Teaching opportunities of live surgery broadcasts debated

Potential for distraction is an issue.

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SAN DIEGO – Two thoracic societies are being challenged to review their rejection of live broadcasts of surgical procedures at medical meetings.

The American Association for Thoracic Surgery and Society of Thoracic Surgeons “should modify their stance on live surgery as an educational tool like almost all of their sister organizations,” said Joseph E. Bavaria, MD, FACS, of the University of Pennsylvania, Philadelphia. “Presently, it is effectively a ban on the practice. But there are no data to suggest that it does harm to patients if done with proper constraints.”

Dr. Bavaria, a former president of the Society of Thoracic Surgeon, spoke during a series of talks on ethics at the annual meeting of the American Association for Thoracic Surgery.

Live broadcasts of surgeries at medical meetings are both common and controversial. Dr. Bavaria listed numerous recent thoracic meetings in Europe and Canada that featured live broadcasts. But, he noted, the AATS and STS are not supportive of the trend.

In a policy amended in 2017, the AATS states, among other things, that “national and international cardiothoracic societies should consider prohibiting live surgery broadcasts to large audiences at their annual meetings.” The STS policy, amended in 2016, is nearly identical. However, it adds language specifying that “violation of these guidelines may lead to disciplinary action by the Society.”

Both the AATS and STS policies state that surgeons should not take part in live broadcasts of operations that are intended for the public. And both policies say “generally, recorded broadcasts, either edited or unedited, are preferable to live surgery broadcasts because recordings intended for later broadcast pose fewer risks of harm to patients.”

The policies don’t elaborate on how a live broadcast of an operation might be more harmful than one aired at a later time. “Where are the data to support this statement?” Dr. Bavaria asked. “Is this what we call the expert opinion of a few people with gray hair? Our European and Canadian colleagues certainly don’t agree with [the policies] and might take issue with our sanctimonious lecturing that’s not supported by any data whatsoever.”

He pointed to a 2011 study that examined 250 cardiac procedures that were broadcast live to 32 scientific meetings. Researchers found that “there is no evidence for an excess perioperative risk for patients operated under the conditions of live broadcasting” (Eur J Cardiothorac Surg. 2011;40[2]:367-71).

A member of the audience at the AATS session pointed out that the study may be misleading because only top surgeons may be willing to perform procedures live on television. Dr. Bavaria responded by noting that the outcomes of surgeries performed on live video were not worse.

Skeptics have also expressed concern about the potential for sensationalism in live broadcasts and the drive for participants to make a splash: “the demands of ‘the performance,’ including questions and discussion with the audience, may divert the surgeon’s attention and produce an inferior outcome,” wrote three physicians in 2011 (J Surg Educ. 2011 Jan-Feb; 68[1]:58-61).

The trio also expressed worry about safety risks posed by extra equipment and extra people in the operating room during a live broadcast. However, Dr. Bavaria said the crowded conditions of an operation observed in person – instead of via video – could be worse: “You don’t have a sterile environment, you have people hanging around all over. A moderated live session could be better for the surgeon and the patient, rather than having a bunch of people in the room.”

Dr. Bavaria was also asked why surgeries couldn’t be recorded for airing later instead of being broadcast live, as this approach “takes you out of the nexus of having two masters, the patient and the audience.” In response, Dr. Bavaria said editing takes extra time in order to capture the nuances of the live procedure.

Dr. Bavaria reports no relevant disclosures.

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Although I do not agree with the suggestion that surgical meetings such as AATS and STS should reverse their ban on live surgery broadcasts, Dr. Bavaria’s suggestion certainly brings attention to an important question about how to maintain the safety of patients in the operating room, while still allowing for optimal teaching opportunities. Most surgeons have accepted that in a live surgical broadcast, the surgeon’s primary attention on the well-being of the patient in the operating room is potentially distracted by the audience viewing the procedure from afar. Although I cannot cite evidence that patient safety is actually compromised from such live broadcasts, self-reflection certainly suggests that there is a potential risk for the surgeon to have competing concerns during surgery, potentially at the expense of safety. In a similar context, I wonder where are the data that previously recorded videos of surgical procedures have less educational value than live operations. I am concerned that the fascination with live broadcasts has much to do with the sense that a complication might occur and that this fascination has little to do with educational value. Although I disagree with Dr. Bavaria’s conclusions on live broadcasting of operations, I commend his refocusing of attention on the educational value for students of viewing surgery in real time. Simulations are good teaching tools, but firsthand observation remains essential.

Peter Angelos, MD, FACS, is the Linda Kohler Anderson Professor of Surgery and Surgical Ethics, chief of endocrine surgery, and associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago. Dr. Angelos has no disclosures.

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Body

Although I do not agree with the suggestion that surgical meetings such as AATS and STS should reverse their ban on live surgery broadcasts, Dr. Bavaria’s suggestion certainly brings attention to an important question about how to maintain the safety of patients in the operating room, while still allowing for optimal teaching opportunities. Most surgeons have accepted that in a live surgical broadcast, the surgeon’s primary attention on the well-being of the patient in the operating room is potentially distracted by the audience viewing the procedure from afar. Although I cannot cite evidence that patient safety is actually compromised from such live broadcasts, self-reflection certainly suggests that there is a potential risk for the surgeon to have competing concerns during surgery, potentially at the expense of safety. In a similar context, I wonder where are the data that previously recorded videos of surgical procedures have less educational value than live operations. I am concerned that the fascination with live broadcasts has much to do with the sense that a complication might occur and that this fascination has little to do with educational value. Although I disagree with Dr. Bavaria’s conclusions on live broadcasting of operations, I commend his refocusing of attention on the educational value for students of viewing surgery in real time. Simulations are good teaching tools, but firsthand observation remains essential.

Peter Angelos, MD, FACS, is the Linda Kohler Anderson Professor of Surgery and Surgical Ethics, chief of endocrine surgery, and associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago. Dr. Angelos has no disclosures.

Body

Although I do not agree with the suggestion that surgical meetings such as AATS and STS should reverse their ban on live surgery broadcasts, Dr. Bavaria’s suggestion certainly brings attention to an important question about how to maintain the safety of patients in the operating room, while still allowing for optimal teaching opportunities. Most surgeons have accepted that in a live surgical broadcast, the surgeon’s primary attention on the well-being of the patient in the operating room is potentially distracted by the audience viewing the procedure from afar. Although I cannot cite evidence that patient safety is actually compromised from such live broadcasts, self-reflection certainly suggests that there is a potential risk for the surgeon to have competing concerns during surgery, potentially at the expense of safety. In a similar context, I wonder where are the data that previously recorded videos of surgical procedures have less educational value than live operations. I am concerned that the fascination with live broadcasts has much to do with the sense that a complication might occur and that this fascination has little to do with educational value. Although I disagree with Dr. Bavaria’s conclusions on live broadcasting of operations, I commend his refocusing of attention on the educational value for students of viewing surgery in real time. Simulations are good teaching tools, but firsthand observation remains essential.

Peter Angelos, MD, FACS, is the Linda Kohler Anderson Professor of Surgery and Surgical Ethics, chief of endocrine surgery, and associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago. Dr. Angelos has no disclosures.

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