Virtual Pointer for Clarity of Instruction in Telementoring

Hannah McGowan¹, Azin Semsar, MS¹, Yuanyuan Feng, MS¹, Hamid Zahiri, DO², Adrian Park, MD², Andrea Kleinsmith, PhD¹, Helena Mentis, PhD¹. ¹University of Maryland Baltimore County, ²Anne Arundel Medical Center

OBJECTIVE OF TECHNOLOGY: Advancements in telecommunications has expanded the ability to collaborate remotely. A challenge faced in telecommunication is reduced ability to use nonverbal communication to convey information. This can lead to reduced clarification in instructing, which can be particularly detrimental in surgical telementoring environments. As such, many telecommunications/telementoring systems offer telestration and pointer conveyance assuming that such technology facilitates instruction/communication.

We previously showed a Virtual Pointer (VP) system can aid in laparoscopic instructional learning in a collocated condition by improving quality of instruction [1]. Here, we investigated whether the same benefits of telestration are observed in a remote condition. We compared telestration use in a simulated telementoring condition to telestration use in a collocated condition. This allows us to address the assumption of the necessity of a telestration tool in telementoring system design.

TECHNOLOGY AND METHODS: We used an in-house developed image annotation system – VP – which allows a remote trainer to point/draw over any image or live video – similar to Storz VISITOR1® and Skype. We employed the VP in a telementoring simulation consisting of a validated laparoscopic training physical model [2] and a divider between the trainer and trainee (Figure 1).

A randomized, within-subjects experiment was used to compare the quality of instruction in a collocated condition to quality of instruction in a telementoring condition. A surgical trainer (attending surgeon) guided 9 surgical trainees (PGY2 and 3) in each condition. Benefits to instruction was assessed by a five-question Likert scale Quality of Instruction Questionnaire [3] completed by the trainees. Using R (version 3.5.1), a linear mixed model analysis was run to analyze the effect of condition (remote vs. collocated) on trainee’s perceived quality of trainer’s instruction. The number of times the trainer used the VP in both conditions was recorded by annotating the start of each new instruction, and analyzed using the linear mixed model.

RESULTS: Although the remote condition was slightly higher in all the questionnaire’s measures, overall, there is no significant effect of condition on perceived quality of instruction. Question 2, pertaining to clarification of instruction, showed significantly reduced perceived need for additional clarification of instruction in the remote condition (p=0.015) (Figure 2). Furthermore, our analysis of the use of the VP showed that the trainer used the telestration tool more often in the remote condition, although not significantly (p=0.055) (Figure 3).

CONCLUSION: The primary results show no overall significant difference in quality of instruction between the telementoring and collocated condition. This suggests the same benefits of telestration use was captured in the remote condition as was seen in our prior study of telestration use in collocated training. Interestingly, in this study, less need for additional clarification of instruction was observed in the remote condition. The greater uses of VP in the remote condition suggests that the less need for additional clarification could be because of greater use of VP by the trainer to facilitate instruction remotely. This indicates that the assumption that telestration is a necessary component of a telementoring system has merit.