Bridging the Gap of Skilled Surgeons in Low and Middle Income Countries Using ICT Based Tools : A Case Study in Super-Speciality Training
Introduction: Over the last two decades, advancement of super specialised surgical disciplines has shown improved health outcome, in particular quality and safety. Although medical technology has developed to meet diagnostics and therapeutic needs, there is a scarcity of trained human resources in advanced specialities in low and middle income countries (LMICs). Innovative methods are needed to educate and train people at their workplaces using collaborative technologies and networks. Methods: Over the last 15 years, two general surgeons in Cuttack have been telementored from Lucknow 1,163 km away, using collaborative technologies to develop Endocrine Surgery. This study reviews the last 11 years of the service which includes a clinical decision support system and treatment planning advice using real time videoconferencing. Results: Over the last 11 years, 199 endocrine surgeries per annum were performed with most being thyroid cases as compared with 119 surgeries per annum during the previous five years. Parathyroid and adrenal cases increased significantly during this period (p <0.001). Rates of temporary and permanent vocal cord palsy (1.7% and 0%), hypocalcaemia (5.9% and 1.1%) were comparable with high volume centres. Based on the quantum, safety and quality outcome of endocrine surgery the provincial government has approved creation of a super-speciality department of endocrine surgery in Cuttack. Conclusion: Sustained engagement using telementoring can transfer surgical skills to needy surgeons and enable them to match the expertise of mentors. This model can be replicated in other specialities in a cost effective way to develop specialised human resources for healthcare, in particular in LMICs.
Kasprisin CA, Boyle SP, Single RM, Muller CB. Building a better bridge: testing etraining to improve e-mentoring programmes in higher education. Mentor Tutoring 2003;11(1):67-78. https://doi.org/10.1080/1361126032000054817
Bierema L, Merriam S. E-mentoring: Using computer mediated communication to enhance the mentoring process. Innov High Educ 2002;26(3):211-227. https://doi.org/10.1023/A:1017921023103
Russell A, Perris K. Telementoring in community nursing: a shift from dyadic to communal models of learning and professional development. Mentor Tutoring 2003;11(2):227-237. https://doi.org/10.1080/13611260306856
Bruschi M, Micali S, Porpiglia F, et al. Laparoscopic telementored adrenalectomy: the Italian experience. Surg Endosc 2005;19(6):836–840. https://doi.org/10.1007/s00464-004-9124-2
Rosser JC, Wood M, Payne JH, et al. Telementoring: a practical option in surgical training. Surg Endosc 1997;11(8):852–855. https://doi.org/10.1007/s004649900471
Challacombe B, Kandaswamy R, Dasgupta P et al. Telementoring facilitates independent hand-assisted laparoscopic living donor nephrectomy. Transplant Proc 2005:37(2):613–616. https://doi.org/10.1016/j.transproceed.2005.01.065
Talbot M, Harvey EJ, Berry GK, et al. A pilot study of surgical telementoring for leg fasciotomy. J R Army Med Corps 2018;164(2):83-86. http://dx.doi.org/10.1136/jramc-2017-000817
World Health Organization. A health telematics policy in support of WHO’s Health-For-All strategy for global health development: report of the WHO group consultation on health telematics, 11–16 December, Geneva, 1997. Geneva, World Health Organization, 1998.
Augestad KM, Han H, Paige J, et al. Educational implications for surgical telementoring: a current review with recommendations for future practice, policy, and research. Surg Endosc 2017;31(10):3836–3846. https://doi.org/10.1007/s00464-017-5690-y
Lee JH, Tanaka E, Woo Y, et al. Advanced real-time multi-display educational system (ARMES): An innovative real-time audiovisual mentoring tool for complex robotic surgery. J Surg Oncol 2017;116(7):894-897. https://doi.org/10.1002/jso.24722
Nguyen NT, Okrainec A, Anvari M, et al. Sleeve gastrectomy telementoring: a SAGES multi-institutional quality improvement initiative. Surg Endosc 2018;32(2):682-687. https://doi.org/10.1007/s00464-017-5721-8
Hadley GP, Mars M. e-Education in paediatric surgery: a role for recorded seminars in areas of low bandwidth in sub-Saharan Africa. Pediatr Surg Int 2011;27(4):407-410. https://doi.org/10.1007/s00383-010-2806-z
Hadley GP, Mars M. Postgraduate medical education in paediatric surgery: Videoconferencing—a possible solution for Africa? Pediatr Surg Int 2008;24(2):223–226. https://doi.org/10.1007/s00383-007-2085-5
Pradeep PV, Mishra A, Mohanty BN, et al. Reinforcement of endocrine surgery training: impact of telemedicine technology in a developing country context. World J Surg 2007;31(8):1665-1671. https://doi.org/10.1007/s00268-007-9108-1
National Knowledge Network. 2016. Available at: http://nkn.gov.in accessed 23 December 2018.
Chand G, Agarwal S, Mishra A, et al. The impact of uniform capsular dissection technique of total thyroidectomy on postoperative complications: An experience of more than 1000 total thyroidectomies from an endocrine surgery training centre in North India. Indian J Endocrinol Metab 2018;22(3):362-367. doi: 10.4103/ijem.IJEM_598_17
Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter. Arch Surg 1999;134(12):1389–1393. doi:10.1001/archsurg.134.12.1389
Serpell JW, Phan D. Safety of total thyroidectomy. ANZ J Surg 2007;77(1-2):15-19. https://doi.org/10.1111/j.1445-2197.2006.03897.x
Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 2002;128(4):389-392. doi:10.1001/archotol.128.4.389
Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: A review of 932 cases. Can J Surg 2009;52(1):39-44. PMID: 19234650
United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision, Key Findings and Advance Tables. Working Paper No. ESA/P/WP.241.
Etzioni DA, Liu JH, Maggard MA, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg 2003;238(2)170-177. doi: 10.1097/01.SLA.0000081085.98792.3d
Rahib L, Smith BD, Aizenberg R, et al. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 2014;74(14):2913-2921. DOI: 10.1158/0008-5472.CAN-14-0155
Saunders BG, Wainess RM, Dimick JB, et al. Who performs endocrine operations in the United States? Surgery 2003;134(6):924-931. https://doi.org/10.1016/S0039-6060(03)00420-3
Sosa JA, Wang TS, Yeo HL et al. The maturation of a specialty: workforce projections for endocrine surgery. Surgery 2007;142(6):876-883, https://doi.org/10.1016/j.surg.2007.09.005
Ranshaw B, Tucker J, Duncan T. Laparoscopic herniorrhaphy: a review of 900 cases. Surg Endosc 1996;10(1):29-32.
Sebajang H, Trudeau P, Dougall A, et al. Telementoring: an important enabling tool for the community surgeon. Surg Innov 2005;12(2):327–331. https://doi.org/10.1177/155335060501200407
Oliveira V, Savassi L, Lemos A, Campos F. eLearning for health in Brazil - UNA-SUS in numbers. J Int Soc Telemed eHealth 2016;4:e9.
de Oliveira AE, Franca RM, Haddad AE, Brasil LS, Pinho JR. Open applications developed in Brazil for distant learning in dentistry: valuable educational resources for academic professional qualification. J Int Soc Telemed eHealth 2016;4:e10.
Chipps J, Ramlall S, Mars M. Videoconference-based education for psychiatry registrars at the University of KwaZulu-Natal, South Africa. Afr J Psychiatry. 2012;15(4):248-254. http://dx.doi.org/10.4314/ajpsy.v15i4.32
Mars M. Tele-education in South Africa. Front Public Health 2014;2:173. https://doi.org/10.3389/fpubh.2014.00173
The RAFT project on telemedicine in French-speaking Africa. Available at: www.keneya.org.ml accessed
Stolyar VL, et al. Experience and perspectives of remote interactive training in medicine, J Int Soc Telemed eHealth 2018;6:e15. https://doi.org/10.29086/JISfTeH.6.e15
Simoes N, Coury W, Ribeiro-Filho JL, et al. National Research and Education Networks to support telemedicine and telehealth. J Int Soc Telemed eHealth 2016;4:e8.
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