The concept of training a group of motivated general surgeons to practice safe endocrine surgery at a remote center via telemedicine-aided reinforcement of their training is thus feasible. This is particularly true in the case of thyroidectomy operations, which constitute the major workload of endocrine surgery in our country. The same program might be applicable to the development of other medical subspecialties in a developing country as well.
Introduction: Over the last two decades, advancement of super specialised surgical disciplines has shown improved health outcome, in particular quality and safety. Although medical technology has developed to meet diagnostics and therapeutic needs, there is a scarcity of trained human resources in advanced specialities in low and middle income countries (LMICs). Innovative methods are needed to educate and train people at their workplaces using collaborative technologies and networks. Methods: Over the last 15 years, two general surgeons in Cuttack have been telementored from Lucknow 1,163 km away, using collaborative technologies to develop Endocrine Surgery. This study reviews the last 11 years of the service which includes a clinical decision support system and treatment planning advice using real time videoconferencing. Results: Over the last 11 years, 199 endocrine surgeries per annum were performed with most being thyroid cases as compared with 119 surgeries per annum during the previous five years. Parathyroid and adrenal cases increased significantly during this period (p <0.001). Rates of temporary and permanent vocal cord palsy (1.7% and 0%), hypocalcaemia (5.9% and 1.1%) were comparable with high volume centres. Based on the quantum, safety and quality outcome of endocrine surgery the provincial government has approved creation of a super-speciality department of endocrine surgery in Cuttack. Conclusion: Sustained engagement using telementoring can transfer surgical skills to needy surgeons and enable them to match the expertise of mentors. This model can be replicated in other specialities in a cost effective way to develop specialised human resources for healthcare, in particular in LMICs.
Objective: Telemedicine is the use of telecommunication for medical diagnosis, treatment, health education and research. Telepathology is diagnostic pathology at a distance. It functions with images viewed on a video monitor rather than directly through a microscope. Many years have passed since the evolution of telepathology. But no study has yet been done to evaluate the benefits postgraduates got through this. Therefore this study is undertaken to analyse the different impacts of telepathology on the postgraduate learning. Material and Methods: The study was done in Telemedicine Center of S. C. B. Medical College, Cuttack over a period of 9 years. The telepathology service was carried out by store and forward method using a CCD, a large computer server and a huge bandwidth network service (VSAT). The sessions with SGPGI, Lucknow were analysed and the benefits of postgraduates were studied. Results: The number of sessions held was 95. Out of which 92 sessions were with SGPGI. It included 202 cases transmitted from Lucknow and 186 cases from S. C. B. Medical College, Cuttack. The postgraduates had a chance to exposure to rare cases in renal pathology, dermatopathology and hepatopathology. The overall concordance rate with glass slide diagnosis was 87%. Conclusion: The diagnostic expertise through light microscopy and tele-images are not the same. But the telepathology system increased the ability of image analysis, histopathologic diagnosis of our postgraduates and also exposed them to many rare and interesting cases.
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