Remote Training of Neurointerventions by Audiovisual Streaming

Abstract

Background Remote access of trainees to training centers via video streaming (tele-observership, e‑fellowship) emerges as an alternative to acquire knowledge in endovascular interventions. Situational awareness is a summary term that is also used in surgical procedures for perceiving and understanding the situation and projecting what will happen next. A high situational awareness would serve as prerequisite for meaningful learning success during tele-observerships. We hypothesized that live perception of the angiographical procedures using streaming technology is feasible and sufficient to gain useful situational awareness of the procedure. Methods During a European tele-observership organized by the European Society of Minimally Invasive Neurological Therapy (ESMINT) and its trainee association (EYMINT), a total of six neurointerventional fellows in five countries observed live cases performed by experienced neurointerventionalists (mentors) in six different high-volume neurovascular centers across Europe equipped with live-streaming technology (Tegus Medical, Hamburg, Germany). Cases were prospectively evaluated during a 12-month period, followed by a final questionnaire after completion of the course. Results A total of 102/161 (63%) cases with a 1:1 allocation of fellow and mentor were evaluated during a 12-month period. Most frequent conditions were ischemic stroke (27.5%), followed by embolization of unruptured aneurysms (25.5%) and arteriovenous malformations (AVMs) (15.7%). A high level of situational awareness was reported by fellows in 75.5% of all cases. After finishing the program, the general improvement of neurointerventional knowledge was evaluated to be extensive (1/6 fellows), substantial (3/6), and moderate (2/6). The specific fields of improvement were procedural knowledge (6/6 fellows), technical knowledge (3/6) and complication management (2/6). Conclusion Online streaming technology facilitates location-independent training of complex neurointerventional procedures through high levels of situational awareness and can therefore supplement live hands-on-training. In addition, it leads to a training effect for fellows with a perceived improvement of their neurointerventional knowledge.

Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study

“…In a study using online streaming of cases where 6 fellows observed 6 mentors practicing in different high-volume centers in 5 different countries over a 12-month period, the trainees reported high levels of situational awareness with a perceived improvement of their neurointerventional knowledge. 79 Another study using virtual reality simulations demonstrated an enhanced capability of performing endovascular procedures on the virtual reality simulator. 80 Although it remains to be seen whether this translates into enhanced procedural performance in real cases, it is a promising option to extend training in certain regions with few operators with advanced knowledge in other neurointerventional procedures.…”

New online tools to speed-up training of neurointerventionalists: an example in Central Asia

“…The goal is to expose young neurointerventionalists to the breadth of neurointerventional procedures performed by highly experienced neurointerventional experts. 8 The e-fellowship is a specific use case for live case broadcast that has been a part of neurointerventional education since the beginning of the field. 9 The e-fellowship program is currently being further developed to reach out to other regions, such as Central Asia.…”