By New Pathway -Apr 23, 2019 – Victor Hetmanczuk, Canada-Ukraine Foundation.

CUF’s team operates at the Ukrainian Military Hospital.  Photo: Adriana Luhovy
CUF’s team operates at the Ukrainian Military Hospital.
Photo: Adriana Luhovy

During the missions, we also provided training to military surgeons, surgical trainees and nursing staff at the Central Military Hospital Clinic (CMHCK). These Ukrainian medical personnel are already in the front lines treating war casualties in the country’s foremost trauma centre. All patient consultations and all surgical procedures were performed in collaboration and with the active participation of Ukrainian surgeons and anesthetists. The projected number of people that would be trained and have their surgical skills enhanced was exceeded. There was such a huge thirst for learning and knowledge from our Ukrainian colleagues that people were constantly coming and observing. Operating tables would have up to 20 people surrounding each of them at any given time.

Each of the 2 missions provided direct intensive intraoperative training to the CMHCK staff: 3 anesthetists, 3 anesthesia assistants, 5 surgeons, 3 surgery assistants/trainees, and 2 nurses. In addition to these 16 people, direct intraoperative training and teaching was provided to 65 visiting surgeons, nurses and medical students. Throughout the mission, military neurosurgeons, maxillofacial surgeons, ENT (ear nose and throat), trauma and plastic surgeons and trainees from Kyiv, Odessa, Lviv, Dnipropetrovsk came and went. In total, over the two medical missions, 81 people (many that observed the first mission returned to observe during the second mission) were able to enhance their skills through training obtained during the course of the medical missions.

The training was provided according to standards employed in Canada for Continuing Medical Education (CME) and resident training. Ukrainian health professionals actively participated in:

  1. Patient assessment, physical examination, radiographic examination
  2. Formulation of treatment plan and surgery preparation
  3. Discussion of options, variables, risks, and risk management
  4. Practical demonstration of requisite surgical skills
  5. Instruction in postop management of pain, infection prophylaxis, etc.

Resident teaching and training is vastly different in Canada and Ukraine, with the Canadian system being much more formal and defined in terms of teaching standards, methods, requirements for competence-based learning, availability of educational resources. One of the unexpected outcomes and legacies of these missions was the demonstration of resident training methods employed in Canada, and the enthusiasm with which local Ukrainian trainees responded to these efforts.

In an effort to maintain and develop this ongoing clinical and educational collaboration across borders, a decision was made to develop a Telemedicine Program. Experience previously obtained in developing live surgery demonstrations for International CME programs (Advanced Craniomaxillofacial Forums) and research of current technology and standards for two way videoconferencing through “Sunnybrook telemedicine” and “Ontario Telemedicine Network” facilitated the design of a telemedicine system that would optimally serve the patient care and educational needs at the Kyiv Main Military Hospital.

The Telemedicine system will be used to:

  1. Document relevant surgical cases performed by orthopaedic, craniofacial, hand and microsurgeons, and neurosurgeons at Sunnybrook Hospital
  2. Conduct combined surgical rounds and seminars featuring recorded surgical cases
  3. Perform remote clinical or radiological consultations

The equipment necessary to establish a telemedicine/ telesurgery link between Ukrainian and Canadian Trauma Centres was selected following presentations and quotes by Stryker Endoscopic Systems and Panasonic. Panasonic was chosen based on quality of product and best price. The system comprises 3 hubs:

  1. A portable OR cart with camera and video recorder. This will be available to any Sunnybrook OR performing relevant surgery. The recorder allows documentation of data from multiple sources: overhead camera, head cam, and computer (for CT data, and powerpoints)
  2. Telecommunications Hub at Sunnybrook Hospital
  3. Telecommunications Hub at Kyiv Main Military Hospital

Panasonic professionals came to Sunnybrook to teach Dr. Antonyshyn the most effective way to set-up and use the equipment. Dr. Antonyshyn shared this information with his Ukrainian colleagues.

The use of two-way videoconferencing and advanced information communication technologies to deliver examinations, treatments, clinical, and education services will allow Sunnybrook Health Sciences in Toronto and the CMHCK to collaborate, share knowledge and consult patient cases for years to come. Dr. Antonyshyn has the same implants, instrument sets and pieces of equipment that were purchased for the CMHCK (to create a centre of excellence in Craniofacial surgery) at Sunnybrook Health Sciences. Since our second medical mission, our colleagues have continued to use the new technologies that were purchased for them. Through telemedicine, Dr. Antontyshyn will continue to train his Ukrainian colleagues to use the new equipment, instruments and implants, that were donated to them, as efficiently and effectively as possible by consulting on specific cases and organizing viewings of his complex surgeries. Dr. Antonyshyn in Canada and Dr. Ihor Fedirko in Ukraine are both committed to using this educational tool for years to come.

Further refinement of these initial efforts and wider adaptation of Telemedicine through Ukrainian Medical teaching centres can potentially revolutionize training of health professionals and delivery of health care. This leaves a legacy.