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Teaching Surgical Skills Using Video Internet Communication in a Resource-Limited Setting

Autry, Amy M. MD; Knight, Sharon MD; Lester, Felicia MD, MPH; Dubowitz, Gerald MD; Byamugisha, Josaphat MBChB, PhD; Nsubuga, Yosam MBChB, MMed; Muyingo, Mark MBChB, MMed; Korn, Abner MD

doi: 10.1097/AOG.0b013e3182964b8c
Original Research

OBJECTIVE: To study the feasibility and acceptability of using video Internet communication to teach and evaluate surgical skills in a low-resource setting.

METHODS: This case-controlled study used video Internet communication for surgical skills teaching and evaluation. We randomized intern physicians rotating in the Obstetrics and Gynecology Department at Mulago Hospital at Makerere University in Kampala, Uganda, to the control arm (usual practice) or intervention arm (three video teaching sessions with University of California, San Francisco faculty). We made preintervention and postintervention videos of all interns tying knots using a small video camera and uploaded the files to a file hosting service that offers cloud storage. A blinded faculty member graded all of the videos. Both groups completed a survey at the end of the study.

RESULTS: We randomized 18 interns with complete data for eight in the intervention group and seven in the control group. We found score improvement of 50% or more in six of eight (75%) interns in the intervention group compared with one of seven (14%) in the control group (P=.04). Scores declined in five of the seven (71%) controls but in none in the intervention group. Both intervention and control groups used attendings, colleagues, and the Internet as sources for learning about knot-tying. The control group was less likely to practice knot-tying than the intervention group. The trainees and the instructors felt this method of training was enjoyable and helpful.

CONCLUSION: Remote teaching in low-resource settings, where faculty time is limited and access to visiting faculty is sporadic, is feasible, effective, and well-accepted by both learner and teacher.


Supplemental Digital Content is Available in the Text.Remote teaching in low-resource settings is feasible, effective, and well-accepted by both learner and teacher.

Departments of Obstetrics, Gynecology, and Reproductive Sciences, and Anesthesia, University of California, San Francisco, San Francisco, California, and the Department of Obstetrics and Gynecology, Mulago Hospital, Makerere University, Kampala, Uganda.

Corresponding author: Amy (Meg) Autry, MD, Professor, Director of GME Education, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 2356 Sutter Street, 6th Floor, San Francisco, CA 94115; e-mail:

Funded by an Association of Professors of Gynecology and Obstetrics Medical Education Foundation award.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the 2013 Annual Association of Professors of Gynecology and Obstetrics/Council on Resident Education in Obstetrics and Gynecology meeting, Phoenix, Arizona, February 28, 2013.

© 2013 by The American College of Obstetricians and Gynecologists.