When the coronavirus outbreak led to closed clinical opportunities all across the nation, it also nudged medical students off campus, and by extension out of operating rooms. At the University of Kansas Medical Center, the department of neurosurgery turned to technology to ensure the continuation of a high-quality educational opportunity.

Since early April, the department has been live streaming surgeries via a secure, HIPAA-compliant version of the videoconferencing platform Zoom. Medical students on the neurosurgery rotation can log into the password-protected feed to view the procedure. Only patients who have consented to their surgery being streamed to students participate.

What started out as a work-around may have additional benefits no one predicted.

"I actually felt like the teaching experience was more personal than if the student were physically in the room standing perhaps behind me," said Paul Camarata, M.D., chair of neurosurgery at KU Medical Center. "Now they are able to see what I'm seeing as if they were directly suspended above the surgical field or looking into the operating microscope. And, they can ask questions that everyone in the room can hear, and they can hear our responses."

Maintaining the teaching mission

Being in the operating room and observing surgeries is a significant part of third- and fourth-year medical students' experiences during their four-week neurosurgery rotation. When pandemic-related restrictions muted that option, the department began seeking a simple, inexpensive solution.

To stream its surgeries, the department is taking advantage of equipment it had on hand and innovations already installed in its operating suite in The University of Kansas Health System's Cambridge Tower A, including cameras built into overhead lights and microscopes, laptops, Bluetooth speakers and GoPro headsets. The department's only purchase was a small piece of equipment that transmits data to the computer to facilitate the video images.

Typically, only one medical student is allowed in the operating room with neurosurgery faculty, but live streaming procedures means multiple students can observe without any additional risks or use of resources, such as personal protective equipment. The ability for students and faculty to interact through the technology makes live streaming the surgeries more similar than dissimilar to the in-person experience.

"I try to emulate what I would do if they were there," said Kushal Shah, M.D., one of the neurosurgery faculty members who has streamed surgeries. "In the operating room, I'd be talking to a student about the various treatment options, what our goals are, what the risks are, and I try to verbalize those same points in this system. Students are home, so I could say, let's go over some anatomy and if you don't know the answer, why don't you find a picture or a resource and then get back to me, so it's active learning in that way. We're still trying to get the same teaching points across. The negative side is they can't get their hands involved in the surgery to assist."

Although the approach is still relatively new, faculty in the department hope the numbers of participating medical students will continue to grow. As word of its clever strategy has spread, students who are not currently on the neurosurgery rotation have inquired about the chance to observe procedures. Meanwhile, shortly after neurosurgery streamed its first surgeries, Camarata connected with Peter J. DiPasco, M.D., director of the surgery medical student clerkship at KU Medical Center, and soon general surgery also was taking advantage of the same technology. Neurosurgery also submitted a paper to the Journal of Surgical Education about its successful experience.

Short-term fix to long-term fixture?

It's clear live-streaming technology holds great potential even well beyond the current health crisis.

"Personally, I believe this is a great tool that should continue even after the pandemic though I don't think it can completely replace a student being in an operating room," Shah said. "It also has other potential uses such as a virtual proctor or getting an opinion from a colleague by having them look in via the live stream."

This creative blend of innovation and education has helped neurosurgery effectively continue its teaching mission during the pandemic. Now, the approach is making a strong bid to become a more permanent fixture. While live surgery courses have been available for years, participants usually had to attend in person and watch from an adjacent or nearby auditorium. Or, for instance, if there was a sizable group of students on a rotation, all of them would have to be in the operating room or a few at a time, which increases the risk of infection and other complications. Technology is influencing that idea.

"Yes, I think this will be very helpful for students," Camarata said. "Students will still need to be present in the OR to experience the operating theater environment. However, there will undoubtedly be much more remote surgery streaming and education. We're not going back."