Comparison of traditional vs. virtual simulation-enhanced training for scaling the cervical cancer surgery workforce in Zambia

我们将使用外科手术过程的虚拟现实模拟来预先训练外科受术者，帮助他们获得心理-运动技能，感觉敏锐度，以及在较小程度上获得进行宫颈癌手术所需的手术灵巧性所需的认知计划。在他们熟练掌握外科手术后，我们将使用一种基于网络的远程指导技术对他们进行监督，这种技术允许正在进行手术的外科实习生戴上耳机，将手术过程的实时视频传输到不在现场的外科专家导师的监视器上。在手术过程中，导师可以向受训者的床边监视器提供实时的遥视反馈（视频馈送上的绘图），也就是说，来自受训者的视频馈送被转移到导师那里，然后导师用后者的遥视将视频馈送回给受训者，就像解说员在单独的屏幕上解说足球比赛一样。我们会比较外科学员使用上述技术获得和维持安全有效地进行子宫颈癌手术所需技术的速度，以及他们使用传统方法接受训练的速度。我们还将比较传统与技术增强培训的经济和财政成本，以使外科医生熟练地治疗宫颈癌。癌症是世界上主要的死亡原因，预计在未来20年将以惊人的速度增长。大多数新病例和死亡将发生在世界上最贫穷的地区。非洲将受到最严重的打击，因为据估计，到2030年，每年将有100万非洲人死于癌症。在非洲，妇女将承受最沉重的负担，因为宫颈癌和乳腺癌是非洲最常见的恶性肿瘤，也是导致癌症相关死亡的原因。事实上，全世界每年因子宫颈癌死亡的人中，有五分之一发生在撒哈拉以南非洲，使其成为全球子宫颈癌的死亡地区。在低收入和中等收入国家，治疗癌症患者的一个主要瓶颈是外科医生短缺，特别是那些接受过专门癌症培训的外科医生。最近的一份报告（柳叶刀肿瘤学委员会全球癌症手术- 2005）显示，生活在中等收入国家需要癌症手术的癌症患者中，只有20%可以获得手术，而在低收入国家，这一比例低于5%。潜在的应用和好处用于LMI国家的外科医生培训课程，包括。LMI国家外科医生培训方式的重大转变。更快、更安全、更有效地培训外科医生进行宫颈癌手术。宫颈癌手术的标准化培训，并可根据个人需要调整培训内容。低收入地区癌症手术服务的迅速扩大，导致手术等待时间的减少，以及相关的疼痛和心理影响。社区中对癌症持宿命论态度的人减少c.减少与LMI国家中年轻母亲死亡有关的经济和社会后果，即儿童在孤儿院的机构化、儿童未能完成初等教育、家庭经济地位下降等。科学的原则证明，技术增强的外科培训是有效的，从而确保对地方、国家和国际层面的政策变化作出贡献。塑造和提升公共卫生服务的成效和形象。以销售技术为目的，吸引全球企业投资。分拆公司的潜力，以及新流程、新产品和新服务的创造。增加捐助资金，用于LMI国家的研究和实施基于技术的外科培训

Proposed workWe will use virtual reality simulation of a surgical procedure to pre-train surgical trainees by helping them acquire the psycho-motor skills, sensory acuity, and to a lesser extent, cognitive planning required to achieve the surgical dexterity necessary to perform cervical cancer surgery. After the have reached surgical proficiency we will use proctor them with a form of web-based tele mentoring technology that allows the surgical trainee who is performing surgery to wear a headset that transmits a live, real-time video feed of the surgical procedure to the monitor of an expert surgical mentor who is offsite. The mentor can provide real-time telestration feedback (drawings on the video feed) to the bedside monitor of the surgical trainee while the surgical procedure is being performed, i.e., the video feed from the trainee is transferred to the mentor and then back to the trainee from the mentor with the latter's telestration, much like commentators illustrating in a football game on a separate screen. We will measure the speed at which surgical trainees acquire and maintain the technical skills necessary to safely effectively perform cervical cancer surgery using the technology above with that when they are trained using traditional methods. We will also compare the economic and financial costs of traditional vs. technology-enhanced training for a surgeon to achieve proficiency in treating cervical cancer.ContextCancer, the world's leading cause of death, is projected to increase at a staggering rate in the next two decades. Most of the new cases, and deaths, will occur in the world's poorest regions. Africa will be hardest hit, as it is estimated that by 2030 cancer will kill one million Africans each year. Within Africa, women will bear the heaviest burden, because cervical and breast cancers are its most common malignancies and causes of cancer-related death. In fact, one in every five of the world's annual cervical cancer deaths takes place in sub-Saharan Africa, making it the global killing field of cervical cancer. A major bottle neck in the care of cancer patients in low and middle income countries is the shortage of surgeons, particularly those with specialized cancer training. A recent report (Lancet Oncology Commission on Global Cancer Surgery - 2105) revealed that only 20% of cancer patients living in middle income countries who need cancer surgery can access it, while in low income countries it's <5%.Potential Applications and Benefits1. Use in the training curriculum for surgeons in LMI countries, includinga. Major shift in the way surgeons are trained in LMI countriesb. Faster, safer and more effective training of surgeons to perform cervical cancer surgeryc. Standardized training for cervical cancer surgery with options to adapt training to individual needs2. Rapid expansion of cancer surgery services in low income settings, leading to a a. Decrease in waiting times for surgery, and associated pain and psychological effectsb. Decrease in fatalistic attitude towards cancer in the community c. Decrease in the economic and societal consequences associated with deaths of young mothers in LMI countries, i.e., institutionalization of children in orphanages, failure of children to complete primary education, drop in economic status of the families etc.3. Scientific proof-of-princple that technology-enhanced surgery training is effective, thus ensuring a. Contribution towards policy changes on the local, national and international levelb. Shaping and enhancing the effectiveness and image of public health servicesc. Attract investments from global businesses for purposes of selling the technologyd. Potential of spin out companies, and the creation of new processes, products and servicese. Increase in donor funding for research and implementation of technology-based surgical training in LMI countries