Can Remote Support be Used to Facilitate Introduction of New Procedures?
Alan B. Lumsden, MD, Ebun O. Ebunlomo, PhD MPH, Melanie Lazarus, MPH.
Houston Methodist Hospital, Houston, TX, USA.
Objective:
Skills training, re-training, and evaluation are core components of competency development. However, “in vivo” proctoring is labor intensive and expensive. Remote visualization with direct audiovisual communication, if validated, could change the way trainees are educated and new procedures introduced. This feasibility study demonstrates a remote proctor’s ability to support endovascular device use for mechanical thrombectomy of iliofemoral deep vein thrombosis. We have previously demonstrated using this technology to train vascular residents in thoracic endografting. In this study, we extend these observations and evaluate remote support as a way of introducing a new endovascular technology.
Methods:
An anatomically appropriate model was used to evaluate feasibility of a remote proctor to safely and effectively teach relative novices to use a new throbectomy catheter. A trained, experienced industry proctor underwent a 30-minute orientation in how to use a remotely controlled flat-panel robot that provides audiovisual communication. The proctor laptop displayed a fluoroscopic image and view of both trainee and simulator. The robotic screen was controlled from the laptop (zoom, pan, laser pointer), and the trainee could both see and hear the proctor. Afterward, learners and proctor quantitatively evaluated the training environment’s effectiveness using a questionnaire.
Results.
Twelve learners participated and completed a 12-item questionnaire. Each question was on a 5-point Likert scale, with 5 being the highest rating. Two additional questions were designed to capture qualitative data to improve future implementation. The proctor also evaluated each interaction using a similar scoring system (Table 1).
| Average | Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree | |
| 1. I was able to understand the remote proctor’s instructions. | 4.50 | 0% | 0% | 0% | 50% | 50% |
| 2. I was able to see the proctor and what he was doing well enough to follow along. | 4.33 | 0% | 0% | 8% | 50% | 42% |
| 3. Features such as the laser pointer function allowed me to understand when certain points were being illustrated. | 4.00 | 0% | 8% | 17% | 42% | 33% |
| 4. The remote presence proctor experience was superior to standard face-to-face proctoring. | 3.25 | 8% | 25% | 33% | 0% | 33% |
| 5. After I became comfortable with the remote proctoring system, the proctor’s present felt lifelike. | 3.92 | 0% | 17% | 8% | 42% | 33% |
| 6. I sometimes forgot that the proctor was not physically present during the session. | 3.58 | 0% | 25% | 17% | 33% | 25% |
| 7. Remote proctoring can be used for other training opportunities. | 4.58 | 0% | 0% | 0% | 42% | 58% |
| 8. After more experience, I would accept remote proctoring as an option for accessing future training opportunities. | 4.33 | 0% | 8% | 0% | 42% | 50% |
| 9. I would accept remote proctoring as part of my regular clinical training/professional development. | 4.33 | 0% | 8% | 0% | 42% | 50% |
| 10. The remote presence proctor enhanced the overall learning experience. | 4.08 | 0% | 8% | 8% | 50% | 33% |
| 11. Overall, I was satisfied with the quality of this remote proctoring experience. | 4.58 | 0% | 0% | 0% | 42% | 58% |
| 12. I feel comfortable with the use of the Thrombectomy system after the remote proctoring experience. | 4.42 | 0% | 8% | 0% | 33% | 58% |
The overall acceptance by both trainees and proctor was very high.
Conclusion
This is the first validation of remote proctoring as a highly effective tool for device-specific training. Remote support has numerous applications in vascular surgical training, education and practice. It is cost effective, permits later review, can be widely broadcast, and is readily accepted by trainees and proctors. There should be further evaluation of this technology for expanded use in vascular surgery training.
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