McCullough Meghan C, Kulber Louie, Sammons Patrick, Santos Pedro, Kulber David A
Division of Plastic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif.
Ohana One, Los Angeles, Calif.
Plast Reconstr Surg Glob Open. 2018 Dec 5;6(12):e1999. doi: 10.1097/GOX.0000000000001999. eCollection 2018 Dec.
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.
Google Glass with live-stream capability was utilized to facilitate tele-proctoring between a surgeon in Mozambique and a reconstructive surgeon in the United States over a 6-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.
Twelve surgical procedures were remotely proctored using the technology. No complications were experienced in any patients. Both participants reported moderate visual impairment due to image distortion and light over-exposure. Video-stream latency and connection disruption were also cited as limitations. Overall, both participants reported that the technology was highly useful as training tool in both the intraoperative and perioperative setting.
Our experience in Mozambique demonstrates the feasibility of wearable technology to enhance the reach and availability of specialty surgical training in LMICs. Despite shortcomings in the technology and logistical challenges inherent to international collaborations, this educational model holds promise for connecting surgeons across the globe and introducing expanded access to education and mentorship in areas with limited opportunities for surgical trainees.
未经治疗的外科疾病占全球疾病总负担的三分之一，而缺乏训练有素的医疗人员是导致低收入和中等收入国家（LMICs）外科护理匮乏的一个重要因素。在资源丰富的环境中，具有实时远程指导功能的可穿戴技术已被证明是推进外科教育和连接医疗人员的一种创新方法，但在LMICs中的应用尚未得到充分描述。
在6个月的时间里，利用具有直播功能的谷歌眼镜促进了莫桑比克的一名外科医生与美国的一名重建外科医生之间的远程指导。在试点期结束时，进行了一项关于图像质量的可接受性以及该技术在不同外科环境中的总体教育效益的调查。
使用该技术对12台外科手术进行了远程指导。所有患者均未出现并发症。两名参与者均报告由于图像失真和光线过度曝光而有中度视力损害。视频流延迟和连接中断也被认为是局限性。总体而言，两名参与者均报告该技术在术中及围手术期作为培训工具非常有用。
我们在莫桑比克的经验证明了可穿戴技术在提高LMICs专科外科培训的覆盖面和可及性方面的可行性。尽管该技术存在不足以及国际合作中固有的后勤挑战，但这种教育模式有望连接全球各地的外科医生，并在外科实习生机会有限的地区扩大教育和指导的获取途径。
