Sleeve gastrectomy telementoring: a SAGES multi-institutional quality improvement initiative.

BACKGROUND: Sleeve gastrectomy is a relatively new procedure that developed as a result of rapid innovation in the field of bariatric surgery. As with any newly developed operation, there is a learning curve that potentially can be associated with higher morbidity. Real-time surgical mentoring reduces the learning curve effect but can be time intensive for the mentor. The aim of this initiative was to evaluate the feasibility, effectiveness, and satisfaction of surgical telementoring for laparoscopic sleeve gastrectomy. This is the first national specialty society effort to determine if the "remote presence" of an expert surgeon (mentor) can help practicing surgeons improve skills. METHODS: The experience of 15 surgical trainees (mentees) who performed laparoscopic sleeve gastrectomy under real-time telementoring by 7 mentors was reviewed. Telementoring was implemented using the Visitor1® remote presence system with two-way live audio and video communication. The receiving platform utilized a conventional laptop, iPad, or iPhone. The mentee followed a structured telementoring program including didactic learning, live case teleobservation, and telementoring of 2-3 cases. A survey on the quality of the telecommunication and effectiveness of the mentoring was performed by the mentor and mentee on a scale of "exceeded," "met," "almost met," or "failed to meet" expectations. The overall telementoring experience was rated on a scale of 1 for "poor" to 5 for "excellent." RESULTS: Based on the mentees' survey, the overall telementoring experience was rated as 4.8. Despite the mentees having experience with laparoscopic sleeve gastrectomy, most commented that the telementoring experience was an excellent educational tool and they learned some new techniques they plan to apply it in their practice. Based on the mentors' survey, the overall telementoring experience was rated as 4.7. All mentors stated that they were satisfied with the telementoring sessions and there were no unexpected intraoperative occurrences. There were some logistical limitations including difficulties in scheduling of cases or the delay of cases. CONCLUSIONS: Surgical instruction by telementoring was shown to be feasible, practical, and successful, and was highly rated in this study by both the mentors and mentees. The currently utilized telementoring platform is thus an effective educational tool that can facilitate acquisition of surgical skills and assist with the conventional on-site surgical mentoring model.

The Society of Thoracic Surgeons/American Association for Thoracic Surgery off-pump training program.

BACKGROUND: Opportunities to acquire knowledge and skills in new technology are limited for cardiothoracic surgeons after completion of residency. In 2000 The Society of Thoracic Surgeons/American Association for Thoracic Surgery Joint Committee for New Technology Assessment accepted an educational grant from the Foundation for Advanced Medical Education to implement and test an instructional program for practicing cardiothoracic surgeons in off-pump coronary bypass surgery. METHODS: Twenty-four surgeons were selected for participation. Instruction was provided in three phases: (1) a preliminary video illustrating the techniques; (2) 2-day training sessions at two separate locations linked by videoconference; and (3) visits by trainees to observe preceptor surgeons at their institutions, followed by visits of preceptor surgeons to the institutions of the trainees. Evaluation of the program was made by review of trainee case lists in the year after completion of the program and by written surveys completed by trainees and preceptors. RESULTS: Seventeen surgeons completed all phases of the program. Most of them reported frequently utilizing off-pump bypass surgery in practice with good results. Two surgeons dropped out of the program before the first phase, and 5 surgeons did not complete all preceptor visits. Most survey respondents commented that the program met or exceeded their expectations. CONCLUSIONS: Some trainees were unable to complete proctor visits because of professional responsibilities at home or because of difficulty in advanced scheduling of procedures. More rigorous selection and stronger administrative controls might have reduced program dropouts. The instructional model worked extremely well for properly selected and motivated surgeons.