Evaluation of Augmented Reality Technology in Global Urologic Surgery

Introduction &Objective: Surgical missions are still largely on pause due to COVID-19, leading to missed opportunities for skill sharing between high-income and middle to low-income countries. New commercially available augmented reality (AR) technology facilitates surgical training, allowing mentors in one country to virtually train and skill-share with a mentee in another country during surgical cases in real-time. We hypothesize that AR technology is an effective live surgical training and mentorship modality. Method(s): To evaluate perceived effectiveness of AR technology in global urologic surgery training, surgeon mentors in the USA and UK worked with mentees in Benin performing surgical cases using the Proximie AR system. Proximie includes audiovisual capabilities allowing a mentor in any location to provide a mentee with real-time guidance during the procedure. Following each case, mentor and mentee individually completed a questionnaire assessing the technology. Result(s): Trainers reported AR technology as easy to set-up and use in 73.3% of cases while the trainee reported easy set-up and use in 100% of cases. The visual quality was acceptable to trainers in 60% of cases and "looks like I'm there" in 40%. Visual input/ability to draw on screen had high impact in 80% of cases, with trainers rating the ability to provide anatomical guidance as invaluable or significant in 93.4% of cases. Audio and anatomical guidance had a significant impact for the trainee in 100% of cases. The quality of virtual training v. in-person training was equivalent in 100% of cases for the trainee while trainers found virtual training inferior in 66.7% of cases and equivalent in only 6.7% of cases. Difficulty connecting occurred often in only 1% of cases for trainers but in 12.5% of cases for the trainee. Trainers reported delay or time lag while using the technology in 40% of cases, with lag being problematic in 12.5% of cases. In contrast, the trainee reported rarely experiencing delay or time lag while using the technology in 100% of cases. Conclusion(s): AR technology is useful in facilitating real-time surgical mentorship during the COVID-19 pandemic. The Proximie technology provides visualization that is acceptable and audiovisual capabilities that have significant positive impact on successful case completion. Though AR technology presents its own set of challenges such as difficulty in connecting virtually between trainer and trainee as well as delay or time lag during surgical cases, AR technology may prove a welcome alternative when in-person training is unavailable or limited.

EVALUATION OF AUGMENTED REALITY TECHNOLOGY IN GLOBAL UROLOGIC SURGERY

INTRODUCTION AND OBJECTIVE: Surgical missions are still largely on pause due to COVID-19, leading to missed opportunities for skill sharing between high-income and middle to low-income countries. New commercially available augmented reality (AR) technology facilitates surgical training, allowing mentors in one country to virtually train and skill-share with a mentee in another country during surgical cases in real-time. We hypothesize that AR technology is an effective live surgical training and mentorship modality. METHODS: To evaluate perceived effectiveness of AR technology in global urologic surgery training, surgeon mentors in the USA and UK worked with mentees in Benin performing surgical cases using the Proximie AR system. Proximie includes audiovisual capabilities allowing a mentor in any location to provide a mentee with real-time guidance during the procedure. Following each case, mentor and mentee individually completed a questionnaire assessing the technology. RESULTS: Trainers reported AR technology as easy to set-up and use in 73.3% of cases while the trainee reported easy set-up and use in 100% of cases. The visual quality was acceptable to trainers in 60% of cases and “looks like I'm there” in 40%. Visual input/ability to draw on screen had high impact in 80% of cases, with trainers rating the ability to provide anatomical guidance as invaluable or significant in 93.4% of cases. Audio and anatomical guidance had a significant impact for the trainee in 100% of cases. The quality of virtual training v. in-person training was equivalent in 100% of cases for the trainee while trainers found virtual training inferior in 66.7% of cases and equivalent in only 6.7% of cases. Difficulty connecting occurred often in only 1% of cases for trainers but in 12.5% of cases for the trainee. Trainers reported delay or time lag while using the technology in 40% of cases, with lag being problematic in 12.5% of cases. In contrast, the trainee reported rarely experiencing delay or time lag while using the technology in 100% of cases. CONCLUSIONS: AR technology is useful in facilitating realtime surgical mentorship during the COVID-19 pandemic. The Proximie technology provides visualization that is acceptable and audiovisual capabilities that have significant positive impact on successful case completion. Though AR technology presents its own set of challenges such as difficulty in connecting virtually between trainer and trainee as well as delay or time lag during surgical cases, AR technology may prove a welcome alternative when in-person training is unavailable or limited.

Improving safety for tracheostomy and laryngectomy patients within a regional head and neck unit

Aim: To improve the safety of tracheostomy and laryngectomy patients within a UK-based regional head and neck unit. Method: This audit was conducted against standards taken from the National Tracheostomy Safety Project (NTSP). Inclusion criteria were all patients with a tracheostomy or laryngectomy on the ward, there were no exclusion criteria. Data was collected per inpatient episode for a one month period pre- and post- implementation of each intervention (1st March to 31st May 2020). Results: Pre-intervention results showed that none of the 19 neckbreathing inpatients during March 2020 had a bedhead sign or emergency algorithm displayed, however all patients had required bedside equipment and the only unavailable ward equipment was capnography. Laminated bedhead signs and algorithms were implemented and 33% neck-breathing patients had signs displayed during April 2020. Further intervention in May 2020 to educate ward staff led to 90% of patients having a bedhead sign displayed and 80% having an algorithm displayed. Conclusions: Overall, our unit has very high standards of care for neckbreathing patients. The use of bedhead signs and emergency airway algorithms is an integral part of providing safe care for neck-breathing patients and all members of staff are responsible for their use. The COVID-19 crisis has impacted on the number of elective procedures being performed which has impacted upon the numbers for the post-intervention arms of our audit. Reduced staffing due to sickness during the pandemic may have contributed to the substandard results.

Augmented reality technology in global urologic surgery

INTRODUCTION AND OBJECTIVE: Surgical medical missions allow for the global transfer of surgical skills, knowledge, and resources between high and low to middle-income countries to the benefit of both the health professionals involved and their patients. The ongoing COVID-19 pandemic, travel restrictions, and general hesitancy to travel has drastically reduced these missions, thus putting a pause on the exchange of surgical skills and training between countries. Augmented reality (AR) technology can mitigate some of these obstacles. AR technology allows mentors and mentees to work together virtually during a live surgical case. Introduction of AR into surgical mission partnerships allows for the continuation of teamwork mentorship, and learning between international teams. We hypothesize that global urologic surgical training can be successfully undertaken through augmented reality. METHODS: In order to evaluate this, members of our team performed several surgical cases while using the Proximie virtual reality system. The Proximie system includes a console with a camera, display monitor, and supported computer system that allows the mentor to visualize the procedure that is being undertaken in the mentee's home country and provide guidance, both visually and through auditory means, during the operation. RESULTS: Multiple procedures were accomplished with this technology. In this video, we will demonstrate endoscopic as well as open cases with a mentee in Benin and mentors in the United Kingdom and the United States. Mentors were able to guide mentees through entire procedures using the AR technology. The audio capabilities of Proximie permitted real time conversation for direct verbal feedback. Proximie technology's visual component allowed mentors to see multiple views simultaneously including the procedure itself as well as endoscopic, fluoroscopic, and sonographic images. Visual feedback was possible through touch screen capability enabling the mentor to mark and circle specific anatomical locations. CONCLUSIONS: Augmented reality technology is feasible for long distance mentor-mentee interactions and global urology “hands on” surgical training.

Finding Our Way Through a Pandemic: Teaching in Alternate Modes of Delivery

The COVID-19 pandemic caused a dramatic pivot to online learning and has forced teachers to critically re-evaluate teaching strategies. Thus, the questions, framing this self-study were: 1) How will I be able to do the learning activities I normally do in the classroom online including individual work, group activities, debates, and whole class discussions? and 2) How will I be able to pivot my signature lessons to the alternate delivery model? This self-study of teaching and teacher education practices (S-STTEP) builds on previous research to transform traditional face-to-face lessons into effective online lessons using alternate modes of delivery. In this paper, Ted shares some of his signature lessons including ice-breakers, critical response questions, discussions, group activities, and jigsaws, utilizing Moodle, Big Blue Button, Padlet, Google Docs, and other online tools. With Georgann’s help as a critical friend, Ted critically analyzed his teaching of Master of Education graduate students through S-STTEP. In addition, he explored comparative ethnographic narrative (CEN) as another way of knowing within the S-STTEP space. Data included detailed weekly reflections. In addition, students provided written feedback at the end of each class, and at the end of term through a survey and course evaluation. Ted shared weekly electronic journal reflections and student feedback with Georgann, via email and teleconferences. Then, together Ted and Georgann made meaning from these field texts. The research text evolved from teacher-to-teacher conversations. Promising pedagogies for synchronous and face to face learning were identified with several signature lessons the focus. Georgann, as Ted’s critical friend helped confirm and verify the most significant results amongst the many interesting reflections made. © Copyright © 2021 Howe and Watson.