Page 5 - CUA2019 Abstracts - Miscellaneous/Other

2019 CUA Abstracts

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The burden of urological disease in Zomba, Malawi: A needs SMARTv: Surgical Mentoring by Annotated Real-Time Video
assessment in a sub-Saharan tertiary care centre Anne-Sophie Blais , Shaun Trecarten , Ivan Reel , Greg Patterson ,
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Tristan Juvet , James Hayes , Sarah R. Ferrara , Duncan Goche , Robert Armando J. Lorenzo , Fadi Zu’bi , Darius J. Bagli 1
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D. MacMillan , Rajiv K. Singal 5 1 Urology, Hospital for Sick Children, Toronto, ON, Canada
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1 Urology, University of Toronto, Toronto, ON, Canada; Urology, Introduction: As surgical modalities expand and operative caseloads are
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University of Ottawa, Ottawa, ON, Canada; Surgery, Zomba Central reduced, new teaching strategies are needed to enhance intraoperative
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Hospital, Zomba, Malawi; Urology, Kelowna General Hospital, Kelowna, learning. We developed a novel intraoperative training strategy of Surgical
BC, Canada; Urology, Michael Garron Hospital, Toronto, ON, Canada Mentoring by Annotated Real- Time Video: SMARTv. Using an iPad and
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Introduction: A large part of the developing world continues to lack Apple Pencil, SMARTv allows a mentor to annotate live video of the surgi-
access to surgical care and this situation is accentuated in sub-Saharan cal field, which is streamed to a trainee video monitor. Without scrubbing
Africa. Urology remains one of the least represented surgical subspe- in, mentors can highlight teaching points directly on the iPad surgical
cialties in global health. In order to begin understanding the burden of field image and bookmark key moments, which can be archived for later
urological illness in sub-Saharan Africa, we sought to characterize all debriefing and longitudinal assessment of improvement. To validate the
patients presenting to a tertiary hospital in Malawi with a urological effectiveness of SMARTv, we conducted a pilot study using open surgery
diagnosis or related complaint in the past year. of the perceived impact of SMARTv on the intraoperative educational
Methods: Retrospective review of the surgical clinic record book and experience of trainees and on the mentoring experiences of educators.
surgical theater record books at Zomba Central Hospital (ZCH) was Methods: Following completion of SMARTv-guided open surgery, the
performed for a one-year time span from March 2017 to March 2018. trainees and their mentor completed a Likert scale (1-strongly disagree,
Patients presenting with urological diagnoses or undergoing a urological 5-strongly agree) assessment questionnaire based on Kirkpatrick’s model
procedure under local or general anesthetic in the operating theater were of effectiveness evaluation.
identified and recorded. Results: To date, five (one mentor, four trainees) surveys were completed.
Results: A total of 440 clinical patients were reviewed (Table 1). The most SMARTv was used to guide trainees through hypospadias repairs and
common clinic presentations were for urinary retention (153 patients, urethrocutaneous fistula repairs. All respondents agreed that the tool was
34.7%), lower urinary tract symptoms (68 patients, 15.5%), and hydrocele easy to use (mean score 4.5/5) and improved instruction clarity and the
(45 patients, 10.2%). A total of 182 surgical cases were reviewed (Table quality (4.4) and quantity (4.2) of feedback. Four respondents agreed
2). The most common diagnoses for surgical patients were urethral stric- that the tool improved trainee autonomy (4.2). No one rated the tool as
ture disease (40 patients, 22%), followed by bladder masses (31 patients, distracting (2.2). Many SMARTv-guided surgeries are scheduled for the
17%) and benign prostatic hyperplasia (BPH) (27 patients, 14.8%). When upcoming months; more data will be obtained.
combined, stricture-related procedures, including visual internal ureth- Conclusions: SMARTv is an innovative tool that provides close intra-
retomy and urethral dilatation, were the most frequent (26 and 14 cases, operative guidance while maintaining trainee autonomy. We speculate
14.2% and 7.7%, respectively). BPH-related procedures, including simple this approach will extract greater learning from each case, require fewer
prostatectomy and transurethral resection of the prostate, were the second cases to achieve competence in surgical training, and find a key role
most common (12 and 15 cases, 6.7% and 8.2%, respectively). in the design of competency-based training. These goals await future
Conclusions: Urethral stricture disease, BPH, and urinary retention rep- long-term studies.
resent the clinical diagnoses with the highest burden of visits at ZCH.
Despite these numbers, very few definitive procedures are performed on
an annual basis. Further focus on urological training in sub-Saharan Africa
should focus on these conditions and their management.
This paper has figures, which may be viewed online at:
https://2019.cua.events/webapp/lecture/153

S116 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)