The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is a 6,600-member medical association with an ambitious goal: to make minimally invasive surgery available to patients in every country in the world.
SAGES members practice techniques such as laparoscopic and endoscopic surgery, the benefits of which are significant and well established — among them, faster recovery from surgery and fewer infections. Of the more than 20 million laparoscopic and endoscopic surgeries performed since the procedures were first introduced, 25 percent have taken place inside the United States. The mission of SAGES’ Go Global program, founded in 2008, is to deliver education and training to physicians everywhere, including in the developing world.
It’s a challenging task, according to SAGES member and former President Steven Schwaitzberg, chief of surgery at the Harvard Medical School Teaching Hospital, speaking at TEDxBeaconStreet in Boston in 2012. Minimally invasive surgery is technically more demanding than traditional surgery, and requires specialized training and equipment. “It’s hard to teach,” Schwaitzberg said. “And it’s not that easy to learn.” Distance is yet another complication when it comes to trying to spread the techniques internationally. Schwaitzberg said: “We can’t travel everywhere.”
POINT TO POINT
One of the best tools for overcoming those obstacles, Schwaitzberg said, is video. Since 2008, SAGES has webcast education to 35 countries outside the United States, training 8,000 doctors as part of Go Global. The program, which offers the training for free, continues to add new ways for physicians to learn, using video in combination with face-to-face learning.
Crucially, SAGES got an early start in using video to deliver education sessions to physicians who couldn’t travel to its meetings, beginning at its Annual Meeting in Atlanta in 2000, said Jason Levine, SAGES’ webmaster and the vice president for information technology at BSC Management Inc., a Los Angeles–based association-management and conference-planning company, which organizes SAGES’ programs. After years of refining — and sometimes discarding — methods of recording and broadcasting sessions, SAGES had collected enough feedback and data to settle on a livestreaming format that “we think works pretty well,” Levine said.
SAGES’ Go Global programming can be delivered directly to an individual user’s laptop, but “the preferred way,” Levine said, “is to reach out to an institution in another country — say, Argentina or Brazil or China — and arrange for a point-to-point broadcast in a local auditorium, where a livestream is displayed over an AV system. It absolutely is possible to sit in your office and watch both live and recorded streams of all kinds of meetings now.” But from a learning standpoint, “it is far more valuable to collaborate with your colleagues and to communicate directly with the person doing the presentation via the audio setup.”
In addition to the webcasts, SAGES volunteer members travel globally to deliver in-person training to local physicians. These International Proctoring Courses (IPC), as they’re called, have been conducted in Mongolia, Haiti, Peru, and other countries where opportunities to learn minimally invasive surgical techniques are rare or nonexistent.
As the administrative director of Go Global, Jacqueline Narvaez, CMP, travels on site to handle support and logistics for the IPC program. The training, funded by the SAGES Education & Research Foundation and other grants, is free to participants, but SAGES asks local medical communities to provide housing and local transportation for the SAGES doctors and staff. “We want local commitment,” Narvaez said.
ON THE GROUND
The goal is not only to give individual doctors opportunities to learn the advanced surgical techniques, but to establish training sites that can spread the education across each country. In Peru, the first doctors to participate in training did so with borrowed equipment, Narvaez said. Now, working with a local university, the doctors have established a regional training center that is providing education to other local doctors as well as visiting physicians from Ecuador.
Following the hands-on program, local doctors receive additional training and support through a telementoring program that remotely broadcasts physicians demonstrating techniques in the operating room, Narvaez said. The remote training is a cost-effective way to offer education, and also helps keep the groups connected with one another.
Narvaez has traveled with SAGES as it has conducted 18 in-person IPC programs, including in Mongolia and Haiti. The international travel is far from luxurious — in Mongolia, Narvaez stayed in an old military bunker. “We stay in remote areas,” she said. “It can be super-cold, the water may shut down, or it’s really, really hot.”
Even by meeting-planner standards, Narvaez’s hours are long, and not just when she’s on site. If SAGES is broadcasting remote training or conducting telementoring to China, for example, her day might start at 4 a.m. “or even earlier.”
In a way, “you are never really off,” she said. Nonetheless, the work is deeply rewarding. “I get to meet all these great people. You see these doctors go from zero to struggling and reaching their educational dreams,” Narvaez said. “And I am working alongside them, to build a program.”