Telemedicine for the operating room of the future.

Telemedicine is becoming a subset of information science and should benefit tremendously from the geometric growth of information architecture in hospitals. The use of telemedicine to break the isolation of the operating room is a highly achievable goal. An open operating room has information on demand for the personnel, fluid communication among operating room personnel, and broad interaction with the learner community and consultants. In an operating room with significant data capture, the patient is brought into the process not only as a real person, but also as a huge data set that acquires all the events of the surgery. The data include the visual, electrical, and mechanical events that define the surgical procedure. As part of a dynamic electronic medical record, they are available to those who are present and those who are asked to help from even a great distance away with real-time advice. The data are also available to those who seek to understand what happened to the patient afterwards for the purpose of root cause analysis, near miss analysis, instruction, or more accurate medical records.

Looking at the forest instead of counting the trees: an alternative method for measuring faculty's clinical education efforts.

PURPOSE: To present an alternative approach to mission-based management (MBM) for assessing the clinical teaching efforts of the faculty in the third and fourth years of medical students' education. METHOD: In fiscal years 2000 and 2001, interviews were conducted with department chairs and faculty members with major responsibilities in education at the University of Maryland School of Medicine. Using a standard worksheet, each rotation was categorized according to the amounts of time students spent in five teaching modes. After each department described its rotation and maximum teaching time, the department team and the MBM team negotiated the final credit received for its course. This final determination of departmental clinical teaching was used in subsequent calculations. Adjustments were made to the department clinical education time based on the teaching mode. Groups of medical students were surveyed to determine the relative value of each teaching mode. These relative values were then used to modify the clinical education times credited to the department. The last step was to distribute the effort of the faculty between clinical and educational missions. RESULTS: The data analysis showed approximately 57,000 credited faculty hours in one year for direct education of medical students in each curriculum year. These hours equal the annual workload of 28 full-time faculty members. CONCLUSIONS: A powerful use of MBM data is to move from thinking about resource allocation to thinking about the effective management of a complex organization with interlaced missions. Reliable data on faculty's contributions to medical students' education across departments enhances other MBM information and contributes to a picture of the dynamic interconnectedness of missions and departments.