Phase 2 (2006 Deadline)
Establishment of Virtual Trainer Lab for Improving Minimally Invasive Surgery Skills of Post-Graduate Trainees and Faculty of the Surgery Department of Rawalpindi Medical College and Allied Hospitals
Dr. Merrell (center) and Dr. Zafar (left) instructing trainees in the operating room during the November 2008 training course at HFH.
Multitasking of Telemedicine/E-health Training Center
Ronald Merrell, Virginia Commonwealth University, Richmond
Asif Zafar Malik, Holy Family Hospital, Rawalpindi
Pakistani Funding (MoST): $270,000
US Funding: $213,000
Project Dates: March 1, 2007 - March 31, 2011
This project included two separate but related components aimed at building Pakistani capacity in the healthcare sphere. The first involved laparoscopic or minimally invasive surgery, which has become very popular in the last 15 years. Because many operations that were once performed “open” are now done almost exclusively laparoscopically, skills training in this area is becoming necessary for many surgical subspecialties. The current goal of simulator training is to help trainees acquire the skills needed to perform complex, minimally invasive surgical procedures prior to practicing them on living patients. Unfortunately, minimally invasive surgery training facilities were previously unavailable in most of the teaching hospitals of Pakistan. During this project, a virtual training laboratory has been established at Surgical Unit II, Holy Family Hospital (HFH), in collaboration with the Medical Informatics and Technology Applications Consortium at Virginia Commonwealth University (VCU). The lab, which includes box trainers, virtual reality simulators, and full procedural simulators, is now being used to train surgical residents. The operating rooms and training lab have been linked together and also to minimally invasive training centers in the United States.
Dr. Asif Zafar (at head of table) leads a telemedicine consultation at HFH via video link with a remote clinic.
The second project component focused on expanding an existing joint telemedicine training program at HFH. Pakistan is one of the most densely populated countries in the world, but the doctor-to-patient ratio is only 1 to 1,555, and there is just one specialist available for every 15,000 citizens. Moreover, the majority of the population resides in rural areas, while medical facilities are concentrated in the urban areas. One solution to bridge this rural-urban disparity is to build new hospitals in rural areas and send specialists to those areas, but this is difficult for a variety of reasons. The other feasible solution is using telemedicine to address the limited availability of specialists at remote sites. The implementation of telemedicine requires health professionals trained in this field, which was previously unknown in Pakistan. In 2003, the partners involved in this project received a grant under the Pakistan-US Science and Technology Cooperation Program in its previous form to provide telemedicine training to medical personnel in Rawalpindi and Islamabad. During that six-month project, 45 doctors and nurses from various institutions were trained, and they are now pursuing telemedicine projects in their own institutions. During the current project, medical personnel from throughout Pakistan were trained at the telemedicine/E-health training center established at HFH. In addition, this facility is being utilized to provide telemedicine training and tele-rehabilitation services to paraplegic victims of the October 2005 earthquake.
- Established a virtual training laboratory at HFH that allows Pakistani surgeons to learn and practice minimally invasive surgical procedures on simulators before operating on real patients
- Provided training to medical personnel from throughout Pakistan at the telemedicine / E-health training center
- Worked with the Pakistani Ministry of Information Technology to extend satellite connectivity for telemedicine activities to 15 districts in Pakistan
- Led to the development of public - private partnership
Progress Report Summaries
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2010 Show summary || Hide summary || Download full report
In March 2010 Dr. Merrell made another week-long-visit to Pakistan during which he helped present a surgical training course for 10 participants and worked alongside the trainees in the operating room to demonstrate minimally-invasive techniques for cholecystectomy and appendectomy. Dr. Merrell was planning a similar visit in early 2011 to participate in another training workshop for surgeons and assist with telemedicine consultations.
In May 2010, Dr. Zafar attended the Fifteenth Annual International Meeting & Exposition of ATA in San Antonio, Texas. Four papers of Telemedicine/E-Health Tranining Center were presented during his meeting.
2009 Show summary || Hide summary || Download full report
In 2009 four more surgical training courses were held (one in March, two in June, and one in July), serving a total of 40 trainees. A short training course in tele-rehabilitation was organized for two trainees from the Abbas Institute of Medical Sciences in Muzaffarabad, and four doctors from HFH attended the ATA annual meeting in Las Vegas, during which they each presented papers on their recent research and training activities. Dr. Zafar has also been appointed to the editorial board of the the ATA journal Telemedicine and e-Health.
Due to the late start of activities as a result of various financial and administrative delays, a no-cost extension has been issued on the US side through March 2011 to provide additional time to complete and consolidate work on this project. Despite the budget delays, the partners have persevered in their work. In December 2009, Dr. Zafar visited the facilities of the Earthquake Reconstruction & Rehabilitation Authority (ERRA) in Muzaffarabad. The Rehabilitation activities at ERRA center in Muzaffarabad were evaluated. It was decided to shift the remote Telerehabilitation center equipment from Abbas Institute of Medical Sciences (AIMS) Tele-Rehabilitation Center, Muzaffarabad to ERRA facility for efficient achievement of the objectives of the project.
2008 Show summary || Hide summary || Download full report
In the second year of the project, five two-week telemedicine training courses were held at HFH in March, April, and June 2008, serving a total of 55 trainees (33 of whom were female) from medical institutions around the country. Plans had initially called for Pakistani doctors to come to VCU for training as well, but after visa complications arose, Dr. Merrell decided to present the course in person instead. He traveled to Pakistan for two weeks in November 2008 to provide minimally invasive surgical training to 10 Pakistani physicians using the new equipment installed at HFH. The course included three modules, including laparoscopic training lectures and demonstrations, work on virtual simulators, and finally hands-on training on patients supervised by Drs. Merrell and Zafar. While in Pakistan, Dr. Merrell also had the opportunity to participate in grand rounds at HFH, visit one of the telemedicine clinics in Attock, and take part in Surgicon 2008, the annual meeting of the Pakistani national surgical society.
2007 Show summary || Hide summary || Download full report
Although both sides experienced significant delays in setting up their grant accounts and agreements at their respective institutions, in May 2007 the VCU team met with Dr. Zafar in Nashville at the American Telemedicine Association (ATA) annual meeting and agreed upon the final revision of the training curriculum and budget. At this meeting, Dr. Zafar and his colleague Dr. Faisal Murad made three presentations on earthquake relief with telemedicine, telemedicine for follow-up of earthquake patients, and telemedicine for pre- and post-operative follow-up of elective surgical patients. The partners all agreed on revision of a formal report on the scientific lessons learned from their first project for publication in the ATA journal Telemedicine and e-Health. After the conference, Dr. Murad spent a week at VCU to examine a variety of telemedicine products and systems in anticipation of setting the equipment list for the project. In addition to working with equipment for training and courses of instruction, he visited with vendor representatives and established the necessary links for purchase orders from Pakistan to the United States.
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