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Background:New care paradigms are required to enable remote life-saving interventions (RLSIs) in extreme environments such as disaster settings. Informatics may assist through just-in-time expert remote-telementoring (RTM) or video-modelling (VM). Currently, RTM relies on real-time communication that may not be reliable in some locations, especially if communications fail. Neither technique has been extensively developed however, and both may be required to be performed by inexperienced providers to save lives. A pilot comparison was thus conducted.Methods:Procedure-naïve Search-and-Rescue Technicians (SAR-Techs) performed a tube-thoracostomy (TT) on a surgical simulator, randomly allocated to RTM or VM. The VM group watched a pre-prepared video illustrating TT immediately prior, while the RTM group were remotely guided by an expert in real-time. Standard outcomes included success, safety, and tube-security for the TT procedure.Results:There were no differences in experience between the groups. Of the 13 SAR-Techs randomized to VM, 12/13 (92%) placed the TT successfully, safely, and secured it properly, while 100% (11/11) of the TT placed by the RTM group were successful, safe, and secure. Statistically, there was no difference (P = 1.000) between RTM or VM in safety, success, or tube security. However, with VM, one subject cut himself, one did not puncture the pleura, and one had barely adequate placement. There were no such issues in the mentored group. Total time was significantly faster using RTM (P = .02). However, if time-to-watch was discounted, VM was quicker (P = .000).Conclusions:Random evaluation revealed both paradigms have attributes. If VM can be utilized during “travel-time,” it is quicker but without facilitating “trouble shooting.” On the other hand, RTM had no errors in TT placement and facilitated guidance and remediation by the mentor, presumably avoiding failure, increasing safety, and potentially providing psychological support. Ultimately, both techniques appear to have merit and may be complementary, justifying continued research into the human-factors of performing RLSIs in extreme environments that are likely needed in natural and man-made disasters.

Background: Surgery training programs in Canada and the United States have recognized the need to modify current models of training and education. The shifting demographic of surgery trainees, lifestyle issues and an increased trend toward subspecialization are the major influences. To guide these important educational initiatives, a contemporary profile of Canadian general surgery residents and their impressions of training in Canada is required. Methods:We developed and distributed a questionnaire to residents in each Canadian general surgery training program, and residents responded during dedicated teaching time.Results: In all, 186 surveys were returned for analysis (62% response rate). The average age of Canadian general surgery residents is 30 years, 38% are women, 41% are married, 18% have dependants younger than 18 years and 41% plan to add to or start a family during residency. Most (87%) residents plan to pursue postgraduate education. On completion of training, 74% of residents plan to stay in Canada and 49% want to practice in an academic setting. Almost half (42%) of residents identify a poor balance between work and personal life during residency. Forty-seven percent of respondents have appropriate access to mentorship, whereas 37% describe suitable access to career guidance and 40% identify the availability of appropriate social supports. Just over half (54%) believe the stress level during residency is manageable. Conclusion:This survey provides a profile of contemporary Canadian general surgery residents. Important challenges within the residency system are identified. Program directors and chairs of surgery are encouraged to recognize these challenges and intervene where appropriate.Contexte : Les programmes de formation en chirurgie au Canada et aux États-Unis ont reconnu qu'il fallait modifier les modèles actuels de formation et d'éducation. La démographie changeante des étudiants en chirurgie, des enjeux liés aux habitudes de vie et une tendance accrue à la surspécialisation constituent les principaux facteurs d'influence. Pour guider ces initiatives d'éducation importantes, il s'impose de dresser un profil moderne des médecins résidents en chirurgie générale au Canada et de leurs impressions au sujet de la formation au Canada.Méthodes : Nous avons créé et distribué un questionnaire aux médecins résidents de chaque programme canadien de formation en chirurgie générale. Les médecins résidents ont répondu au cours d'une période réservée à l'enseignement.Résultats : Au total, 186 questionnaires ont été renvoyés pour analyse (taux de réponse de 62 %). Les médecins résidents en chirurgie générale au Canada ont en moyenne 30 ans, 38 % sont des femmes, 41 % sont mariés, 18 % ont des personnes à charge de moins de 18 ans et 41 % prévoient commencer une famille ou augmenter la leur au cours de la résidence. La plupart (87 %) des médecins résidents prévoient poursuivre des études postdoctorales. Une fois leur formation terminée, 74 % des médecins résidents prévoient demeurer au Canada et 49 % veulent ...

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