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Fernandes RD, Ghasroddashti A, Sorefan-Mangou F, Williams E, Choi K, Fasola L, Szasz P, Zevin B. Educational Effectiveness of Telementoring as a Continuing Professional Development Intervention for Surgeons in Practice: A Systematic Review. ANNALS OF SURGERY OPEN 2023; 4:e341. [PMID: 38144497 PMCID: PMC10735140 DOI: 10.1097/as9.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/26/2023] [Indexed: 12/26/2023] Open
Abstract
Objective We performed a systematic review to determine the educational effectiveness of telementoring as a continuing professional development (CPD) intervention for surgeons in practice. Background Surgeons can mentor their peers in remote locations using videoconferencing communication, referred to as telementoring. Methods We searched MEDLINE and EMBASE and included studies assessing the educational effectiveness of telementoring interventions used by surgeons in practice. We excluded studies involving only trainees and those not evaluating educational effectiveness. Two reviewers independently screened, extracted data, and assessed study quality using the Medical Education Research Study Quality Instrument (MERSQI; maximum score 18). Educational outcomes were categorized using Moore's Outcomes Framework. Results We retrieved a total of 1351 records, and 252 studies were selected for full-text review. Twenty-eight studies were included with 1 randomized controlled trial, 19 cohort studies, 5 qualitative studies, and 3 case studies, totaling 178 surgeons and 499 cases. The average MERSQI score was 10.21 ± 2.2 out of 18. Educational outcomes included surgeons' satisfaction with telementoring interventions (Moore's Level 2) in 12 studies, improvement in surgeons' procedural knowledge (Level 3b) in 3 studies, improvements in surgeons' procedural competence in an educational setting (Level 4) in 4 studies, performance in a workplace-based setting (Level 5) in 23 studies, and patient outcomes (Level 6) in 3 studies. No studies reported community health outcomes (Level 7). Conclusions Moderate-level evidence demonstrates the use of telementoring as effective in changing surgeons' knowledge and competence in both educational and workplace-based settings. Its use is also associated with changes in patient outcomes.
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Affiliation(s)
| | | | | | - Erin Williams
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Ken Choi
- From the The School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Laurie Fasola
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Peter Szasz
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Boris Zevin
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
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2
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Pfennig M, Lee A, Mi M. How does telementoring impact medical education within the surgical field? A scoping review. Am J Surg 2022; 224:869-880. [PMID: 35545476 PMCID: PMC9417933 DOI: 10.1016/j.amjsurg.2022.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/01/2022] [Accepted: 04/30/2022] [Indexed: 12/04/2022]
Abstract
Background Surgical education strongly involves the use of mentorship to improve the confidence and efficiency of trainees. Social distancing due to the COVID-19 pandemic may serve as a catalyst to promote the use of telementoring and other remote learning opportunities in medical education. Methods A comprehensive literature review was performed using the electronic databases PubMed, Embase, Web of Science, Scopus, and the Cochrane Library with respect to telementoring in the surgical field. Results The overall consensus of telementoring experience among all 25 studies was generally positive, citing “positive experience,” “increased confidence,” and “increased surgical skill.” Using over 15 different technologies, a total of 12 simulations, 149 tasks, and 491 surgeries were conducted via telementoring. Eight mentor-mentee relationships were identified, with the most common relationship being surgeon-to-surgeon in 12 studies. Conclusions The implementation of telementoring has been shown to be effective in improving surgical skills and learner experiences while overcoming financial and geographical barriers.
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Affiliation(s)
- Mitchell Pfennig
- Third-year Medical Student, Oakland University William Beaumont School of Medicine, USA.
| | - Andrew Lee
- Third-year Medical Student, Oakland University William Beaumont School of Medicine, USA.
| | - Misa Mi
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, USA.
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Raborn LN, Janis JE. Overcoming the Impact of COVID-19 on Surgical Mentorship: A Scoping Review of Long-distance Mentorship in Surgery. JOURNAL OF SURGICAL EDUCATION 2021; 78:1948-1964. [PMID: 34059480 PMCID: PMC8894132 DOI: 10.1016/j.jsurg.2021.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/05/2021] [Accepted: 05/02/2021] [Indexed: 05/04/2023]
Abstract
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.
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Affiliation(s)
- Layne N Raborn
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
| | - Jeffrey E Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University, Wexner Medical Center Columbus, Columbus, Ohio.
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Gerardo R, Lele P, Sundaram K, Ponsky T. Surgical telementoring: Feasibility, applicability, and how to. J Surg Oncol 2021; 124:241-245. [PMID: 34245573 DOI: 10.1002/jso.26511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/11/2022]
Abstract
Surgical training does not end at the conclusion of residency training. Expansions in medical technology and surgical technique have created a steep learning curve for the young attending surgeon. The emergence of intraoperative telementoring has allowed experienced surgeons to guide learners through complex surgical cases remotely with the assistance of streaming video technology. Here, we describe the basics of telementoring, financial and legal considerations, and recommend hardware specifications for optimal use.
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Affiliation(s)
- Rodrigo Gerardo
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Prachi Lele
- Department of Surgery, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Krithika Sundaram
- Department of Surgery, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Todd Ponsky
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Surgery, Northeast Ohio Medical University, Rootstown, Ohio, USA
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Beqari J, Seymour NE. Application of technology to educational needs in surgery. J Surg Oncol 2021; 124:181-192. [PMID: 34245576 DOI: 10.1002/jso.26512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 01/22/2023]
Abstract
Innovations in surgical education follow advancing clinical technology. New surgical methods have prompted demand for systematic methods to leverage computing power and internet tools to achieve proficiency-based training goals. Virtual reality, high-fidelity patient simulation, web-based resources to facilitate performance assessment, and telementoring have become mainstream practices, although patient outcomes benefits are not well studied. Remote virtual meeting and mentoring have had transformative effects on resident experiences, the full effects of which remain to be seen.
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Affiliation(s)
- Jorind Beqari
- University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Neal E Seymour
- University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
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Shabir D, Abdurahiman N, Padhan J, Trinh M, Balakrishnan S, Kurer M, Ali O, Al-Ansari A, Yaacoub E, Deng Z, Erbad A, Mohammed A, Navkar NV. Towards development of a tele-mentoring framework for minimally invasive surgeries. Int J Med Robot 2021; 17:e2305. [PMID: 34256415 DOI: 10.1002/rcs.2305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/02/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tele-mentoring facilitates the transfer of surgical knowledge. The objective of this work is to develop a tele-mentoring framework that enables a specialist surgeon to mentor an operating surgeon by transferring information in a form of surgical instruments' motion required during a minimally invasive surgery. METHOD A tele-mentoring framework is developed to transfer video stream of the surgical field, poses of the scope and port placement from the operating room to a remote location. From the remote location, the motion of virtual surgical instruments augmented onto the surgical field is sent to the operating room. RESULTS The proposed framework is suitable to be integrated with laparoscopic as well as robotic surgeries. It takes on average 1.56 s to send information from the operating room to the remote location and 0.089 s for vice versa over a local area network. CONCLUSIONS The work demonstrates a tele-mentoring framework that enables a specialist surgeon to mentor an operating surgeon during a minimally invasive surgery.
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Affiliation(s)
- Dehlela Shabir
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | | | - May Trinh
- Department of Computer Science, University of Houston, Houston, Texas, USA
| | | | - Mohamed Kurer
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Omar Ali
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Elias Yaacoub
- Department of Computer Science and Engineering, Qatar University, Doha, Qatar
| | - Zhigang Deng
- Department of Computer Science, University of Houston, Houston, Texas, USA
| | - Aiman Erbad
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Amr Mohammed
- Department of Computer Science and Engineering, Qatar University, Doha, Qatar
| | - Nikhil V Navkar
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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Velazco CS, Davila VJ, Alhajjat AM, Ostlie DJ, Garvey EM. Mentorship in pediatric surgery: A need for structure? J Pediatr Surg 2021; 56:892-899. [PMID: 33139033 DOI: 10.1016/j.jpedsurg.2020.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/31/2020] [Accepted: 09/21/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Mentorship in surgical training is critical but differs greatly from the early apprenticeship model and often spans generations. This study evaluates the current state of and desire for structured mentorship in pediatric surgical training from the perspective of program directors (PDs) and trainees. METHODS A survey addressing demographics, presence of or desire for structured mentorship, and proposed mentoring topics was emailed to pediatric surgery PDs (n = 58) and trainees completing fellowship in 2018-2020 (n = 72). RESULTS The response rate was 38.5%. 50% of trainees were female versus 15% of PDs (p = 0.02). 19% of trainees reported having a structured mentorship program versus 26% of PDs (p = 0.72). The majority, 83%, of trainees felt a structured mentorship program is warranted versus 40% of PDs (p = 0.002). There were differing opinions between trainees and PDs regarding important components of a mentoring program. Trainees felt the following were more important: transition to practice, job negotiation, CV review, financial planning and performance review. PDs felt the following were more important: quality improvement projects and work/life balance. Both agreed academic development and job search were important. CONCLUSIONS The majority of pediatric surgery trainees desire structured mentorship programs; however, few institutions have them. Training programs and program directors warrant a response to this gap. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Cristine S Velazco
- Department of General Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Victor J Davila
- Division of Vascular Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054
| | - Amir M Alhajjat
- Division of Pediatric Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016
| | - Daniel J Ostlie
- Division of Pediatric Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016
| | - Erin M Garvey
- Division of Pediatric Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016.
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Tel A, Bortuzzo F, Pascolo P, Costa F, Sembronio S, Bresadola V, Baldi D, Robiony M. Maxillofacial Surgery 5.0: a new paradigm in telemedicine for distance surgery, remote assistance, and webinars. ACTA ACUST UNITED AC 2020; 69:191-202. [DOI: 10.23736/s0026-4970.20.04274-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Ljuhar D, Gibbons AT, Ponsky TA, Nataraja RM. Emerging technology and their application to paediatric surgical training. Semin Pediatr Surg 2020; 29:150909. [PMID: 32423598 DOI: 10.1016/j.sempedsurg.2020.150909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Damir Ljuhar
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne Australia; Department of Surgical Simulation, Monash Children's Hospital, Melbourne Australia
| | - Alexander T Gibbons
- Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH United States
| | - Todd A Ponsky
- Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH United States; Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH United States
| | - Ramesh M Nataraja
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne Australia; Department of Surgical Simulation, Monash Children's Hospital, Melbourne Australia; Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne Australia.
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Harting MT, Wheeler A, Ponsky T, Nwomeh B, Snyder CL, Bruns NE, Lesher A, Pandya S, Dickie B, Shah SR. Telemedicine in pediatric surgery. J Pediatr Surg 2019; 54:587-594. [PMID: 29801660 DOI: 10.1016/j.jpedsurg.2018.04.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/13/2018] [Accepted: 04/28/2018] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction. OBJECTIVE To review the current spectrum, potential strategies, and implementation process of telemedicine in pediatric surgery. DESIGN Review and opinion design. SETTING n/a. PARTICIPANTS n/a. MAIN OUTCOMES AND MEASURES: n/a. RESULTS n/a. CONCLUSIONS AND RELEVANCE Telemedicine is an emerging approach with the potential to facilitate efficient, cost-effective delivery of pediatric surgical services. BRIEF ABSTRACT Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction. The objectives of this review are to explore common terms in telemedicine, provide an overview of current legislative and billing guidelines, review the current state of telemedicine in surgery and pediatric surgery, and provide basic themes for successful implementation of a pediatric surgical telemedicine program. TYPE OF STUDY Review. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Children's Memorial Hermann Hospital, Houston, TX.
| | - Austin Wheeler
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Children's Memorial Hermann Hospital, Houston, TX
| | - Todd Ponsky
- Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH
| | - Benedict Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Chuck L Snyder
- Department of Pediatric Surgery, Childrens Mercy Hospital, Kansas City, MO
| | - Nicholas E Bruns
- Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Aaron Lesher
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Samir Pandya
- Division of Pediatric Surgery, Department of Surgery, UT Southwestern Medical Center and Children's Medical Center, Dallas, TX
| | - Belinda Dickie
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Sohail R Shah
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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Erridge S, Yeung DKT, Patel HRH, Purkayastha S. Telementoring of Surgeons: A Systematic Review. Surg Innov 2018; 26:95-111. [DOI: 10.1177/1553350618813250] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Abstract
PURPOSE Tremendous interest and need lie at the intersection of telemedicine and minimally invasive surgery. Robotics provides an ideal environment for surgical telementoring and telesurgery given its endoscopic optics and mechanized instrument movement. We review the present status, current challenges and future promise of telemedicine in endoscopic and minimally invasive surgery with a focus on urological applications. MATERIALS AND METHODS Two paired investigators screened PubMed®, Scopus® and Web of Science® databases for all full text English language articles published between 1995 and 2016 using the key words "telemedicine," "minimally invasive surgical procedure," "robotic surgical procedure," "education" and "distance." We categorized and included studies of level of interaction between proctors and trainees. Research design, special equipment, telecommunication network bandwidth and research outcomes of each study were ascertained and analyzed. RESULTS Of 65 identified reports 38 peer-reviewed studies qualified for inclusion. Series were categorized into 4 advancing levels, ie verbal guidance, guidance with telestration, guidance with tele-assist and telesurgery. More advanced levels of surgical telementoring provide more effective and experiential teaching but are associated with increased telecommunication network bandwidth requirements and expenses. Concerns regarding patient safety and legal, financial, economic and ethical issues remain to be reconciled. CONCLUSIONS Telementoring and telesurgery in minimally invasive surgery are becoming more practical and cost effective in facilitating teaching of advanced surgical skills worldwide and delivery of surgical care to underserved areas, yet many challenges remain. Maturity of these modalities depends on financial incentives, favorable legislation and collaboration with cybersecurity experts to ensure safety and cost-effectiveness.
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Abstract
Telemedicine is increasingly becoming an important part of the health care system as it has the potential to help deliver quality medical care to underserved areas. When implemented correctly, it can be a cost-effective way of expanding access to excellent medical care. However, because it is a relatively new and quickly changing field, there are multiple issues and challenges that need to be addressed. This article reviews the current literature on various modalities of telemedicine, evidence for teletrauma, and challenges and barriers related to telemedicine.
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Affiliation(s)
- Paul T Kim
- Department of General Surgery, University of Cincinnati Medical Center, Cincinnati Children׳s Hospital Medical Center, Cincinnati, Ohio
| | - Richard A Falcone
- Division of Pediatric and Thoracic Surgery, Cincinnati Children׳s Hospital Medical Center, Cincinnati, Ohio.
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15
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El-Sabawi B, Magee W. The evolution of surgical telementoring: current applications and future directions. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:391. [PMID: 27867943 DOI: 10.21037/atm.2016.10.04] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Bassim El-Sabawi
- Keck School of Medicine of USC, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - William Magee
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA;; Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
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17
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Snyderman CH, Gardner PA, Lanisnik B, Ravnik J. Surgical telementoring: A new model for surgical training. Laryngoscope 2016; 126:1334-8. [DOI: 10.1002/lary.25753] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/25/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Carl H. Snyderman
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
- Department of Neurological Surgery; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Paul A. Gardner
- Department of Neurological Surgery; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Bostjan Lanisnik
- Department of Otolaryngology; University of Maribor; Maribor Slovenia
| | - Janez Ravnik
- Department of Neurological Surgery; University of Maribor; Maribor Slovenia
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18
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Gibreel W, Zendejas B, Joyce D, Moir CR, Zarroug AE. Minimally Invasive Repairs of Pectus Excavatum: Surgical Outcomes, Quality of Life, and Predictors of Reoperation. J Am Coll Surg 2016; 222:245-52. [DOI: 10.1016/j.jamcollsurg.2015.11.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 11/07/2015] [Accepted: 11/12/2015] [Indexed: 11/26/2022]
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AlJamal YN, Zendejas B, Gas BL, Ali SM, Heller SF, Kendrick ML, Farley DR. Annual Surgeon Volume and Patient Outcomes Following Laparoscopic Totally Extraperitoneal Inguinal Hernia Repairs. J Laparoendosc Adv Surg Tech A 2016; 26:92-8. [DOI: 10.1089/lap.2015.0368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yazan N. AlJamal
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Benjamin Zendejas
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Becca L. Gas
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Shahzad M. Ali
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Stephanie F. Heller
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Michael L. Kendrick
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David R. Farley
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
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Bruns NE, Irtan S, Rothenberg SS, Bogen EM, Kotobi H, Ponsky TA. Trans-Atlantic Telementoring with Pediatric Surgeons: Technical Considerations and Lessons Learned. J Laparoendosc Adv Surg Tech A 2016; 26:75-8. [DOI: 10.1089/lap.2015.0131] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicholas E. Bruns
- Department of Pediatric Surgery, Akron Children's Hospital, Akron, Ohio
| | - Sabine Irtan
- Department of Pediatric Surgery, Trousseau Hospital, Paris, France
- Sorbonnes Universités, Pierre and Marie Curie University, University of Paris 06, Paris, France
| | - Steven S. Rothenberg
- Department of Pediatric Surgery, Rocky Mountain Hospital for Children, Denver, Colorado
| | - Etai M. Bogen
- Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Henri Kotobi
- Department of Pediatric Surgery, Trousseau Hospital, Paris, France
| | - Todd A. Ponsky
- Department of Pediatric Surgery, Akron Children's Hospital, Akron, Ohio
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Kirkpatrick AW, Tien H, LaPorta AT, Lavell K, Keillor J, Wright Beatty HE, McKee JL, Brien S, Roberts DJ, Wong J, Ball CG, Beckett A. The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study. J Trauma Acute Care Surg 2015; 79:741-7. [PMID: 26422331 PMCID: PMC4623848 DOI: 10.1097/ta.0000000000000829] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemorrhage is the leading cause of preventable posttraumatic death. Many such deaths may be potentially salvageable with remote damage-control surgical interventions. As recent innovations in information technology enable remote specialist support to point-of-care providers, advanced interventions, such as remote damage-control surgery, may be possible in remote settings. METHODS An anatomically realistic perfused surgical training mannequin with intrinsic fluid loss measurements (the "Cut Suit") was used to study perihepatic packing with massive liver hemorrhage. The primary outcome was loss of simulated blood (water) during six stages, namely, incision, retraction, direction, identification, packing, and postpacking. Six fully credentialed surgeons performed the same task as 12 military medical technicians who were randomized to remotely telementored (RTM) (n = 7) or unmentored (UTM) (n=5) real-time guidance by a trauma surgeon. RESULTS There were no significant differences in fluid loss between the surgeons and the UTM group or between the UTM and RTM groups. However, when comparing the RTM group with the surgeons, there was significantly more total fluid loss (p = 0.001) and greater loss during the identification (p = 0.002), retraction (p = 0.035), direction (p = 0.014), and packing(p = 0.022) stages. There were no significant differences in fluid loss after packing between the groups despite differences in the number of sponges used; RTM group used more sponges than the surgeons and significantly more than the UTM group (p = 0.048). However, mentoring significantly increased self-assessed nonsurgeon procedural confidence (p = 0.004). CONCLUSION Perihepatic packing of an exsanguinating liver hemorrhage model was readily performed by military medical technicians after a focused briefing. While real-time telementoring did not improve fluid loss, it significantly increased nonsurgeon procedural confidence, which may augment the feasibility of the concept by allowing them to undertake psychologically daunting procedures.
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Affiliation(s)
- Andrew W Kirkpatrick
- From the Canadian Forces Health Services (A.W.K., H.T., J.W., A.B.); Departments of Surgery (A.W.K., D.J.R., C.G.B.), Critical Care Medicine (A.W.K.), and Community Health Sciences (D.J.R.), and Regional Trauma Services (A.W.K., C.G.B.), Foothills Medical Centre; and Innovative Trauma Care (J.L.M.), Edmonton, Calgary, Alberta; Sunnybrook Health Sciences Centre (H.T.), Toronto; and Royal College of Physicians and Surgeons (S.B.); and Flight Research Laboratory (J.K., H.E.W.B.), National Research Council of Canada, Ottawa, Ontario, Canada; Rocky Vista University, Parker, Colorado (A.T.L.); and Strategic Operations (K.L.), San Diego, California
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Ure B, Zoeller C, Lacher M. The role of new information technology meeting the global need and gap of education in pediatric surgery. Semin Pediatr Surg 2015; 24:134-7. [PMID: 25976150 DOI: 10.1053/j.sempedsurg.2015.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traditionally, pediatric surgical education consisted of exposure to patients, textbooks, lectures, team-based education, congresses, and workshops. Over the last decades, however, new information technology (IT) and the internet revolutionized the sharing of information and communication. IT has become relevant in particular for the younger generation of pediatric surgeons. Today, gaps in children's health and the quality of pediatric surgical education persist between countries and regions. Advances in health care are not shared equitably. The use of IT for resource libraries, teleconferences, virtual symposiums, and telementoring has great potential in closing this gap and meeting the global needs for pediatric surgical education. This article focuses on the potential role of IT in this respect.
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Affiliation(s)
- Benno Ure
- Department of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany.
| | - Christoph Zoeller
- Department of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany
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