M. C. McCullough5, L. Kulber2, P. Sammons5, P. Santos3, D. Kulber5,6 2Mending Kids, International,Los Angeles, CA, USA 3Matola Hospital,Plastic And Reconstructive Surgery,Matola, Mozambique 5University Of Southern California,Plastic And Reconstructive Surgery,Los Angeles, CA, USA 6Cedars-Sinai Medical Center,Plastic And Reconstructive Surgery,Los Angeles, CA, USA
Introduction: Untreated surgical conditions account for one third of the total global burden of disease, and a lack of trained providers is a significant contributor to the paucity of surgical care in low and middle-income countries (LMICs). Wearable technology with real-time tele-proctoring has been demonstrated in high-resource settings to be an innovative method of advancing surgical education and connecting providers, but application to LMICs has not been well-described. We share our six-month experience with Google Glass in Mozambique and demonstrate the feasibility of using wearable technology with tele-proctoring to expand access to training opportunities in reconstructive surgery in this low resource setting.
Methods: Google Glass with live-stream capability was utilized to facilitate pre and intra-operative tele-proctoring sessions between a surgeon in Mozambique and a reconstructive surgeon in the United States over a six month period. At the completion of the pilot period a survey was administered regarding the acceptability of the image quality as well as the overall educational benefit of the technology in different surgical contexts. Additional narrative interviews were conducted with both participants to gain further insight into potential challenges and limitations of the program.
Results: Twelve surgical procedures were remotely proctored using the technology. No complications were experienced in any patients. Survey results demonstrate the biggest limitations to the experience, from the perspective of both participants, were issues related to image distortion. Image quality was sufficient for the mentor surgeon to perceive and to comment on pertinent anatomical structures, instrument handling, positioning and technique, but distortion due to light over-exposure, motion artifact and image resolution were rated as moderate impairments. Video-stream latency and connection disruption were also cited as limitations. Despite image distortion, both surgeons found the technology to be highly useful as a training tool in both the intraoperative and perioperative setting.
Conclusion: Our experience in Mozambique demonstrates the feasibility of wearable technology to enhance the reach and availability of specialty surgical training in LMICs. Surgical aid to LMICs has long been dominated by short-term trips by high-income country volunteers, and creative solutions are needed to re-focus efforts on surgical education and prioritize the development of local surgeons within their countries and local practice settings. Despite shortcomings in the technology and logistical challenges inherent to international collaborations, this educational model holds promise for connecting surgeons across the globe, introducing expanded access to education and mentorship in areas with limited opportunities for surgical trainees and generating discussion around the potential for innovative technologies to address needs in training and care delivery in LMICs.