Equipment advances and innovative treatments have led to new opportunities in medicine, but surgeons who have completed training prior to the introduction of these new techniques may not know how to perform them. Akron Children’s Hospital has been at the forefront of a solution to this problem through a concept called “telementoring.”
“Telementoring allows physicians to perform new techniques safely by communicating remotely with an experienced advisor,” said Todd Ponsky, MD, a pediatric surgeon at Akron Children’s Hospital who specializes in minimally invasive surgery. “We use it to help surgeons who want to learn a newly developed technique maintain and enhance their skills following on-site training at a hands-on or virtual course.”
Akron Children’s is a national leader in developing a skills acquisition model (SAM) for practicing surgeons. This method involves a combination of observership, proctorship and simulation training, followed by the more recent addition of telementoring.
Using this model, a trainee would first attend a course, then observe an expert performing the procedure. If applicable, the trainee would then practice the procedure on a surgical simulator or model.
Next, the expert visits the trainee at his location to proctor and mentor him through several cases. Eventually, the trainee performs the procedure by himself, with the expert mentoring and proctoring virtually through telementoring.
“Ideally, the experts can telestrate and point using remotely controlled lasers or remotely drawing or pointing on the laparoscopic monitor,” said Dr. Ponsky. “Currently, we use the InTouch or Visit OR1 endoscope. It is an expensive system, but provides high-fidelity transmission and is HIPAA compliant.”
Akron Children’s has used this approach both to train young surgeons, as well as to help more experienced surgeons navigate through particularly challenging cases.
“Having a virtual mentor greatly eases the anxiety of doing an unusual case,” he said. “It’s just so helpful, especially in pediatric surgery, because so much of what we do can be considered to be rare.”
He is quick to add, though, that he and his colleagues would never proceed with a telementoring case unless they feel the surgeon is prepared to complete it alone in the event of a power failure or bad Internet connection.
“The telementor is intended to provide an extra set of eyes and ears, not to serve as an essential part of the surgery’s success,” Dr. Ponsky stressed.
Telementoring may also be helpful for surgical procedures in rural areas, where a patient requires treatment at a more specialized facility but is not stable enough to be transferred. A large hospital system with remote surgical centers could also use telementoring as a means to share expertise among these sites without surgeons having to log the road miles.
Dr. Ponsky would also like to see telementoring become a required part of the first year for all surgeons’ careers, and has engaged in discussions with several professional medical societies and organizations about making that happen.
“Extending telementoring to the first year of practice would allow former residents to continue working with the same surgeons who trained them during residency,” he added. “We are still working out the cost to do this, but it will be well worth it if we succeed. Telementoring will help us maximize outcomes for patients by drawing on experts who can help incorporate the latest information into each procedure.”
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