Telemedical teaching is taking off: Tübingen’s Sectio chirurgica (TSC) is already used by around 25% of all medical students in German-speaking countries. TSC transmits surgical interventions and procedures performed by renowned surgeons into auditoriums and via Internet live stream.
It all started rather modestly: PD Dr. Bernhart Hirt wanted to give as many medical students in Tübingen as possible a motivational tool to show them why the traditional dissection courses needed to remain a central element in medical programmes. “Anatomy courses are very specialised and focus on the smallest details, which is why students might sometimes lose sight of the connection with their medical activity. We established a pedagogical concept in which surgical prosection is performed in addition to traditional dissection courses in order to forestall this problem. As an anatomist, I also wanted to show the students that anatomy is really rather a vibrant subject,” said Hirt, who heads the Clinical Anatomy team at the University of Tübingen.
It became soon clear that this could only be achieved using cutting-edge multimedia technologies; it was the only way for TSC initiators to effectively communicate anatomic details as well as a vision of surgical competence. This led to the idea of asking experienced surgeons to carry out classical and innovative surgical interventions under realistic conditions in the anatomy classroom. In this case, realistic means that surgery is carried out on human corpses. The corpses are from people who have expressed the wish to donate their body for scientific purposes and aid in the advancement of medical knowledge and medical training after death.
The surgeons are specialists from hospitals in Tübingen. “We asked the medical directors of the University Hospital of Tübingen and the BG-Trauma Hospital whether they would be prepared to assist outside their working hours. They all promptly agreed to our request, and the first telemedical lecture series in the 2010/2011 winter term involved many renowned surgeons,” Hirt said. The interactive sessions are held during the winter semester on specific dates, always starting at 6 p.m., and are transmitted into the auditorium in order to enable as many students as possible to follow the surgical intervention live. Sectio chirurgica is also transmitted via live stream. People with a professional interest, i.e. medical and medical technology students, doctors, care personnel and other medical professionals can apply for password-protected access and participate in the interactive events. “Access to Sectio chirurgica is limited to professionals as we do not want it to become a sensational event open to all,” Hirt says.
Around 16,000 people have already registered for Sectio chirurgica although the TSC team has never promoted the event. “Up to 25% of all medical students in German-speaking countries are already participating in Sectio chirurgica. Students from Tübingen have talked about the interactive event, and have also recommended it to peers at other universities. We now transmit the event into the auditoriums of other universities where other surgeons moderate and comment on the surgery as it takes place,” said Hirt, going on to refer to another major feature and success factor of Sectio chirurgica: all spectators can participate interactively. In general, every TSC surgery in Tübingen is moderated by an anatomist who translates the surgical terms, explains what the surgeon is doing and leads an excursion into the human anatomy. The anatomist also uses plastinates to specifically point out important surgical landmarks, amongst other things. External spectators are always welcome to pose questions, comment on and discuss the surgery. “We have established a live-chat forum where we can react directly to what is happening on the Internet. For example, if a particular question comes up several times and leads to controversial debate, our live studio can take it up and the surgery team in the operating room can reply, explain and join the discussion.
Hirt pointed out that the event is not intended to replace classical anatomy courses. “Sectio chirurgica is an add-on, a teaching activity in which surgical prosection is performed in addition to the usual dissection course. A donated body is usually used for around 120 hours, but not exclusively for dissection courses, which means that we are able to use it for our purposes between the individual dissection course days. Our telemedical events do not focus on dissection, but rather on surgical prosection where students watch a professional carry out surgery and learn from him or her.” One particular side effect is that the TSC participants are provided with insights into cutting-edge medical technology. Renowned medical device producers provide the Clinical Anatomy team with their most modern devices and equipment, with some element of self-interest as the companies are thus able to see and test their products in authentic applications.
Sectio chirurgica covers the entire range of surgical applications, from classical scalpel cuts to high-frequency surgery. Hirt is particularly interested in being able to show methods and products that might represent a paradigm change in the field of surgery. The team tries to highlight the differences between classical and cutting-edge surgical interventions, for example by carrying out robot-assisted surgery in one operating theatre and conventional surgery in another. Both types of surgery are transmitted to the classrooms and over the Internet. In the 2012/2013 winter term, Sectio chirurgica featured the implantation of an artificial heart along with the implantation of a “normal” one, in order to highlight the differences between the two. Prof. Dr. Dr. h.c. Christian Schlensak, medical director of the Department of Cardiac, Thoracic and Vascular Surgery at Tübingen University Hospital, showed how an artificial, left-ventricular assist device was implanted.
Another exciting aspect is the explantation and implantation of organs in one session. For example, in the last semester, Prof. Dr. Alfred Königsrainer, medical director of the Department of General, Visceral and Transplantation Surgery at the University Hospital in Tübingen, and his colleague Dr. Silvio Nadalin performed a kidney transplantation.
3D endoscopy is an emerging technology and a particular challenge for the series of events. “Two-dimensional endoscopic surgery requires highly experienced surgeons to stitch wounds inside the human body. It can be assumed that this becomes simpler in a three-dimensional space and might potentially also save time,” said Hirt. The last Sectio chirurgica featured stomach reduction surgery carried out by a surgeon wearing 3D glasses: Dr. Zdichavsky, senior physician in the Department of General, Visceral and Transplantation Surgery at the University Hospital of Tübingen, carried out this new surgical option to deal with obesity. In November 2012, the available media technology only enabled the two-dimensional transmission of the surgical intervention. Hirt’s team hopes to change this soon by technically upgrading the available technology. “We are working hard to make 3D live streams and 3D videos accessible online. However, at present we do not have the necessary 3D platforms to make this possible,” Hirt said, going on to highlight the importance of this innovation. “3D surgery is the future and we would like to be among the first to teach it.”
The TSC team is also planning to offer English versions of Sectio chirurgica and make the sessions available to an international professional audience. In addition, a basic anatomical lecture similar to Sectio chirurgica surgery will be offered from spring 2014 onwards. In order to be able to transform their ambitious plans to reality, Hirt and his team depend on third-party funds. They have already received a financial injection in June 2013 when the team won a MOOC fellowship which comes with a purse of 25,000 euros and assistance with course production. MOOC stands for massive open online courses, i.e. courses aimed at large-scale interactive participation and open access via the Internet. The European-wide MOOC Production Fellowship contest was organised by the Stifterverband für die Deutsche Wissenschaft with the aim of identifying the ten best innovative concepts for MOOCs. Sectio chirurgica will start with new sessions in October 2013, and the programme will be published on the Sectio chirurgica homepage (see link in the top right-hand corner) in September.
Further information:University of TübingenInstitute of AnatomyClinical AnatomyPD Dr. med. Bernhart Hirt
Efriede-Aulhorn-Straße 872076 TübingenTel.: +49 (0)7071 29-72186E-mail: bernhard.hirt(at)klinikum.uni-tuebingen.de