Live‐streaming surgery during <scp>COVID</scp>‐19 using a <scp>3D</scp> printed camera

Abstract

The COVID-19 pandemic provided an unprecedented challenge to communities and health systems throughout the world. In order to protect patients, health workers and students, many hospitals imposed restrictions that resulted in excluding medical students. Experience in the operating theatre is an important part of medical student education, where precious time allocated to surgical education may be as short as 10 weeks. During the COVID-19 pandemic, there was still urgent surgery being performed which potentially provided valuable and unique learning opportunities. The challenge for educators was how to bring these opportunities to the students in a safe and effective way. During the 2020 COVID-19 pandemic, 39 Deakin School of Medicine students based at the University Hospital Geelong clinical school, Victoria, Australia, were scheduled to rotate through general surgery but had restricted access to operating rooms due to government-imposed state-wide restrictions. These students were invited to participate in a pilot program where a surgeon conducted teaching associated with real-time video streaming of the operative procedure. A 3D printed camera with audio and visual capability was custom designed and developed by Deakin University engineers to fit the headpiece of the surgeon (Fig. 1). Students were based offsite with access to the live educational session using readily available electronic devices (laptops, smartphones or tablet devices). An interactive tutorial was given by the surgeon to describe the clinical scenario and background information relevant to the operative case. Questions between the educators and medical students were encouraged throughout the operation. Approval for this teaching modality was gained from the clinical school director prior to commencement. Patients all gave verbal consent prior to their operation and videoing was only of the surgical field with no identifying patient details to protect privacy. Students were educated on respecting patient privacy and asked to ensure no viewings outside the tutorial group. Following these tutorials, all 39 students were invited to participate in an electronic survey to assess their experience of engaging in live-streaming tutorials. The survey utilized a 5-point scale, with the option of additional comments. All responses were de-identified to the researchers. Ethics approval was gained from the Deakin University Faculty of Health Human Ethics Advisory Group. Twenty-five students of 39 completed the survey, achieving a response rate of 64%. A variety of open and laparoscopic general surgery procedures were observed by survey responders, where the majority of students were satisfied or very satisfied with the learning content of each surgery (Table 1). Only 3 (12%) reported that COVID-19 had not significantly impacted their surgical learning, whilst one respondent commented that ‘almost all aspects [were affected] including theatre experience, ward exposure, clinic exposure’. With regard to participating in live-streamed operations, 20 respondents (80%) found it at least somewhat useful (Fig. 2). Furthermore, 25 respondents (100%) found the introductory teaching at least somewhat beneficial in aiding surgical learning. Eighteen students (72%) indicated that increasing the frequency of live streaming would be at least somewhat beneficial in aiding surgical learning. Twenty-three (92%) students found narration and teaching during the procedure beneficial. Students found the quality of the video and audio variable with 22 (88%) responding that the quality impacted their learning. Furthermore, 19 (76%) reported that live-streaming did not compensate for in-person theatre time. Fourteen (56%) reported they see a role for this teaching modality when there are no COVID-19 restrictions on their attendance. During COVID-19 medical schools around the world adopted a wide variety of strategies. In Italy, almost 10 000 medical students were fast-tracked into the workforce