Virtual telementoring to instruct selective dorsal rhizotomy technique in a resident cadaver laboratory at Philippine General Hospital

OBJECTIVE: To address unmet neurosurgery needs in the Philippines, particularly in remote areas of the archipelago, workforce development requires increased trainee learning opportunities and modalities for mentorship with existing surgeons. Telementoring adjuncts could facilitate these in an accessible, active, and continuing manner. Therefore, the aim of this study was to assess the feasibility and efficacy of telementoring to instruct a cadaveric selective dorsal rhizotomy dissection laboratory for neurosurgery residents in the Philippines. METHODS: Junior neurosurgical residents at Philippine General Hospital participated in a virtual lecture, which was followed by telementored cadaver dissections using an operative microscope guided by an overseas faculty neurosurgeon during a live audio/video exchange. Usability metrics and survey responses were recorded. Postlaboratory unproctored dissections were completed by each participant, and surgical skills as demonstrated on the video recordings were evaluated by two blinded adjudicators via the Objective Structured Assessment of Technical Skills (OSATS) tool. RESULTS: Four rhizotomy-naive junior residents participated. During each 1-on-1 telementored dissection session, a mean of 30 question-answer or mentor-mentee redirection exchanges transpired. Internet connection problems were frequent, with a mean of 5 connectivity issues requiring reconnection per session. All residents reported improved confidence in performing selective dorsal rhizotomy. In postlaboratory assessments, all participants successfully completed the main components of the procedure, with the OSATS evaluations demonstrating basic proficiency in all surgical domains. CONCLUSIONS: A telementored cadaver laboratory session was conducted by a live remote surgical instructor to junior neurosurgery residents in a middle-income country setting. The study demonstrated the feasibility of teaching operative skills using this method, with evaluation and feedback via OSATS scoring. It is recommended that a reliable internet connection be ensured before telementoring is trialed in a live clinical setting.