Can we be in two (or more) places at once?

by Hiep Nguyen on May 31, 2011

Hiep Nguyen (L) and two of his Kenyan colleagues during one of the 41 procedures they performed together in five days. (Photo: Kelly Kristof and Hiep Nguyen)

For over a decade, Hiep Nguyen, MD, FAAP has been traveling the world as part of a nonprofit surgical and education team, dedicated to improving pediatric urology in developing countries. Nguyen’s recent experiences leading a surgical team in Kenya highlighted the need for a better way to keep his international colleagues up to date on the rapidly evolving field of pediatric urologic surgery.

Once a year, I lead a group of dedicated volunteers from International Volunteers in Urology (or IVUmed) to a remote part of the world to help train local physicians to care for children with urological problems, in particular congenital anomalies of the genitourinary tract. Despite these conditions being common – they affect between two and 15 percent of all children – very few physicians are specifically trained to take care of children who have them. The ways in which we diagnose and care for congenital urological problems are evolving rapidly and, consequently, such care is increasingly delivered by full-time specialists – specialists who are often in limited supply, especially outside of the United States.

On a trip to Kenya last month, our IVUmed team, assisted by the local surgeons, operated on 41 patients in five days. In the process, the physicians there got their first exposure to many aspects of diagnosing and managing congenital genitourinary malformations. They soaked up the knowledge with enthusiasm and demanded more, but unfortunately, our time there was limited, and it will be another year before we return and resume their education.

Despite the success of these trips, I always sense that we could do a better job if we could work with our colleagues overseas more consistently and expose them more constantly to the urologic techniques and concepts we teach. But it is impossible to be there with them every day.

Or is it?

Telecommunication technologies have rapidly evolved during the last decades, removing physical distance as a barrier to communication and education. With the Internet, people can transmit visual and audio data anywhere in the world in near-real time, allowing for constant telepresence. In the Department of Urology here at Children’s, we have a mission to establish excellent pediatric urological care globally.

Using the most up-to-date telecommunications technology, my colleagues here and I have developed the Pediatric TeleUrology Center (PTUC), a solution-based telemedicine program focused specifically on pediatric urology. The Center uses web-based video conferencing technologies to meet its four goals:

  1. to provide global access to specialized pediatric health care urology;
  2. to provide education experiences for physicians in the diagnosis, management and care of children with urogenital anomalies;
  3. to facilitate communication between physicians internationally; and
  4. to promote better understanding of global health care issues.

All a doctor needs in order to register and access the service is an Internet connection and a computer.

A screenshot from the PTUC's video library.

The PTUC has two components First, patient/case consultation: With video conferencing, a patient, referring doctor, and Children’s Hospital Boston’s specialist can discuss cases in real time. Second, educational materials and research projects: Through the website, physicians throughout the world can share interesting case studies and receive helpful comments on the diagnosis and management of urological conditions. A radiologic library is also available for physicians to view the radiologic findings associated with specific urological anomalies and share interesting articles and publications, broadening our collective understanding.

Through the PTUC, we want to educate and train physicians globally in a continuous fashion, building day by day. In addition to knowledge sharing, we can facilitate inter- and multinational research projects. In the future, we hope to expand the PTUC’s educational offerings to include “State of the Art“ and Grand Rounds lectures, surgical and other instructional videos, simulations and an advanced degree curriculum.

Our on-site surgical mission will always be needed; nothing replaces the learning that takes place “in-person.” However, an ongoing telepresence would augment, enrich and reinforce these learning experiences through timely evaluation of clinical problems as they present themselves.

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