Das Aufkommen von Teleproctoring in der chirurgischen Ausbildung

The following case report dives into the advantages of teleproctoring for both mentors and mentees in the context of surgical training. For Dr. De Vos, navigating her first solo procedure under remote supervision accelerated her learning and strengthened her independence. The lack of an onsite proctor pushed her to resolve challenges independently, enhancing her decision-making abilities and leadership within the OR. On the mentor side, Prof. Dr. Oosterlinck experienced significant time and resource savings, highlighting the efficiency and environmental benefits of teleproctoring by eliminating the need for travel.

Die kommende Herausforderung

Dr. Marie De Vos is a cardiac surgeon in her fourth year of residency ready to transition from a supporting role to a leading one in the operating room.

Nachdem sie sich in den vergangenen zwei Jahren unter der fachkundigen Anleitung von Prof. Dr. Wouter Oosterlinck mit minimalinvasiven Koronareingriffen beschäftigt hatte, wagte sie den Schritt in die digitale Welt und entschied sich bei ihrem ersten Solo-Eingriff für Teleproctoring.

Operating out of general hospital AZ Sint-Jan Brugge, Bruges, Belgium, Dr. De Vos prepared to undertake the procedure with the digital remote support of Prof. Dr. Oosterlinck, who would be proctoring from Leuven, roughly a 2,5-hour car drive away. This arrangement promised to blend the autonomy necessary for Dr. De Vos’ growth with the safety net of expert supervision.

Abbildung 1 Dr. Marie De Vos und ihre Kollegen Dr. Willem Ranschaert (links) und Dr. Wim Vergauwen (rechts) im AZ Sint-Jan Brugge, Brügge, Belgien

Timing der Bereitschaft zur Fernsteuerung

The journey from observer to practitioner in the field of surgery is multifaceted and varies for each individual. The consensus between the resident surgeon and her mentor, highlights a critical aspect of transitioning to teleproctoring: the readiness of the surgeon. “It’s essential that you’ve been part of the procedure extensively,” Dr. De Vos explained. “The decision to start teleproctoring is a collaborative one between the proctor and the surgeon. In my case, I felt prepared for remote support, and Prof. Dr. Oosterlinck agreed.”

Dr. De Vos’ 2 year preparation included three months of meticulous observation, attending procedures at least twice per week, followed by another three months of intensive training where she actively participated in various aspects of the surgery. This progressive approach built her confidence and skill set.

Prof. Dr. Oosterlinck, endorsing his mentee’s readiness, stated, “She successfully completed every step, and together, we chose a straightforward patient for her first solo procedure” —a decision that was as strategic as it was pedagogical.

Now it was about connecting all these individual steps into one fluid operation. They opted for a case that demanded a high level of technical skill and mental fortitude, especially for a surgeon’s first solo procedure.

Die Fernverbindung

For Dr. De Vos’ solo procedure, the Rods&Cones Remote Collaboration Service served as the digital bridge between her and her Proctor. During the mammary harvesting phase of the procedure, the robot’s video feed was shared with Prof. Dr. Oosterlinck and during the open anastomosis phase of the operation, she wore smart glasses that offered her proctor a first-person perspective of the surgical field.

Abbildung 2 Fernansicht der Videoübertragung des Roboters
Abbildung 3 Dr. Marie De Vos während des robotischen Eingriffs

From his office in Leuven, the Professor was virtually present in the operating room in Bruges via his computer screen. This setup enabled him to observe and follow the procedure with the same level of detail as if he were physically present.

Reflecting on the experience, Dr. De Vos noted the unobtrusiveness of the smart glasses. “The camera didn’t interfere with my work and the audio quality was excellent—I could hear Prof. Dr. Oosterlinck clearly,” she said. The seamless integration of the technology into her surgical process showcased its ability to enhance the procedure without causing distractions or discomfort.

Vorteile für Auszubildende - Förderung von Selbstständigkeit und Entscheidungskompetenz

Teleproctoring bietet einen besonderen Vorteil in der chirurgischen Ausbildung, da es ein ausgewogenes Verhältnis zwischen Anleitung und Unabhängigkeit schafft, was wiederum die Lernkurve für Auszubildende wie Dr. Marie De Vos verbessert. Die Notwendigkeit für den Auszubildenden, Probleme ohne die physische Anwesenheit des Prüfers zu lösen, vermittelt ein Gefühl der Autonomie und fördert das kritische Denken.

The surgical practitioner experienced this firsthand, the absence of the proctor in the room compelled her to rely on her skills and judgment to complete the procedure. “It was more effective remotely, as this way, I had to finish the procedure myself. It gives me more time to find solutions to problems before seeking assistance”.

The absence of the proctor’s physical presence also ensures that the trainee maintains the leading role in the operating room, reducing distractions. Prof. Dr. Oosterlinck acknowledged the benefits of this approach. “There should be only one operating surgeon. If somebody else is giving orders, it is distracting for the team. It is the safest approach,” he said. Proctoring remotely, the proctor guides and supports without overshadowing the surgeon’s authority.

Durch die Schaffung und Erleichterung eines Szenarios, in dem der angehende Chirurg entschlossen handeln und die volle Verantwortung für den Eingriff übernehmen muss, beschleunigt das Teleproctoring die Entwicklung des Auszubildenden. Diese Methode stellt sicher, dass der Auszubildende, wenn er schließlich ohne Aufsicht operiert, gut darauf vorbereitet ist, die Rolle eines selbstbewussten und kompetenten Leiters im Operationssaal zu übernehmen.

Abbildung 4 Dr. Marie De Vos und das OP-Team während des offenen Eingriffs mit der Smart Glasses

Proctor Perspective - Verbesserung der Mentorenschaft durch digitale Mittel

Abbildung 5 Prof. Dr. Wouter Oosterlinck - Remote Proctor führt Dr. Marie De Vos durch den Eingriff.

Prof. Dr. Oosterlinck expressed a high level of satisfaction with the process: “I was very positive about the steps we took. The interventions and guidance helped to identify problems and find solutions. It underlines that our physical presence is not necessary to achieve these outcomes.”

For the experienced cardiologist, successful teleproctoring hinges on the preparation of the trainee and the quality of digital communication tools. “If the trainee is well-prepared, physical presence is not required. What’s essential is the ability to communicate, solve problems, and provide intellectual and mental support digitally. The tools we used met these needs exceptionally well.”

Another significant benefit for the proctor is the considerable saving of time and resources. He compared the logistics of in-person proctoring with the teleproctoring session. “I logged in at about 9:00 and was done by 1:00. In contrast, an in-person visit would require leaving home around 6 and not returning until between 3 and 4, not to mention the unpredictability of traffic.

Je größer die Entfernung, desto größer die Unsicherheit und der Zeitaufwand. Und wenn wir internationale Entfernungen berücksichtigen, steigen der Zeitaufwand und die Kosten, einschließlich der Umweltauswirkungen, exponentiell an.

"Bei der Auswertung aller Proctoring-Fälle, mit denen ich zu tun hatte, könnte ein erheblicher Prozentsatz aus der Ferne betreut werden", meint er. "Ich glaube, dass ein Fachmann mit einem koronaren Hintergrund und einer angemessenen Simulationsausbildung nach ein oder zwei physischen Besuchen in der Lage wäre, mit digitaler Unterstützung fortzufahren.

Oosterlinck envisions a functional model involving one-third physical presence and two-thirds remote assistance. “I am convinced of this approach.”

Reflecting on the time spent traveling for in-person proctoring, the Professor often questions the necessity of his physical presence. The effort of being on-site, the eight-hour travels, the planes, the traffic—it all comes into question when he finds himself simply offering support from the sidelines, a role that, as demonstrated with Dr. De Vos, can effectively be fulfilled from a distance. The ability to identify issues, ask the right questions, and provide solutions does not always require being physically present in the operating room. The Session with Dr. De Vos made it clear to him, that remote teleproctoring is not just a viable option but also a potentially superior one in certain contexts.

Diese kosteneffiziente Methode verringert nicht nur die finanzielle Belastung, sondern entspricht auch dem wachsenden Bedürfnis nach Umweltbewusstsein, da sie den mit Reisen verbundenen CO2-Fußabdruck minimiert.

Moreover, trainees like Dr. De Vos benefit from this model, gaining independence more quickly, thereby diminishing the need for constant proctor presence. “Dr. De Vos is already taking off after this session. With support for maybe three or four more cases, she’ll be ready to proceed independently. And I anticipate that within a year, she’ll be tackling more complex cases, potentially requesting my digital presence as a safety net,” Prof. Dr. Oosterlinck projected.

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