JMIR Publications

ABSTRACT

Background:

Developing surgical skills among residents requires time and resources, often in conflict with the goals of efficiency and hospital economics in surgical practice. It is necessary to optimize resident training to prevent a decline in quality. Skilled surgeons are vital for effective and safe performance, yet the training path for surgical residents is often inefficient, especially in the minimally invasive surgery era. Establishing a framework that efficiently disseminates surgical skills is essential to cultivate skilled future surgeons within an acceptable timeframe. Surgical telementoring (ST) aligns well with minimally invasive surgery since the operating mentee shares the same perspective of the operating field as the telementor. Despite growing experience with telemedicine, data on educational outcomes is still under evaluation.

Objective:

The efficiency and safety of ST as a skill development tool will be evaluated for selected residents performing laparoscopic cholecystectomy (LC). Technical and non-technical surgical skills of included surgical registrars will be evaluated in addition to the satisfaction scores of patients, registrars, and mentors.

Methods:

In this pilot randomized controlled trial (RCT), eligible residents will be assigned in a 1:1 ratio to either the intervention group (real-time ST and postoperative coaching) or the control group (traditional intraoperative hands-on teaching). This research adheres to the extended CONSORT statements for pilot RCTs and follows the intention-to-treat principle (ITT). The residents in both groups will perform five consecutive procedures under standardized intraoperative conditions. The primary outcomes are the global assessment tool for evaluating Laparoscopic Skills (GOALS-score) and a score assessing non-technical surgical skills (NOTSS-score). We hypothesize skill enhancement in the intervention group by 3–5 points on the GOALS score compared to the control group. Secondary outcomes will be satisfaction scores of patients, included registrars and mentors in both groups. For the definite RCT to attain 0.8 statistical power, a p-value of less than 0.05, and a 20% dropout rate, 12 residents per group are needed. However, the trial's novelty requires a pilot study to clarify the premises of a future definite RCT.

Results:

Before the trial begins, all telementors and on-site consulting surgeons will participate in a LapCo TT course (LapCo train the trainer course). The configuration of the telementoring system was finalized in December 2023. All residents, consulting surgeons, and telementors were instructed on how to set up and use the telementoring system. The recruitment commenced in spring 2024. Due to licensing issues, the MedPrescence equipment was replaced by Proximie in the summer of 2025 after the recruitment of 4 residents in the study. The telementors underwent a course for acquaintance with the new telementoring software system before the remaining inclusions commenced in August 2025, scheduled for three months. This will enable data analysis in the fall of 2025, and findings should be submitted for publication in an international peer-reviewed journal by spring 2026.

Conclusions:

The SURGTEACH trial is the first known trial that evaluates surgical telementoring as an educational method in a pilot-RCT assessing both technical and nontechnical surgical skills. Globally and domestically, there are constraints on the number of surgeons available and a strain on the surgical education system. The Norwegian healthcare system needs help adequately training enough surgeons, mainly due to geographical obstacles and limitations in the educational system. Therefore, there is a need for a fundamental change in surgical education, and surgical telementoring has the potential to overcome these obstacles. This study has the potential to provide substantial evidence that may be used to enhance surgical education, particularly in rural healthcare facilities. Clinical Trial: Trial registration: ClinicalTrial.gov NCT06421584