title: Assessing the impact of telestration on surgical telementoring: A randomized controlled trial.
abstract: BACKGROUND
  Using graphical annotations in surgical telementoring promises vast improvements in both clinical and educational outcomes. However, these assumptions do not consider the potential patient safety risks resulting from this feature. Major differences in regulations regarding the implementation of telestration encourage an assessment of the utility of this feature on the outcomes of telementoring sessions.
  
  
  METHODS
  Eight students participated in a randomized controlled trial, comparing verbal with annotation-supplemented telementoring via video conferencing. A remote mentor guided the participants through four localization exercises, identifying the features in a still laparoscopic surgery scene using a laparoscopic simulator. Clinical and educational outcomes were assessed; the time consumption and quality of mentoring were determined.
  
  
  RESULTS
  The study revealed no significant difference in localizing the intervention between the studied methods, while educational outcomes favoured verbal mentoring. Telestration-supplemented guidance was considerably faster and resulted in fewer miscommunications between the mentor and mentee.
  
  
  CONCLUSIONS
  The initial hypothesis of the major clinical and education benefits of telestration in telementoring was not supported. A potential 33% decrease in the duration of the mentored episodes is expected due to the ability to annotate live video content. However, the impact of time saving on the outcome of the procedure remains unclear. Regardless of the quantitative measures, most of the participants and the mentor agreed that graphical annotations provide advantages over verbal guidance.
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway Andrius.Budrionis@telemed.no.
authors.forename: Andrius
authors.initials: A
authors.lastname: Budrionis
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Per
authors.initials: P
authors.lastname: Hasvold
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Hartvigsen
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Johan Gustav
authors.initials: JG
authors.lastname: Bellika
mesh_terms: D000328:Adult; D002983:Clinical Competence; D020375:Education, Distance / Q000379:methods*; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D000071252:Mentoring / Q000379:methods*; D012371:Robotics; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D049269:Videoconferencing
keywords: Telementoring; accuracy; annotation; clinical; telestration