Laparoscopy and the internet. A surgeon survey

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.

Evaluation of Patient Feedback following Laparoscopic Cholecystectomy based on Information Described in the Informed Consent form Developed by the Association of Polish Surgeons

The cholecystectomy procedure is the most routinely performed intervention in general surgery. The current international gold standard is via the laparoscopic approach. It is a safe, minimally-invasive procedure; however, it is associated with complications in 1% of cases. The aim of the study was to analyze patient feedback, by means of a survey, to determine how much knowledge patients possessed about their disease state and proposed surgical intervention, based primarily on information contained within the informed consent form developed by the Association of Polish Surgeons.

MATERIAL AND METHODS

This study involved the participation of 51 patients who underwent laparoscopic cholecystectomy, indicated by a diagnosis of gallstones, in the years 2014 and 2015.

RESULTS

Despite having signed the informed consent form, there was considerable variation among the responses given to the survey by the 51 patients in this study. Some patients' responses were tangential to the questions asked; many patients did not respond to any of the sub points.

CONCLUSIONS

Given that this study is based on a small sample size of patients, it must be presumed that the process by which the patient declares his or her informed consent requires further consideration with respect to the means by which it is obtained. The authors of this study thus recommend that multimedia resources be harnessed as part of the process of obtaining the informed consent of patients prior to surgical intervention.

Leakage after Surgery for Rectum Cancer: Inconsistency in Reporting to the Danish Colorectal Cancer Group

Purpose. Anastomotic leakage accounts for up to 1/3 of all fatalities after rectal cancer surgery. Evidence suggests that anastomotic leakage has a negative prognostic impact on local cancer recurrence and long-term cancer specific survival. The reported leakage rate in 2011 in Denmark varied from 7 to 45 percent. The objective was to clarify if the reporting of anastomotic leakage to the Danish Colorectal Cancer Group was rigorous and unequivocal. Methods. An Internet-based questionnaire was e-mailed to all Danish surgical departments, who reported to Danish Colorectal Cancer Group (DCCG) in 2011. There were 23 questions. Four core questions were whether pelvic collection, fecal appearance in a pelvic drain, rectovaginal fistula, and "watchfull" waiting patients were reported as anastomotic leakage. Results. Fourteen out of 17 departments, who in 2011 according to DDCG performed rectal cancer surgery, answered the questionnaire. This gave a response rate of 82%. In three of four core questions there was disagreement in what should be reported as anastomotic leakage. Conclusion. The reporting of anastomotic leakage to the Danish Colorectal Cancer Group was not rigorous and unequivocal. The reported anastomotic leakage rate in Danish Colorectal Cancer Group should be interpreted with caution.

Internet and continuing medical education

Keeping abreast of medical advances is an important, ongoing responsibility for medical professionals, one that categorises physicians as lifelong students. In the USA, continuing medical education (CME) is the bridge that connects basic research and the practicing physician, who must fulfill credit requirements for licensure and board certification. Developments in multimedia technology and the Internet have made online CME courses possible, making the process of obtaining CME credits more efficient and convenient for physicians. Although first-generation courses have been criticised for the lack of interactivity, new developments in multimedia technologies and broadband connectivity promise a new online learning experience, where distant participants can communicate using voice or video channels. In addition, future online CME generations may incorporate virtual reality modules that will enable physicians to learn and practice procedural techniques, as well as gain knowledge. Continued application of sophisticated technologies and continued content-development promises to add new dimensions to traditional learning and may identify online CME courses as a major medical education paradigm.

Surgical education and Internet-based simulation: The World Virtual University

The new means and modalities of communication and information technologies have significantly revolutionized access to surgical education. The introduction of the Internet information highway into mainstream clinical practice as an information sharing medium offers a wide range of opportunities to healthcare professionals. High-speed Internet broadcasting allows the display of high-quality full-screen videos. Access to surgical procedures through the Internet already plays a major role in continuing medical education nowadays and will undoubtedly be gaining grounds in the future. WebSurg.com, the World Virtual University, a web-based surgical university, is dedicated to minimally invasive laparoscopic surgery. Using brand-new multimedia data, the electronic university provides thorough descriptions of over 150 procedures in minimal access surgery and 265 videos of surgical interventions. Such a teaching tool recreates all the prerequisites and requirements of a traditional School of Medicine, incorporating the manifold standpoints of world-renowned experts about specific topics and hands-on hints in various surgical specialities. Following the evolution of technologies, recent advances have made it possible to display items of Websurg.com on handheld devices (personal data/digital assistance also known as PDAs, Pocket PCs, and smart phones). Integrating all these elements into a unique World Virtual University, Websurg.com epitomizes the concept of a unified academic center providing teaching and tutorials administered by international experts. The Internet assuredly contributes to the worldwide diffusion of scientific information in an easy and user-friendly way.

Using the Internet to conduct surveys of health professionals: a valid alternative?

OBJECTIVE

The purpose of this study was to examine whether Internet-based surveys of health professionals can provide a valid alternative to traditional survey methods.

METHODS

(i) Systematic review of published Internet-based surveys of health professionals focusing on criteria of external validity, specifically sample representativeness and response bias. (ii) Internet-based survey of GPs, exploring attitudes about using an Internet-based decision support system for the management of familial cancer.

RESULTS

The systematic review identified 17 Internet-based surveys of health professionals. Whilst most studies sampled from professional e-directories, some studies drew on unknown denominator populations by placing survey questionnaires on open web sites or electronic discussion groups. Twelve studies reported response rates, which ranged from nine to 94%. Sending follow-up reminders resulted in a substantial increase in response rates. In our own survey of GPs, a total of 268 GPs participated (adjusted response rate = 52.4%) after five e-mail reminders. A further 72 GPs responded to a brief telephone survey of non-respondents. Respondents to the Internet survey were more likely to be male and had significantly greater intentions to use Internet-based decision support than non-respondents.

CONCLUSIONS

Internet-based surveys provide an attractive alternative to postal and telephone surveys of health professionals, but they raise important technical and methodological issues which should be carefully considered before widespread implementation. The major obstacle is external validity, and specifically how to obtain a representative sample and adequate response rate. Controlled access to a national list of NHSnet e-mail addresses of health professionals could provide a solution.

Live streaming video for medical education: a laboratory model

At the University of Kentucky (UK), we applied streaming video technology to develop a webcast model that will allow institutions to broadcast live and prerecorded surgeries, conferences, and courses in real time over networks (the Internet or an intranet). We successfully broadcast a prerecorded laparoscopic paraesophageal hernia repair to domestic and international clients by using desktop computers equipped with off-the-shelf, streaming-enabled software and standard hardware and operating systems. A web-based user interface made accessing the educational material as simple as a mouse click and allowed clients to participate in the broadcast event via an embedded e-mail/chat module. Three client computers (two connected to the Internet and a third connected to the UK intranet) requested and displayed the surgical film by means of seven common network connection configurations. Significantly, no difference in image resolution was detected with the use of a connection speed faster than 128 kilobytes per second (kbps). At this connection speed, an average bandwidth of 32.7 kbps was used, and although a 15-second delay was experienced from the time of data request to data display, the surgical film streamed continuously from beginning to end at a mean rate of 14.4 frames per second (fps). The clients easily identified all anatomic structures in full color motion, clearly followed all steps of the surgical procedure, and successfully asked questions and made comments by using the e-mail/chat module while viewing the surgery. With minimal financial investment, we have created an interactive virtual classroom with the potential to attract a global audience. Our webcast model represents a simple and practical method for institutions to supplement undergraduate and graduate surgical education and offer continuing medical education credits in a way that is convenient for clients (surgeons, students, residents, others). In the future, physicians may access streaming webcast material wirelessly with hand-held computers, so that they will be freed from computer stations.