L'ascesa del teleproctoring nella formazione chirurgica

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.

La sfida che ci attende

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.

Dopo aver dedicato gli ultimi due anni a padroneggiare le procedure coronariche minimamente invasive sotto la guida esperta del Prof. Dr. Wouter Oosterlinck, ha abbracciato la frontiera digitale optando per il teleprotettore durante il suo primo intervento in solitaria.

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 dott.ssa Marie De Vos e i suoi colleghi, il dott. Willem Ranschaert (a sinistra) e il dott. Wim Vergauwen (a destra), presso l'AZ Sint-Jan Brugge, Bruges, Belgio.

Tempistica della preparazione per il telecomando

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 connessione remota

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 del feed video del robot
Figura 3 La dottoressa Marie De Vos durante l'intervento robotico

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.

Vantaggi per i tirocinanti - Coltivare l'indipendenza e le capacità decisionali

Il teleproctoring offre un vantaggio distintivo nella formazione chirurgica, poiché raggiunge un delicato equilibrio tra guida e indipendenza, che a sua volta affina la curva di apprendimento per i tirocinanti come la dott.ssa Marie De Vos. La necessità per il tirocinante di risolvere i problemi senza la presenza fisica del proctor infonde un senso di autonomia e favorisce il pensiero critico.

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.

Creando e facilitando uno scenario in cui il chirurgo in formazione deve agire con decisione e assumersi la piena responsabilità dell'intervento, il teleproctoring accelera lo sviluppo del tirocinante. Questo metodo garantisce che, quando il tirocinante si esibisce senza tutoraggio, sia ben preparato ad assumere il ruolo di leader sicuro e capace in sala operatoria.

Figura 4 La dott.ssa Marie De Vos e l'équipe della sala operatoria durante l'intervento aperto con gli smart glasses

Proctor Perspective - Migliorare la mentorship attraverso i mezzi digitali

Figura 5 Il Prof. Dr. Wouter Oosterlinck - Remote Proctor guida la Dr.ssa Marie De Vos durante l'intervento.

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.

Maggiore è la distanza, maggiore è l'incertezza e l'impegno di tempo. E se consideriamo le distanze internazionali, i tempi e i costi, compreso l'impatto ambientale, aumentano esponenzialmente".

"Valutando tutti i casi di proctoring in cui sono stato coinvolto, una percentuale significativa potrebbe essere gestita in remoto", suggerisce. "Per un professionista con un background coronarico e un'adeguata formazione in materia di simulazione, credo che dopo una o due visite fisiche, il team sarebbe pronto a procedere con il supporto digitale".

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.

Questo metodo conveniente non solo riduce gli oneri finanziari, ma si allinea anche alla crescente esigenza di consapevolezza ambientale, riducendo al minimo l'impronta di carbonio associata ai viaggi.

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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