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StayCurrentMD
Surgical Skill Acquisition in the Modern Era: Comparative Technology in...
With Dr. Todd Ponsky
Part of
Trauma 6 items
Chapter 1 of 5 · Fundamentals
Education history
Historical context of surgical education and the apprenticeship model
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Sir William Osler decided that medical training needed residency programs to bring doctors to patients, moving away from lecture-based education
Dr. William Halstead, a surgeon, adapted Osler's residency concept to create surgical residency programs
One-day surgical courses contradict Halstead's apprenticeship model, which requires intensive process of watching an expert and being watched by them
The skill acquisition model consists of 5 steps: course attendance, trainee observes expert, trainee performs with expert watching, telementoring, and teleproctoring
Telementoring should be introduced at step 4 of the skill acquisition model, not step 1, after a relationship has been established
Virtual courses allow surgeons to learn without traveling, using the internet in ways that make sense
In the first telementoring case using Skype for a lung resection, verbal pointing without telestration was really difficult for guiding the surgeon
The Visitor One solution provides telestration capability allowing the mentor to draw on the surgical video in real-time
Off-the-shelf technology including Androids and iPads can be used for telestration, based on solutions developed by the Norway team
Telestration lines move when the camera moves during surgery, which is a technical limitation
The surgeon performing the operation must be able to complete it independently if technology fails or internet connection is lost
Two weeks prior to this presentation, a trauma patient at a non-pediatric trauma center was too unstable to transfer, requiring phone guidance until the speaker could drive to the hospital
Some envision an emergency 'break the glass' telementoring system where a mentor helps through a case without prior relationship, called the co-pilot method or virtual first assistant
The more accepted model incorporates telementoring at the end of a staged stepwise process following the skill acquisition model
For telementoring to work on a global scale, experts need justification for not spending time in their own operating rooms, requiring compensation beyond goodwill
The American College of Surgeons Education Committee under David Hoyt and Sadiva are pushing telementoring initiatives
Demand for telementoring has come from rural surgeons working alone who want help without sending all patients to tertiary centers
The Akron-Tromsø project tested whether laparoscopic non-mesh hernia repair could be taught using the skill acquisition model
The Akron-Tromsø project began with a virtual course watched by Norwegian surgeons, followed by in-person training in Norway
The first telementoring case in the Akron-Tromsø project had the mentor present in the same operating room 4 feet away to test the model before going fully remote
The second telementoring test had the mentor on the 4th floor of the hospital while the surgeon operated, allowing the mentor to come down if needed
Transatlantic telementoring was successfully performed at 3 AM for a full day of cases using iPad drawing system
Medical knowledge doubles every 18 months, making techniques learned in training rapidly obsolete