Bridging the Gap of Skilled Surgeons in Low and Middle Income Countries Using ICT Based Tools : A Case Study in Super-Speciality Training

Introduction: Over the last two decades, advancement of super specialised surgical disciplines has shown improved health outcome, in particular quality and safety. Although medical technology has developed to meet diagnostics and therapeutic needs, there is a scarcity of trained human resources in advanced specialities in low and middle income countries (LMICs). Innovative methods are needed to educate and train people at their workplaces using collaborative technologies and networks. Methods: Over the last 15 years, two general surgeons in Cuttack have been telementored from Lucknow 1,163 km away, using collaborative technologies to develop Endocrine Surgery. This study reviews the last 11 years of the service which includes a clinical decision support system and treatment planning advice using real time videoconferencing. Results: Over the last 11 years, 199 endocrine surgeries per annum were performed with most being thyroid cases as compared with 119 surgeries per annum during the previous five years. Parathyroid and adrenal cases increased significantly during this period (p <0.001). Rates of temporary and permanent vocal cord palsy (1.7% and 0%), hypocalcaemia (5.9% and 1.1%) were comparable with high volume centres. Based on the quantum, safety and quality outcome of endocrine surgery the provincial government has approved creation of a super-speciality department of endocrine surgery in Cuttack. Conclusion: Sustained engagement using telementoring can transfer surgical skills to needy surgeons and enable them to match the expertise of mentors. This model can be replicated in other specialities in a cost effective way to develop specialised human resources for healthcare, in particular in LMICs