European Institute for TeleSurgery Experience - Free

Malassagne et al.: Teleeducation in Surgery 1493
1997 their number has increased by 875% and by more than 40%
during the last 6 months [23]. Among the 300 million regular Web
users in the world, 52% (156 million) regularly search for healthcare
information. This number should increase to 520 million
within the next 5 years [23]. The great attraction of virtual learning
is its convenience. Internet allows independent work whenever
and wherever. On-line information is available everywhere 24
hours a day, 7 days a week, with no constraint of time or travel. In
this manner surgeons will continue to care for patients while
improving their skills. Moreover they will remain connected to
their favorite website members, discuss surgical indications and
videos of new surgical procedures, and sometimes make new
virtual friends via e-mail, discussion forum (asynchronous), and
chat room (synchronous). Direct dialogue with experts in chat
rooms during their virtual “office hours” or communication with
them via e-mail or forum is possible. Downloading computer files
from the site allows reading the text more than once, rather than
relying on notes written during the videoconference. The constant
updating of information, use of videos, and 3-D animated computer
graphic illustrations are the future of the diffusion of surgical,
medical, and scientific knowledge. Technology will also offer
customized information according to the surgeon’s profile. This
could be the first step of computer-assisted highly personalized
surgical education.
The great difference between Internet and all other sources of
medical information is that e-information is not restricted to
professionals but is open to the public. Cybermedicine is characterized
by a strong “consumer pull” [24]. Patients may learn more
about their own disease on-line than the general knowledge of the
medical staff. In the future, surgeons will treat very well informed
patients and in return the surgeons will ask for high-quality CME
and constant surgical training. Conversely, surgeons will be helped
by patients who are better informed and therefore more involved
in the decision-making process concerning their own health. The
healthcare information market represents a huge economic potential.
Portals proliferate on the Web, promising an open-source
database of nearly all healthcare topics. Obviously all sites do not
offer the same quality, and associations such as the Internet
Healthcare Coalition have been established to provide clear guidance
for evaluating sources and promoting sites of high quality.
The need for a surgical site created by surgeons and dedicated
to surgeons and their patients was strongly expressed by the
surgical community. This is why the WeBSurg project was
launched by EITS (Fig. 3). Contributions from international experts
in each surgical field represent the core of its content.
However, WeBSurg is not limited to its “World Virtual Encyclopedia”
of operative techniques, but uses all the multimedia applications
required for an attractive, interactive, and entertaining
presentation using streaming video and audio, interactive tools
such as Web forums, newsgroups, and chat rooms. Teleconferencing
and videoconferencing are also possible. WeBSurg is userfriendly
and respects cultural and linguistic differences, being
translated in 10 languages. These criteria follow the recent recommendations
expressed during the “Internet Healthcare 2000”
Conference held in New York City in April 2000. WeBSurg will
diffuse updated and extensive surgical information under the
scientific authority and control of national and international wellidentified
and well-recognized scientific societies and editorial
boards. Plans also include the delivery of teleaccreditation in
accordance with the accreditation systems of the surgeon’s country.
Conclusions
By leading the way in a virtual world, today’s surgeons demonstrate
their high capacity to adapt and to remain in charge of
global surgical information. However, in the future we must assess
objectively the impact of these new technologies on surgical education
and determine their exact cost-effectiveness [25, 26]. As
computer power and availability increase we can expect a preeminent
role for these technologies at not necessarily reduced costs.
Finally, while teaching their students, surgeons should never forget
that the surgical profession is not only technology-driven but
based on compassion, altruism, respect for patients, and optimum
care.
Résumé
L’âge de l’information a révolutionné la pratique et
l’apprentissage en chirurgie. L’utilisation du système de la
vidéoconférence par la télétransmission ISDN permet de mettre
en rapport direct les chirurgiens du monde entier sans se soucier
des distances. La télé-éducation, la télé-enseignement, le téléapprentissage,
la télé-guidance et la télé-accréditation ont fait
leurs épreuves et sont actuellement de pratique courante. On peut
obtenir des conseils en interrogeant les experts du réseau. On
peut reconstruire, à partir des données des patients une image en
trois dimensions, analysée par l’ordinateur et les procédés
chirurgicaux peuvent ainsi être simulés pour obtenir une décision
chirurgicale optimisée. Enfin, l’utilisation de l’Internet permet
d’accéder à cette information, quand on veut et chaque fois que
c’est nécessaire, par des sites du web dédiés. Il reste à démontrer,
cependant, que ces moyens améliorent les soins aux patients.
Resumen
La era de la informática ha revolucionado la práctica y la
formación quirúrgicas. La utilización de video-conferencias a
través de la teletransmisión ISDN permite la conexión de
cirujanos de todo el mundo, sin que la distancia constituya un
factor limitante. En la actualidad ha quedado claramente
demostrado que la teleeducación, teleenseñanza, teleformación,
telemonitorización y teleacreditación son hechos habituales.
Opiniones quirúrgicas pre e intraoperatorias pueden obtenerse de
expertos a través de la Red. Los datos de los pacientes pueden
reconstruirse como imágenes tridimensionales virtuales que se
analizan mediante ordenadores; las técnicas quirúrgicas pueden
simularse con objeto de adoptar la mejor solución quirúrgica. Por
último, la utilización de Intenert permite el acceso a esta
información donde y cuando sea necesaria, merced a las páginas
web dedicadas a estos fines. Sin embargo, todavía falta demostrar
fidedignamente que estos medios mejoren la asistencia sanitaria.
References
1. Grosfeld, J.L.: Presidential Address. Visions: medical education and
surgical training in evolution. Arch. Surg. 134:590, 1999
2. Berne, T.V.: The sophomore surgeon revisited. Arch. Surg. 134:805,
1999