title: Impact of remote monitoring and supervision on resident training using new ACGME milestone criteria.
abstract: BACKGROUND
  The study objective was to determine the impact of remote monitoring and supervision (RMS) in integrated endourology suites (IES) on residents achieving endoscopic training milestones.
  
  
  METHODS
  Twenty-one urology residents evaluated RMS in IES using a 25-question survey. IES provided audio-visual communication for faculty to supervise residents remotely. Questionnaire used a linear visual scale of 1-10 to assess acceptability (8 questions), impact on training (10 questions), supervision level (1 question), and pre- and post-training milestone self-assessments (6 questions). Improvements in Patient Care Milestone #7 (upper/lower tract endoscopic procedures) and Patient Care Milestone #9 (office-based procedures) were analyzed.
  
  
  RESULTS
  Twenty-one urology residents (out of potential 23) evaluated RMS in IES using a 25-question survey (91.3% response rate). Overall RMS acceptability and satisfaction was high (mean score = 9.1/10) with a majority (95.2%) feeling comfortable being alone with the patient. Residents reported positively on the following parameters: autonomy without compromising safety (8.7), supervision level (8.6), achieving independence (8.4), education quality (8.3), learning rate (8.1), clinical decision-making (8.0), and reducing case numbers to achieve proficiency (7.6). Residents perceived no issues with under- or over-supervision, and a majority (76.2%) expressed that RMS should be standard of training in residency programs. Residents reported mean level increases of 2.5 and 2.8 (out of 5) in Patient Care Milestones for endoscopic procedures and office-based procedures, respectively (p < 0.0001).
  
  
  CONCLUSIONS
  RMS in integrated endourology suites may enhance resident education and endoscopic training. The study demonstrated an increase in competency levels reported by residents trained using RMS.
authors.affiliation: Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia, USA.
authors.forename: Ilan J
authors.initials: IJ
authors.lastname: Safir
authors.forename: Adam B
authors.initials: AB
authors.lastname: Shrewsberry
authors.forename: Isabella M
authors.initials: IM
authors.lastname: Issa
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ogan
authors.forename: Chad W M
authors.initials: CW
authors.lastname: Ritenour
authors.forename: Jerry
authors.initials: J
authors.lastname: Sullivan
authors.forename: Muta M
authors.initials: MM
authors.lastname: Issa
mesh_terms: D001291:Attitude of Health Personnel; D003258:Consumer Behavior; D003558:Cystoscopy / Q000193:education; D004521:Educational Measurement; D004724:Endoscopy / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007858:Learning; D008096:Lithotripsy; D011468:Prostatectomy; D019114:Remote Consultation; D011795:Surveys and Questionnaires; D018666:Ureteroscopy / Q000193:education; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014572:Urology / Q000193:education*; D049269:Videoconferencing