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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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EDITORIAL
Year : 2018  |  Volume : 23  |  Issue : 2  |  Page : 55-56
 

Live workshops: A time to rethink


Department of Pediatrics, The Calcutta Medical Research Institute, Kolkata, West Bengal, India

Date of Web Publication29-Mar-2018

Correspondence Address:
Subhasis Saha
The Calcutta Medical Research Institute, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_46_18

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How to cite this article:
Saha S. Live workshops: A time to rethink. J Indian Assoc Pediatr Surg 2018;23:55-6

How to cite this URL:
Saha S. Live workshops: A time to rethink. J Indian Assoc Pediatr Surg [serial online] 2018 [cited 2018 Apr 24];23:55-6. Available from: http://www.jiaps.com/text.asp?2018/23/2/55/228894






Subhasis Saha

Live workshops have become a part and parcel of our academic calendar. It is the star attraction which increases the number of registration. Without a live workshop, a course or an academic event seems to remain incomplete. It is an inimitable feeling of all pediatric surgeons to watch a renowned faculty, demonstrating a difficult procedure live. We can get a real-time feel of the details of the procedure, not available in text books. We can learn from the “horse's mouth” how to avoid the common pitfalls and how to troubleshoot at an unexpected turn of event. However, over the last decades, we have had our share of complications in various live workshops at various corners of our country, in various disciplines. There have been a few mortalities and many morbidities. The discontinuity of surgical care can become a medicolegal issue today. The unfortunate kid who develops postoperative urethral stricture and wound dehiscence after demonstration of urethroplasty in the workshop no longer has the luxury of being managed by the renowned urologist who operated on him/her.

This brings us to the present debate whether we should continue with our live workshops or move away from this format.

A live workshop is now considered a part and parcel of any workshop and is supposed to be the main crowd puller. An edited video of a new/complicated procedure may mask the difficult steps where the surgeon had stumbled upon. However, one gets to see the problems as they evolve when he/she watches the procedure being done live and gets to observe the nuanced way how an expert overcomes the difficulty. A few basic steps, for example, port placements and the ergonomics of the same, may not be so obvious in a video, but can be clarified during a live surgical demonstration. One can share the feelings of doom when a major vessel is cut or an organ is damaged and gets to know how an expert can circumvent the impediment and take steps to address the situation without panicking. But, all said and done, the cons exceed the pros.

In the usual scenario, the guest surgeon who scrubs in for the demonstration is new to the place and completely unaware of the facilities available to the hospital. His/her own hospital may have a completely different generation of instruments. The preoperative preparation of the patient had not been done under his/her supervision and has a chance of remaining suboptimal. Surgery is a team event. He/she has to work with hitherto unknown team members including a new anesthesiology team in a workshop, and a lower level of coordination among them is only inevitable. Third, he/she has to operate under the prying eyes of scores of delegates and simultaneously go on talking to entertain the crowd and often forced to answer not so interesting questions. Except a few stalwarts like Prof. Alberto Pena, for most of us, it is ardent task balancing a continuous dialogue with the audience and at the same time maintaining the dexterity at work. Last but not the least, a lot of time is lost preparing the patient for anesthesia, positioning the patient for surgery, in discussing various relevant issues, and of course in the postoperative recovery. Legal issues of taking informed consent from the parents about their child being operated by an unknown person are also relevant. Technical issues such as obtaining permission from the Indian Medical Council for the foreign faculties and state medical council for national faculties need due consideration and may be time consuming.

So, if we are not comfortable with live workshops anymore, what are the options before us?

Surgery is an art. We all love to see live surgeries as we are all surgeons and would prefer to see how an expert tackles a problem step by step, and how an artwork takes shape and puts on color. This would perhaps be best achieved if the said artist is allowed to paint in his/her own studio. In other words, the best performance of a surgeon is possible in his/her own operating theater with his/her own team with whom he had been operating for years. He will be having a complete knowledge of all instruments at his/her disposal. The patient will have been prepared to his/her content. He/she can be responsibly available to take care of the patient in the postoperative period. In today's world, transmission of this procedure in the form of a webinar is quite feasible and we have already embarked on this path with initiative by our dynamic Honorary Secretary Dr. Prakash Agarwal last month. Another advantage of this approach is the participation by the delegates from the comfort of their home or office without applying for a leave and without leaving the town. Once popularized, this can ensure the maximum participation of delegates from all over the country and can even ensure higher international participation. We can cut down on the budget as well.

The other option is edited/unedited videos with discussion by the surgeon himself/herself. If we think carefully, in a surgical demonstration, there will be a few take-home messages. Majority of the rest is mere repetition. If the surgeon carefully selects the portion of his/her recorded video which he/she wants to highlight or share with the audience and he/she presents the same, we can actually discuss many more and varied topics in the same duration of time. For example, a live laparoscopic cholecystectomy can take around an hour or more including bringing the patient on table to complete recovery from anesthesia. In 1 h, we can discuss six 10-min clips of various aspects of laparoscopic cholecystectomy. This is more relevant if the surgery is a major procedure such as a lap fundoplication or lap excision of choledochal cyst, the live demonstration of which consumes a lot of time. The time thus saved can be utilized for discussing topics, hitherto thought to be irrelevant like “medicolegal issues relevant to pediatric surgery,” etc.

If we look at international experience, most associations in developed countries are gradually giving up live workshops altogether. Live workshops are held as a part of a focused course in the lead surgeon's own center or in the form of webinars transmitted from the operating surgeon's hospital. It is the time that we spare a thought at our own place too. After all, the medical ethics is based on the principle of doing no harm whatsoever Primum non nocere. Perhaps ethically we will be on a much higher platform if we choose to do away with live workshops.

Acknowledgement

We thankfully acknowledge the financial support from Dr. Ashok Sengupta Memorial Fund and Contribution from West Bengal Chapter of IAPS.






 

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