Characterization of remote second-opinion oncology patients and associated changes in management

Background: The utilization of virtual second opinions in oncology has increased considerably in the last decade, driven by the increased complexity of care and desire for expert opinion, improved technologies in telemedicine, and the acceleration of virtual services due to the Covid-19 pandemic. Therefore, it is important to further understand the patient populations that currently use virtual second opinion programs and to measure their effectiveness. Virtual second opinion programs provide a platform for patients to submit their medical history and questions regarding their condition to remote specialists who then render their opinions on diagnosis and management. Currently there is a paucity of research on the types of patient populations that seek second opinions and the outcomes of these rendered opinions. Here we describe the patient characteristics and changes in management associated with utilization of a virtual second opinion service at an academic medical center. Methods: In this IRB-approved retrospective review, we identified 657 cancer patients that utilized a virtual digital health platform to engage in second opinions at Stanford Healthcare. Patient demographics, cancer staging, site of origin, and prior therapeutic and surgical history were collected. Physician opinions rendered were self-classified into “major change in treatment”, “minor change in treatment”, or “no change in treatment.”. Results: The majority of patients who utilized the virtual second-opinion platform had a diagnosis late-stage cancer (with 77.2% at Stage III or IV). Breast cancer was the most common primary tumor site (24.7% of patients) followed by GI (21.9%) and GU malignancies (14.0%). Patients diagnosed with dermatological (4.4%), head and neck (3.3%), and neurological (3.2%) malignancies were least common. Physicians providing the virtual second-opinion were primarily medical oncologists (67.6%), followed by gynecologists (6.8%), urologists (5.2%), radiation oncologists (5.0%), and surgical oncologists (4.4%). Physicians self-reported that in more than half of cases reviewed (53.8%) a minor or major treatment change was recommended. Conclusions: This study showed that patients access second opinion platforms at late stage of cancer disease progression. With treatment changes recommended for more than half of the cases, virtual second opinion programs can potentially have a significant impact on cancer care. Patient satisfaction and clinical outcomes from virtual second opinion programs is an area of on-going research.

Unlocking growth options in surgical education and training during the pandemic

Introduction: The COVID-19 pandemic brought widespread disruption to structured surgical education and training. The knee-jerk reaction is often pessimism about surgical training's future, particularly in the Improved Surgical Training (IST) pilot's context. However, Einstein famously once said, 'In the midst of every crises lies great opportunity'. Unlocking growth during periods of high uncertainty is a premise of real options theory;one utilised by supply chain managers and decision scientists, but novel to medical education. This study explores the growth options that have resulted from new operational models during the pandemic. Method: Using a qualitative case study approach, data were obtained from interviews with core surgical trainees across Scotland. Data coding and inductive thematic analysis were undertaken. Results: Forty-six trainees participated. Analysis from trainees' perspective revealed: unexpected fulfilment from redeployment to nonsurgical specialties, benefits to personal development from the unintended broad-based training across surgical specialties, improved collaborative teamworking between specialties and allied healthcare professionals, and enhanced supervised learning opportunities. Institutional growth options reported by trainees included: rapid uptake of telemedicine and digital technology, implementation of single hospital episode encounters for minor conditions, streamlined processes in theatre and acute admissions, and changes in working culture towards rationalising and teamworking. Conclusions: Growth options have been deliberately and unintentionally unlocked due to individual and institutional adaptions and innovations in response to the exogenous disruption. While some changes may be temporary, hopefully structured reflection on these changes and responders to them will drive surgical education and training into a new sustainable and resilient post-pandemic era.

Unlocking growth options in surgical education and training during the pandemic

Introduction: The COVID-19 pandemic brought widespread disruption to structured surgical education and training. The knee-jerk reaction is often pessimism about surgical training's future, particularly in the Improved Surgical Training (IST) pilot's context. However, Einstein famously once said, “In the midst of every crises lies great opportunity”. Unlocking growth during periods of high uncertainty is a premise of real options theory;one utilised by supply chain managers and decision scientists, but novel to medical education. This study explores the growth options that have resulted from new operational models during the pandemic. Methods: Using a qualitative case study approach, data were obtained from interviews with core surgical trainees across Scotland. Data coding and inductive thematic analysis were undertaken. Results: Forty-six trainees participated. Analysis from trainees' perspective revealed: unexpected fulfilment from redeployment to non-surgical specialties, benefits to personal development from the unintended broad-based training across surgical specialties, improved collaborative teamworking between specialties and allied healthcare professionals, and enhanced supervised learning opportunities. Institutional growth options reported by trainees included: rapid uptake of telemedicine and digital technology, implementation of single hospital episode encounters for minor conditions, streamlined processes in theatre and acute admissions, and changes in working culture towards rationalising and teamworking. Conclusion: Growth options have been deliberately and unintentionally unlocked due to individual and institutional adaptions and innovations in response to the exogenous disruption. While some changes may be temporary, hopefully structured reflection on these changes and responders to them will drive surgical education and training into a new sustainable and resilient post-pandemic era.