title: Reinforcement of endocrine surgery training: impact of telemedicine technology in a developing country context.
abstract: OBJECTIVE
  Technology-based outreach programs for knowledge sharing and skill development using telemedicine is a novel approach to developing subspecialties in regions where there is a lack of specialists and dedicated departments. Endocrine surgery is one such emerging subspecialty. There are few dedicated surgeons and centers even in the developed world. India has only one such center. The aim of this study was to assess the feasibility and impact of telemedicine on the reinforcement of endocrine surgery training at distant places to develop this subspecialty in a developing country such as India.
  
  
  METHODS
  Two faculty members from the General Surgery Department at SCB Medical College in Cuttack, Orissa, India registered at Sanjay Gandhi Postgraduate Institute of Medical Sciences in Lucknow for a short 3-month training course in endocrine surgery in 1998 and thereafter consulted through telephone calls and e-mail when required. Telemedicine-based mentoring was introduced in 2001 as a reinforcement method for continuing training and skills development. Various training modules were used, including tele-consultation, case presentation, treatment planning, tele-radiology, tele-pathology, and tele-continuing medical education (CME) programs and workshops. The outcome was assessed in terms of the increase in the number of patients with endocrine disorders seen and operated on by trainees and the complication rates.
  
  
  RESULTS
  A total of 70 telemedicine sessions were held between 2001 and 2005. They included tele-education and surgical treatment planning (n = 44), tele-consultation including tele-pathology and tele-radiology (n = 26), and tele-surgical conferences/CME (n = 6). The number of endocrine surgical cases performed by trainees after training (phase II) increased significantly compared to those before training (phase I), with a further increase after starting telemedicine-enabled mentoring (phase III). Most of the patients operated on by the trainees had thyroid problems, although these surgeons started operating on a few patients with parathyroid and adrenal disorders as well. The morbidity figures for the thyroidectomy operations (including total thyroidectomy) were comparable to those at the training institution.
  
  
  CONCLUSIONS
  The concept of training a group of motivated general surgeons to practice safe endocrine surgery at a remote center via telemedicine-aided reinforcement of their training is thus feasible. This is particularly true in the case of thyroidectomy operations, which constitute the major workload of endocrine surgery in our country. The same program might be applicable to the development of other medical subspecialties in a developing country as well.
authors.affiliation: Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: P V
authors.initials: PV
authors.lastname: Pradeep
authors.forename: Anjali
authors.initials: A
authors.lastname: Mishra
authors.forename: B N
authors.initials: BN
authors.lastname: Mohanty
authors.forename: K C
authors.initials: KC
authors.lastname: Mohapatra
authors.forename: Gaurav
authors.initials: G
authors.lastname: Agarwal
authors.forename: Saroj Kanta
authors.initials: SK
authors.lastname: Mishra
mesh_terms: D004502:Education, Medical, Continuing / Q000379:methods / Q000458:organization & administration*; D034742:Electronic Mail; D013507:Endocrine Surgical Procedures / Q000193:education*; D005240:Feasibility Studies; D006801:Humans; D007194:India; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D013689:Telephone; D049269:Videoconferencing