO is a validated telementoring model that has been adopted by over 700 organisations globally across multiple sectors. To date there is no consolidated list of success indicators by which organisational teams can assess or benchmark their implementation of Project ECHO across sectors. An e-Delphi methodology was adopted to facilitate a comprehensive means of identifying indicators that could be used to assess the implementations of Project ECHO globally. This paper presents a consolidated framework of indicators that support teams to assess their implementation of Project ECHO. These indicators have been derived by an international panel of experts across the healthcare, education, and university sectors. The final framework identified 54 distinct indicators across four domains: (1) spoke participant engagement, (2) ECHO Hub/teleECHO Network design and operation, (3) ECHO Hub team engagement and (4) Local Impact. This paper highlights that Project ECHO implementation indicators can vary between being dynamic, static, and iterative, depending on the phase of implementation. These findings are significant because they are generalisable to any organisation/sector implementing Project ECHO or similar telementoring models.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43477-022-00050-7.

Evidence-based Guidelines on the Use of Virtual Surgical Education Pertaining to the Domains of Cognition and Curriculum, Psychomotor Skills Training, and Faculty Development and Mentorship

OBJECTIVE

To identify, categorize, and evaluate the quality of literature, and to provide evidence-based guidelines on virtual surgical education within the cognitive and curricula, psychomotor, and faculty development and mentorship domains.

SUMMARY OF BACKGROUND DATA

During the coronavirus disease 2019 pandemic, utilizing virtual learning modalities is expanding rapidly. Although the innovative methods must be considered to bridge the surgical education gap, a framework is needed to avoid expansion of virtual education without proper supporting evidence in some areas.

METHODS

The Association for Surgical Education formed an ad-hoc research group to evaluate the quality and methodology of the current literature on virtual education and to build evidence-based guidelines by utilizing the SiGN methodology. We identified patient/problem-intervention-comparison-outcome-style questions, conducted systematic literature reviews using PubMed, EMBASE, and Education Resources information Center databases. Then we formulated evidence-based recommendations, assessed the quality of evidence using Grading of Recommendations, Assessment, Development, and Evaluation, Newcastle-Ottawa Scale for Education, and Kirkpatrick ratings, and conducted Delphi consensus to validate the recommendations.

RESULTS

Eleven patient/problem-intervention-comparison-outcome-style questions were designed by the expert committees. After screening 4723 articles by the review committee, 241 articles met inclusion criteria for full article reviews, and 166 studies were included and categorized into 3 domains: cognition and curricula (n = 92), psychomotor, (n = 119), and faculty development and mentorship (n = 119). Sixteen evidence-based recommendations were formulated and validated by an external expert panel.

CONCLUSION

The evidence-based guidelines developed using SiGN methodology, provide a set of recommendations for surgical training societies, training programs, and educators on utilizing virtual surgical education and highlights the area of needs for further investigation.

Effect of the COVID‐19 pandemic on surgical oncology practice—Results of an SSO survey

Background and Objectives

The COVID‐19 pandemic significantly affected healthcare delivery, shifting focus away from nonurgent care. The aim of this study was to examine the impact of the pandemic on the practice of surgical oncology.

Methods

A web‐based survey of questions about changes in practice during the COVID‐19 pandemic was approved by the Society of Surgical Oncology (SSO) Research and Executive Committees and sent by SSO to its members.

Results

A total of 121 SSO members completed the survey, 77.7% (94/121) of whom were based in the United States. Breast surgeons were more likely than their peers to refer patients to neoadjuvant therapy (p = 0.000171). Head and neck surgeons were more likely to refer patients to definitive nonoperative treatment (p = 0.044), while melanoma surgeons were less likely to do so (p = 0.029). In all, 79.2% (95/120) of respondents are currently using telemedicine. US surgeons were more likely to use telemedicine (p = 0.004). Surgeons believed telemedicine is useful for long‐term/surveillance visits (70.2%, 80/114) but inappropriate (50.4%, 57/113) for new patient visits.

Conclusion

COVID‐19 pandemic resulted in increased use of neoadjuvant therapy, delays in operative procedures, and increased use of telemedicine. Telemedicine is perceived to be most efficacious for long‐term/surveillance visits or postoperative visits.

Remote Surgeon Virtual Presence: A Novel Telementoring Method for Live Surgical Training

PURPOSE

We describe the first known use of telementoring in corneal surgery and technology combining a 3-dimensional microscope system, 5G live streaming technology, group chat software, and a virtual reality headset for intercontinental surgical supervision.

METHODS

Three surgeons in Toronto were proctored by a surgeon in Israel in the implantation of a novel keratoprosthesis device (CorNeat KPro; Ra'anana, Israel) into cadaver eyes. In Toronto, the NGENUITY platform (Alcon) transmitted high-definition, 3-dimensional images to the proctor in Israel who viewed the live video through a GOOVIS Virtual Reality headset with subsecond latency. This was made possible by the LiveU technology (Hackensack, NJ), which is a portable device to increase the bandwidth of transmission. The primary outcome was the successful completion of CorNeat KPro implantation. After each procedure, all surgeons completed a Likert scale questionnaire that assessed opinions on telementoring.

RESULTS

All participants implanted the CorNeat KPro device. There was significant satisfaction reported. A total cumulative score from the questionnaire was 149 of 150 from the operating surgeons, with a score of 135 of 150 by the proctor. All felt that there was excellent AV quality with no lag time and recommended the technology.

CONCLUSIONS

Telementoring is a promising tool that can traverse large distances for ophthalmic education.

Overcoming the Impact of COVID-19 on Surgical Mentorship: A Scoping Review of Long-distance Mentorship in Surgery

BACKGROUND

Mentorship in the surgical field has been increasingly recognized as a crucial component of career success. Distance mentorship models may be utilized to overcome geographic limitations, increase mentorship access, and strengthen mentoring relationships in surgery.

OBJECTIVE

This review aimed to identify the scope of literature on distance mentoring in surgery, the range of its application, its effectiveness, and any gaps in the literature that should be addressed in order to enhance mentorship in the surgical field.

DESIGN

A comprehensive PubMed review was performed in January 2021 on distance mentorship of students, trainees, and surgeons in the surgical field. Reviews, replies, and non-English articles were excluded. Data was extracted regarding publication year, author's country, specialty, subjects, aim of mentorship model, and efficacy.

RESULTS

134 total studies met inclusion and exclusion criteria. Most studies were published in 2020, written by authors in the United States, from general surgery, and featured an expert surgeon paired with a more junior fully trained surgeon. In all, 93.3% of studies utilized distance mentorship to enhance surgical skill through telementoring and only 4.5% were focused on mentorship to enhance careers through professional development. The remaining studies utilized distance mentorship models to increase surgical research (0.7%) and clinical knowledge (1.5%).

CONCLUSION

The results of this review suggest successful implementation of distance mentoring in surgery through telementoring, but a lack of professionally aimed distance mentorship programs. Amidst COVID-19, distance mentorship is particularly important because of decreased face-to-face opportunity. Future studies in the surgical field should investigate distance mentoring as a means of increasing mentorship for professional development.

Overcoming the Impact of COVID-19 on Surgical Mentorship: A Scoping Review of Long-distance Mentorship in Surgery

BACKGROUND

Mentorship in the surgical field has been increasingly recognized as a crucial component of career success. Distance mentorship models may be utilized to overcome geographic limitations, increase mentorship access, and strengthen mentoring relationships in surgery.

OBJECTIVE

This review aimed to identify the scope of literature on distance mentoring in surgery, the range of its application, its effectiveness, and any gaps in the literature that should be addressed in order to enhance mentorship in the surgical field.

DESIGN

A comprehensive PubMed review was performed in January 2021 on distance mentorship of students, trainees, and surgeons in the surgical field. Reviews, replies, and non-English articles were excluded. Data was extracted regarding publication year, author's country, specialty, subjects, aim of mentorship model, and efficacy.

RESULTS

134 total studies met inclusion and exclusion criteria. Most studies were published in 2020, written by authors in the United States, from general surgery, and featured an expert surgeon paired with a more junior fully trained surgeon. In all, 93.3% of studies utilized distance mentorship to enhance surgical skill through telementoring and only 4.5% were focused on mentorship to enhance careers through professional development. The remaining studies utilized distance mentorship models to increase surgical research (0.7%) and clinical knowledge (1.5%).

CONCLUSION

The results of this review suggest successful implementation of distance mentoring in surgery through telementoring, but a lack of professionally aimed distance mentorship programs. Amidst COVID-19, distance mentorship is particularly important because of decreased face-to-face opportunity. Future studies in the surgical field should investigate distance mentoring as a means of increasing mentorship for professional development.

Learning Process Effectiveness During the COVID-19 Pandemic: Teleproctoring Advanced Endoscopic Skills by Training Endoscopists in Endoscopic Sleeve Gastroplasty Procedure

Background and Aims

The COVID‐19 pandemic has led health institutions to cancel many of the activities including training in different fields. Most practices and training programs have been encouraged to use teleproctoring as an alternative method to enhance physician’s ability and assure training. We aimed to evaluate remote training program for endoscopy sleeve gastroplasty (ESG).

Methods

Ten consecutive patients underwent an endoscopic sleeve gastroplasty procedure guided by a proctor expert using an online platform. A stepwise approach was created to assure skill acquisition.

Results

All cases were safely performed with no serious adverse events under teleproctoring. The average surgical and suturing times significantly decreased during the training model. From the first 5 cases to the last 5 ones, the endoscopic procedure time decreased from 120 to 93.4 min while suturing time from 92.8 to 68.4 min. The effect size was large in both cases, and the changes were meaningful according to the fitted learning curves.

Conclusions

The proposed teleproctoring program was effective to deliver advanced endoscopic skills such as endosuturing for ESG, despite the restrictions imposed by the COVID-19 pandemic.

Graphical abstract

Team training and surgical crisis management

Team training and crisis management derive their roots from fundamental learning theory and the culture of safety that burgeoned forth from the industrial revolution through the rise of nuclear energy and aviation. The integral nature of telemedicine to many simulation-based activities, whether to bridge distances out of convenience or necessity, continues to be a common theme moving into the next era of surgical safety as newer, more robust technologies become available.

Telemedicine and telementoring in the surgical specialties: A narrative review

BACKGROUND

The field of telemedicine has grown tremendously over the last decade. We present a systematic review of publications on telemedicine as it pertains to surgery, addressing six facets: 1) telerobotics, 2) telementoring, 3) teleconsulting, 4) telemedicine in post-operative follow-up, 5) tele-education, and 6) current technology.

DATA SOURCES

A search of relevant literature querying PubMed, Web of Science, and Science Direct was performed using the following keywords: telecommunication, telemedicine, telehealth, virtual health, virtual medicine, general surgery, surgery, surgical or surgical patients.

CONCLUSIONS

Telemedicine is being used to care for patients in remote areas, to help expert surgeons assist other specialists in the office or novice surgeons in the operating room, as well as to help teach the next generation of surgeons. There are many opportunities for surgeons to utilize this technology to optimize their practice.

Google Glass for Remote Surgical Tele-proctoring in Low- and Middle-income Countries: A Feasibility Study from Mozambique

BACKGROUND

Untreated surgical conditions account for one-third of the total global burden of disease, and a lack of trained providers is a significant contributor to the paucity of surgical care in low- and middle-income countries (LMICs). Wearable technology with real-time tele-proctoring has been demonstrated in high-resource settings to be an innovative method of advancing surgical education and connecting providers, but application to LMICs has not been well-described.

METHODS

Google Glass with live-stream capability was utilized to facilitate tele-proctoring between a surgeon in Mozambique and a reconstructive surgeon in the United States over a 6-month period. At the completion of the pilot period, a survey was administered regarding the acceptability of the image quality as well as the overall educational benefit of the technology in different surgical contexts.

RESULTS

Twelve surgical procedures were remotely proctored using the technology. No complications were experienced in any patients. Both participants reported moderate visual impairment due to image distortion and light over-exposure. Video-stream latency and connection disruption were also cited as limitations. Overall, both participants reported that the technology was highly useful as training tool in both the intraoperative and perioperative setting.

CONCLUSIONS

Our experience in Mozambique demonstrates the feasibility of wearable technology to enhance the reach and availability of specialty surgical training in LMICs. Despite shortcomings in the technology and logistical challenges inherent to international collaborations, this educational model holds promise for connecting surgeons across the globe and introducing expanded access to education and mentorship in areas with limited opportunities for surgical trainees.

Telementoring of Surgeons: A Systematic Review

Background. Telementoring is a technique that has shown potential as a surgical training aid. Previous studies have suggested that telementoring is a safe training modality. This review aimed to review both the technological capabilities of reported telementoring systems as well as its potential benefits as a mentoring modality. Methods. A systematic review of the literature, up to July 2017, was carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Study quality was assessed using the Oxford Levels of Evidence proforma. Data were extracted regarding technical capabilities, bandwidth, latency, and costs. Additionally, the primary aim and key results were extracted from each study and analyzed. Results. A total of 66 studies were identified for inclusion. In all, 48% of studies were conducted in general surgery; 22 (33%), 24 (36%), and 20 (30%) of studies reported telementoring that occurred within the same hospital, outside the hospital, and outside the country, respectively. Sixty-four (98%) of studies employed video and audio and 38 (58%) used telestration. Twelve separate studies directly compared telementoring against on-site mentoring. Seven (58%) showed no difference in outcomes between telementoring and on-site mentoring. No study found telementoring to result in poorer postoperative outcomes. Conclusions. The results of this review suggest that telementoring has a similar safety and efficacy profile as on-site mentoring. Future analysis to determine the potential benefits and pitfalls to surgical education through telementoring are required to determine the exact role it shall play in the future. Technological advances to improve remote connectivity would also aid the uptake of telementoring on a larger scale.

The evolution of surgical telementoring: current applications and future directions

Surgical telementoring is a concept within telemedicine that involves the use of information technology to provide real-time guidance and technical assistance for surgical procedures from an expert physician at a different geographical location. It is a means to overcome the logistic obstacles associated with traditional mentoring and can aid in the distribution of advanced surgical techniques. In addition to its perceived educational benefits, it has the potential to directly impact patient care by providing immediate access to specialized surgical expertise in areas lacking access to qualified surgeons. With advances in technology, surgical telementoring has made significant strides in the past two decades and a breadth of positive experiences have been published in the literature. Despite this growth, questions remain regarding ideal videoconferencing methodology, resolution and latency requirements, security and liability issues, and telementoring in combination with emerging technology. This review addresses the history and progression, current applications, and future directions of surgical telementoring as a means to distribute advanced surgical expertise around the world.