Educational implications for surgical telementoring: a current review with recommendations for future practice, policy, and research

Augestad, Knut Magne; Han, Heeyoung; Paige, John T.; Ponsky, Todd A.; Schlachta, Christopher M.; Dunkin, Brian J.; Mellinger, John D.

doi:10.1007/s00464-017-5690-y

Cited by 54 publications

(50 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There have been considerable advances in the implementation of telemedicine and the development of technology. Telemedicine applications are continually emerging to new areas, such as surgical telementoring, emergency medicine collaboration, education of medical personnel, multidisciplinary team meetings and postoperative follow‐up. Postoperative follow‐up by teleconsultation (TC) has the potential to improve care, and the technology has become user‐friendly.…”

Section: Introductionmentioning

confidence: 99%

Telemedicine in postoperative follow-up of STOMa PAtients: a randomized clinical trial (the STOMPA trial)

Augestad

Sneve

Lindsetmo

2020

British Journal of Surgery

View full text Add to dashboard Cite

Background A stoma has severe impact on the patient's quality of life (QoL). Postoperative home community follow‐up by teleconsultation (TC) and stoma nurses may reduce the burden of travel and improve QoL. Methods A university hospital and five district medical centres participated. Patients with a stoma were randomized to follow‐up by either TC (intervention) or hospital (control). Stoma nurses performed the clinical examination at the TC studio, aided remotely by hospital nurses and surgeons. The primary endpoint was the EQ‐5D™ index score; secondary endpoints were the Stoma Quality‐of‐Life Scale, the OutPatient Experiences Questionnaire, and use of hospital resources. Results A total of 110 patients were randomized to hospital (58 patients) or TC (52) follow‐up; 64 patients (hospital 38, TC 26) were followed for more than 12 months and 246 consultations (hospital 151, TC 95) were performed. There were no differences in QoL: EQ‐5D™ index score (P = 0·301) and EQ‐5D™ visual analogue scale (VAS) score (P = 0·775); Work/Social Function (P = 0·822); Sexuality/Body Image (P = 0·253) and Stoma Function (P = 0·074). Hospital follow‐up performed better for organization of care (staff collaboration, P = 0·004; met same persons, P = 0·003) and communication (surgeon understandable, P < 0·001; surgeon caring P = 0·003). TC did not increase the number of hospital consultations (P = 0·684) and reduced the number of journeys of more than 8 h (P = 0·007). Conclusion Telemedicine follow‐up by stoma nurses did not improve the QoL of patients, but decreased the readmission rate and burden of travel. Registration number NCT01600508 ( https://www.clinicaltrials.gov).

show abstract

Section: Introductionmentioning

confidence: 99%

Telemedicine in postoperative follow-up of STOMa PAtients: a randomized clinical trial (the STOMPA trial)

Augestad

Sneve

Lindsetmo

2020

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Numerous case studies-the earliest dating from the 1960s-have presented videoconferencing as a safe and efficacious way of providing surgical mentoring, enabling safe adoption of new techniques through remote expert guidance [2,6,7,21]. However, surgical telementoring is not widely used [5] and its impact over time is not well understood [6]. Implementation outcomes in health care are strongly affected by organizational context and how well an innovation answers to user needs [22].…”

Section: Related Researchmentioning

confidence: 99%

“…Rapid development of surgical techniques and medical technology creates a continual need for retraining among surgeons [1,2]. Remote surgical guidance through telementoring and teleconsulting [3] can be a cost-effective way to facilitate teaching and training for less experienced surgeons [4] and support safe adoption of new clinical methods among experienced practitioners [5][6][7][8][9]. However, telemedicine innovations rarely move from the pilot stage to routine delivery [10,11].…”

Section: Introductionmentioning

confidence: 99%

Telemedicine for Remote Surgical Guidance in Endoscopic Retrograde Cholangiopancreatography: Mixed Methods Study of Practitioner Attitudes (Preprint)

Aminoff¹,

Meijer²,

Arnelo³

et al. 2020

Preprint

View full text Add to dashboard Cite

BACKGROUND A telemedicine service for remote surgical guidance had shown teaching effects and impact on clinical practice during a highly specialized endoscopic procedure called ERCP. However, doctors’ interest in the innovation did not appear to correspond to the anticipated needs, and there was concern about how to make the practice an integrated and accepted way of working. OBJECTIVE In this study, the Technology Acceptance Model (TAM) is used as a conceptual framework to structure a qualitative investigation into endoscopic surgeons attitudes towards remote surgical guidance in ERCP, prior to its implementation. METHODS 20 semi-structured interviews were conducted with ERCP staff from 5 hospitals to elicit details about work practices, common challenges during procedures and factors contributing to performance during ERCP, as well as beliefs regarding the value of teleguidance. Theoretical constructs from TAM were used to guide the thematic analysis of the interviews. The findings from the interviews guided the preparation of test items for a questionnaire directed to a wider group of ERCP specialists. Descriptive statistics were employed to calculate mean scores and variance. In addition, results were dichotomized due to the small sample, in order to support comparison between groups. RESULTS In the interviews, practitioners described performance during ERCP as dependent on individual, team and and organisational factors. They weighed the value of teleguidance in terms of how it might affect both their individual performance but also how it might interact with the wider context. The questionnaire results from 23 respondents at 15 different ERCP clinics indicated a number of differences between novices’ and experts’ attitudes. Novices were generally positive towards the usefulness of teleguidance (69% giving a positive rating). While the experts also were generally positive (64 %), there was more variance in this group, and some respondents were consistently very negative. CONCLUSIONS The findings from the interviews and the questionnaire indicated that novices and experts weigh the value of teleguidance in different ways. Senior practitioners have less urgent needs for consultation and often have managerial functions, hence a different perspective of the changes that teleguidance might entail. As senior clinicians are more likely to be key decision makers, the attitudes among this group can have a greater relative importance for adoption than that of the novices. TAM can be seen as a valuable conceptual framework to help direct an investigation about acceptance of teleguidance. However, a TAM questionnaire can only capture a small portion of the factors affecting how a telemedicine service in complex and collaborative clinical work can come to be adopted. CLINICALTRIAL Swedish Ethical Review Authority 2014/859-31

show abstract

“…1 Telementoring can also benefit surgical training with simulators, especially when it is costly or difficult for an expert to be physically present and to interact with each of a large number of trainees. 2 In recent years, telementoring has seen advances because of the use of augmented reality (AR), which can overlay graphical information authored by a remote mentor directly onto a trainee surgeon's view of the operating field. Such approaches have shown the important advantage of reducing the trainee's need to shift focus away from the operating field during a procedure.…”

mentioning

confidence: 99%

Augmented Reality Future Step Visualization for Robust Surgical Telementoring

et al. 2019

View full text Add to dashboard Cite

Surgical telementoring connects expert mentors with trainees performing urgent care in austere environments. However, such environments impose unreliable network quality, with significant latency and low bandwidth. We have developed an augmented reality telementoring system that includes future step visualization of the medical procedure. Pregenerated video instructions of the procedure are dynamically overlaid onto the trainee's view of the operating field when the network connection with a mentor is unreliable. METHODS Our future step visualization uses a tablet suspended above the patient's body, through which the trainee views the operating field. Before trainee use, an expert records a "future library" of stepby-step video footage of the operation. Videos are displayed to the trainee as semitransparent graphical overlays. We conducted a study where participants completed a cricothyroidotomy under telementored guidance. Participants used one of two telementoring conditions: conventional telestrator or our system with future step visualization. During the operation, the connection between trainee and mentor was bandwidth throttled. Recorded metrics were idle time ratio, recall error, and task performance. RESULTS Participants in the future step visualization condition had 48% smaller idle time ratio (14.5% vs. 27.9%, P < 0.001), 26% less recall error (119 vs. 161, P = 0.042), and 10% higher task performance scores (rater 1 = 90.83 vs. 81.88, P = 0.008; rater 2 = 88.54 vs. 79.17, P = 0.042) than participants in the telestrator condition. CONCLUSIONS Future step visualization in surgical telementoring is an important fallback mechanism when trainee/mentor network connection is poor, and it is a key step towards semiautonomous and then completely mentor-free medical assistance systems.

show abstract

Educational implications for surgical telementoring: a current review with recommendations for future practice, policy, and research

Cited by 54 publications

References 44 publications

Telemedicine in postoperative follow-up of STOMa PAtients: a randomized clinical trial (the STOMPA trial)

Telemedicine in postoperative follow-up of STOMa PAtients: a randomized clinical trial (the STOMPA trial)

Telemedicine for Remote Surgical Guidance in Endoscopic Retrograde Cholangiopancreatography: Mixed Methods Study of Practitioner Attitudes (Preprint)

Augmented Reality Future Step Visualization for Robust Surgical Telementoring

Contact Info

Product

Resources

About