Telementoring and remote training in the present era

Editor,

Access to surgical teaching and expertise can be challenging at the best of times but in the era of COVID‐19 and social distancing how can we ensure its delivery? This pandemic has seen a raft of innovative solutions emerge, in both the clinical and educational spaces, that may well lay the foundations for the future.

Telementoring is the use of information technology to provide real‐time guidance despite different geographical locations (Huang et al 2019), and the concept dates back to the mid‐1990s (El‐Sabawi & Magee 2016). The effectiveness of surgical telementoring compared with on‐site training has been reported in systematic reviews, where comparable safety and efficacy profiles between the two techniques were found (Bilgic et al 2017; Erridge et al 2019). So why has deployment to date largely focused on remote or rural areas and been so poorly adopted?

The answer is primarily tradition. The legal, ethical and cost issues melted away within weeks of the pandemic commencing, and it has rapidly become apparent over the last few months that it is more rather than less time efficient. Lacking infrastructure has also become a somewhat redundant argument given that a plethora of technologies already existed but were poorly utilised by healthcare as whole. In the last few weeks, the authors have used a combination of tele‐education and tele‐medicine platforms including AttendAnyWhere (Attend Anywhere, Australia), WhatsApp (WhatsApp Inc., US), Zoom (Zoom Video Communications, Inc., US), Teams (Microsoft, US), Cisco Webex (Cisco Systems, Inc., US), Lifesize (Lifesize, Inc., US), FaceTime (Apple Inc., US), Skype (Microsoft, US), GoToMeeting (LogMeIn, Inc., US), Google Hangouts (Google, US) and these, in turn, are but a small sample of the available options.

Beyond traditional teaching using video, the last few months have seen various interactive solutions from tele‐appraisal to supervision during tele‐consultations (where the trainer, trainee and patient video conference from disparate respective locations). Surgical training has also adapted, with socially distanced training on the Eyesi simulator (VRmagic, Haag‐Streit Diagnostics, Switzerland) and HelpMeSee (HelpMeSee, Inc, US), via a live video feed, streamed through a laptop, along with a webcam capturing the trainees hand movements and general environment. While it is clear that some enthusiasm for the ‘tele‐revolution’ is clearly present, not all teaching will ultimately convert to this modality.

Telehealth does, however, have great potential for unifying differing locations and accessing specialist educators much further afield. This means that ‘dialling’ into highly specialized multidisciplinary meetings, obtaining second opinions rapidly and better integration of primary‐secondary‐tertiary care through these systems may all become possible. Additionally, one of the core purported aims, that of training in remote and developing world locations, will become more attainable if this practice becomes more commonplace.

John F Kennedy once remarked that when written in Chinese, the word ‘crisis’ is composed of two characters—one representing danger and the other representing opportunity. At this juncture, there appears to be the means, the technology and the need to rapidly evolve our utilisation of remote training and telementoring. To what extent it becomes integral to our practice is yet to be determined but in all probability it will have a much greater role in the near term and more distant future.