El auge del teleproctorado en la formación quirúrgica

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.

El reto del futuro

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.

Tras dedicar los dos últimos años a dominar los procedimientos coronarios mínimamente invasivos bajo la experta dirección del Prof. Dr. Wouter Oosterlinck, abrazó la frontera digital optando por el teleproctorado durante su primera intervención en solitario.

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.

Figura 1 La Dra. Marie De Vos y sus colegas, el Dr. Willem Ranschaert (izquierda) y el Dr. Wim Vergauwen (derecha) en AZ Sint-Jan Brugge, Brujas, Bélgica.

Calendario de preparación para la teleasistencia

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.

La conexión a distancia

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.

Figura 2 Vista remota de la señal de vídeo del robot
Figura 3 Dra. Marie De Vos durante la intervención robótica

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.

Ventajas para los becarios - Cultivar la independencia y la capacidad de tomar decisiones

El teleproctorado ofrece una ventaja distintiva en la formación quirúrgica al lograr un delicado equilibrio entre orientación e independencia, lo que a su vez agudiza la curva de aprendizaje de alumnos como la Dra. Marie De Vos. La necesidad de que el alumno resuelva los problemas sin la presencia física del supervisor infunde un sentido de autonomía y fomenta el pensamiento crítico.

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.

Al crear y facilitar un escenario en el que el cirujano en formación debe actuar con decisión y asumir toda la responsabilidad de la cirugía, el teleproctorado acelera el desarrollo del alumno. Este método garantiza que, cuando el alumno finalmente actúe sin supervisión, esté bien preparado para asumir el papel de líder seguro y capaz en el quirófano.

Figura 4 La Dra. Marie De Vos y el equipo de quirófano durante la intervención abierta con gafas inteligentes

Perspectiva del Proctor - Mejorar la tutoría a través de medios digitales

Figura 5 Prof. Dr. Wouter Oosterlinck - Remote Proctor guiando a la Dra. Marie De Vos durante la intervención.

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.

Cuanto mayor es la distancia, mayor es la incertidumbre y el compromiso de tiempo. Y si consideramos las distancias internacionales, el tiempo y los costes, incluido el impacto medioambiental, aumentan exponencialmente."

"Al evaluar todos los casos de proctoring en los que he participado, es factible que un porcentaje significativo pudiera gestionarse a distancia", sugiere. "Para un profesional con formación coronaria y formación adecuada en simulación, creo que tras una o dos visitas físicas, el equipo estaría preparado para progresar con soporte digital".

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.

Este método rentable no sólo reduce las cargas financieras, sino que también se ajusta a la creciente necesidad de conciencia medioambiental al minimizar la huella de carbono asociada a los viajes.

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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