Telementoring panel discussion: Comparative Technology in Telementoring 2016

Anyone have questions while we're looking at these? In the faculty. I'm happy to comment about Google Glass a little bit. I mentioned it in our, in my presentation. And um you know, the, uh, it's been about a year since we worked with it. So, and, and it's off the market as I think everybody knows, um, but uh Uh, uh, I think there are pros and cons of the technology. So that the pros are the form factor is fantastic. I mean, the idea of being able to put something on, I can see what you see, you can project back to me into my monocle, uh, something. I think that is the right idea. And that's a scalable idea too, right? That can go 3G, 4G, wireless, uh, those kinds of things. I'm not, I'm not wrapped around any wires or any fixed form factor like the visitor factor that I got to put somewhere in the room or build into the room. Uh, the downside really is just a limitation of the technology, which I'm completely confident we will overcome. Um, when we first started working on wearable technology, we were literally using Handheld LCD projectors. I don't know if you remember these things. They were like the, the size of a uh a cigarette carton, and you could project on a wall or a ceiling or something like that. And as we started putting this together, the iPad came out. We're like, OK, well, forget this, you know, it's just the, the technology leapfrogged again. So the current limitation from our perspective on Google Glass was that You can get concepts across projecting images back into the monocle, and you can see relatively OK in seeing what the surgeon sees. But if you want to illustrate tissue planes and subtle things about surgery and telestrate in fine detail where you want someone to dissect and cut and that kind of thing, we weren't able to do that effectively with Google Glass. So it may actually in your model, Todd, where you're saying, you know, you work through. um observation and then, um, and then, you know, doing a case with me there and you had a progressive model. It may be that something that's of lower fidelity, but more scalable, more available comes even a little later than that. So we can step down in the technology. You, you kind of understand the planes and that kind of thing, but I want to help you with some other parts of the procedure. So, uh, and the other limitation I would say was battery power. We were, uh, uh, you know, so you had to do quick procedures. Heat would get a little bit uncomfortable with the heat on your head, that form factor. All of these things we're going to overcome. Um, and it's just, it's just a matter of time. It's like 15 minutes, right, Brian? Is that what, or even the recording time or something like that? Yeah, better than that. One of the, you know, the reason why we were working with that company Pristine is they basically stripped the operating system down to just the things that we needed to do to communicate, and that helped lengthen the battery life and decrease some of the heat buildup. But, but still it was limited. In fact, we would, we would use it wired to a battery pack for a meaningful case because it just didn't last long enough. Wow. Uh, well, thanks for that. I know that there are people playing around with Google Glass, and I haven't tried it myself. There was a question or comment from Dr. Rupachetti, who asks, and this is, I think, Brian, you had this in your talk. He says, do you think it will ultimately be that there will be a virtual sort of humanoid robot that would replace the human mentor, someone that would be a robotic mentor. Um, the closest I know of that now is the robot. I mean, that is the ultimate in robotic surgery, which is different. Whereas that's, that makes a great distinction, that the mentor is not physically doing anything. They're just giving tips. Robotic surgery is when the virtual surgeon actually physically does something to the patient. So you're crossing between Mentorship and robotic surgery, once you start having something that's physically carrying out a task. And, and I don't know if that answered your question or not. The other question here is the cost of tel uh I think I meant telestration. We don't know yet. Um, I don't think telestration has a cost per se, but I know myself, I've seen probably 4 or 5 systems that are coming out soon in the next year of companies that are having robust telestration systems. Um, regarding the cost of the visitor one, I would direct you to to Leslie Landrum, and she could probably talk to you offline of the price of their telestration system. Um. So, uh, and if any of the faculty want to make a comment, please speak up. Otherwise, I'm going to keep rambling here. Um, so, uh, the other, I, I, we did ask the audience, should the mentor have a prior relationship with the patient? Uh, and 64% of you said no. Uh, enough of you did say that they believe that they should. And so, please feel free to write your comments in here as we Uh, in the next few minutes, wind up the event. But, uh, if there's any comments or questions, uh, go ahead. Um, Steve, Brian, or Knut, I know you guys are muted, um, but I don't know if you have any final comments or thoughts about what's been said today. OK, um, Uh, I think, you know, everything is about the surgical education and, uh, we have been, uh, developing, you know, different educational settings for, uh, for decades within surgery, but, uh, but now it's, uh, it's, uh, all this new technology makes it possible to enhance and promote and do, uh, surgical education in a new way. And I absolutely love your skills acquisition model, Todd. That's, I think that's one of the, will be one of the main frameworks within, within, uh, surgical, uh, telementoring, and I, I think also that, uh, that Brian's, uh, mention of the labco model, uh, where we have a structured framework of, uh, of, uh, actually how to discuss and speak during surgical tele mentoring is It's very important. And then finally, I want to mention that it, it was just published a paper related to uh the need for surgeons, uh, and in, I think that uh within a very few years it will be a lack of 20 to 3000 general surgeons in the United States and I think we will face the same thing in, in Europe. Uh, so we have to enhance, uh, uh, and, and, um, affect us, um, uh, surgical education. And I think that surgical telementoring may be a way forward to, to improve, uh, and, and, uh, improve the quality and and decrease the length of surgical education. Yeah, and that's another point, by the way. Other uses of telementoring that I've heard are that residents that finish their residencies still need to be mentored in their next two years out. That way, the relationship's already been established, and it allows them to sort of gradually get into practice when they're out on their own. People have asked if the, you know, it's interesting in the United States to become board certified, you need to take a written or an oral test, but no one ever checks to see if you're a good surgeon. So maybe we'll be having telepromptering as part of the board certification. Uh, people have thought about the use of it for that purpose. Um, that's actually how the board started, Todd, that they did used to come to your operating room in the early days of the American Board of Surgery and watch you operate. That was part of the examination process. Wow. So, Todd, I would just say I think one of the biggest hurdles is honestly surgeon mentality. I mean, we're used to standing alone. You know, we're not, we're, we're sort of taught to do it on our own. Our egos get in our way. Uh, we may not ask for help when we should. Um, there's a, I, I don't know if an embarrassment factor is the right word, but there's a hesitancy to, to show weakness, you know, to, to say I can't do it. And I think the real question is, why would you not want the most expertise in every procedure that you could do it. Not just maybe telementoring, uh, you know, you're, so that you can do a lap colon, uh, the first few times, but, but on every case, or certainly the most complicated cases. Why wouldn't you want someone with much more experience there just to help, help with that, and that's got to improve patient outcomes. We know it does when that mentor or advisor is there in the room. There's no question that it would, it could do it as well over, you know, over the internet, and I think we, we have to kind of change our mentality and accept that, um, saying that we're, we're doing this because we want to do what's best for our patients. We want the best outcomes. And if we embrace that as surgeons, then I think we have a chance of getting hospital systems and the government and regulatory agencies to embrace it too, because if you go, if you go to the, you know, the American Medical Society or even go to Congress and say, you know what, you have created all these roadblocks for us to do this. Why would you not want the most expertise in every case for a better outcome for that patient? What are they going to say to you? You know, if we provide the framework to show that we're actually doing that, how can you say no? You know, I think, and I think that's where we have to go. Yeah. So, you know, it's a, I don't know if there's an awareness really among our kind of policymakers about this world. I think they kind of look at telemedicine with one view, and that's you and me directly interacting with a patient and doing some kind of care. They don't understand this is a quality initiative. I, I, I think that we need to get across to them that Um, this is a virtual university. I mean, look at moves and things like that. Universities reach out and train hundreds and thousands of people beyond their walls and beyond their, their city and their state. It's a similar concept, and I, and I love your comments about, um, we got to open up this black box of the operating room and um And start, you know, understanding better what's happening there and allowing interaction. It's actually happening anyways in this world of trying to decrease variability of the delivery of care, um, we're already getting our performance of our surgery looked at. We've got data now to say that patient outcome is directly related to technical ability. And so institutions that are looking for value and care, they're going to want to make sure the best technical ability is being delivered to their patients and, and sharing how to do that using technology is a way to do it. So I love your comments on that, opening up that black box. Uh, Todd, may I make a, a, a final comment, um, and that's related to, uh, research on surgical telementoring. Um, and, uh, we know that, uh, that there are a lack of good quality studies on surgical telementoring, unfortunately, and that has to do with the, with the, the huge obstacles with logistics and also that the technology has been, uh, quite cumbersome to, to use, but I think that this will change, but Uh, but, but to get really hard evidence, we have to join forces internationally, and I want to repeat my, my, my suggestion, uh, which I made at the, the Project 6 meeting where we should, uh, create an international, uh, surgical, uh, quality registry of surgical telementoring where we can include all cases. Instead of publishing small series of 1015, 20, uh, telementored cases, we can, we can join forces and, and, uh, and, uh, make a quality registry that will make a change and will make an impact, not this year, not in 5 years, but might maybe in, in 10 years. I agree it's, uh, Knut, but I'll tell you that I think that, um. You're, you're not gonna see enough cases being done to have worthwhile information until the fear of telementoring is alleviated. And once we can figure out the medical legal hurdle. Uh, I think then when we start doing it legitimately through licensing, through credentialing where people feel comfortable, you'll start seeing much more wide scale use of a widespread use of this technology, and then you can start doing prospective studies comparing one case without mentoring and one with mentoring, one with physical mentoring versus virtual mentoring, like Brian talked about. But right now, everyone's scared. And this is, like I said, anyone who's here today is a pioneer. This is, you're, you're, you're stepping on a little bit of cowboy dangerous territory, but we're doing it because we know that ultimately it's absolutely the right thing for the patient. So, I agree, Knut, but maybe it won't happen immediately. Uh, any final words or comments? I think it's, if everyone's OK, we might finish a little early here today. If there's any last questions from the audience, go ahead now. Otherwise, uh feel free to send us a comment or an email, and we can send it to the faculty. Um, if anyone, if no one has any other final comments or thoughts, then I will conclude here and thank.