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

建议工作我们将使用虚拟现实模拟手术过程，通过帮助外科实习生获得心理运动技能、感官敏锐度，以及在较小程度上获得进行宫颈癌手术所需的手术灵活性所需的认知规划，对外科实习生进行预培训。在达到手术熟练程度后，我们将通过一种基于网络的远程指导技术使用Proctor They，该技术允许正在进行手术的外科实习生佩戴耳机，将手术过程的实时视频传输到不在现场的专家外科导师的监视器上。当外科手术正在进行时，导师可以向外科实习生的床边监视器提供实时的远程传送反馈(视频馈送上的图画)，即来自受训者的视频传送到导师，然后通过后者的远程传送从导师返回到受训者，很像在单独屏幕上的足球比赛中的解说员插图。我们将测量外科实习生获得和保持安全有效地使用上述技术进行宫颈癌手术所需的技术技能的速度，以及他们使用传统方法进行培训时的速度。我们还将比较传统和技术强化培训对外科医生的经济和财务成本，以熟练地治疗宫颈癌。上下文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，妇女将承担最重的负担，因为宫颈癌和乳腺癌是非洲最常见的恶性肿瘤和癌症相关死亡的原因。事实上，全球每年每5例宫颈癌死亡病例中就有1例发生在撒哈拉以南非洲地区，使其成为全球宫颈癌的杀伤场。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缺乏外科医生，特别是那些接受过专门癌症培训的医生。最近的一份报告(《柳叶刀肿瘤委员会全球癌症手术-2105》)显示，在需要接受癌症手术的中等收入国家的癌症患者中，只有20%的人可以使用它，而在低收入国家，这一比例为5%。在LMI国家的外科医生培训课程中使用，包括a。LMI国家外科医生培训方式的重大转变b。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，可根据个人需要调整培训2。低收入环境下癌症手术服务的迅速扩大，导致a.等待手术的时间减少，以及相关的疼痛和心理影响b。社区对癌症宿命论态度的减少c.与LMI国家年轻母亲死亡有关的经济和社会后果的减少，即孤儿院儿童被收容、儿童未能完成初等教育、家庭经济地位下降等。科学地证明技术强化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效力和形象。吸引来自全球企业的投资，以销售技术。分拆公司的潜力，以及创造新的流程、产品和服务。在大湄公河次区域国家增加捐助者资金用于研究和实施以技术为基础的外科培训

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