Remote Video Lecture Education Improves Anesthesiology Residency Training in Tibet of China
The Qinghai-Tibet Plateau, often referred to as the “roof of the world,” is characterized by its extreme environmental conditions and limited medical resources. Since the establishment of the People’s Republic of China, the Chinese government has made significant investments to develop the Tibet Autonomous Region and improve the quality of healthcare. These efforts have yielded substantial results, with life expectancy in the region increasing from 36 years in the 1950s to 68 years today, and the population growing from less than 1 million to 3.31 million. However, despite these achievements, healthcare access and quality in Tibet remain suboptimal compared to other regions in China. According to a 2016 Lancet report, there are striking disparities in healthcare access and quality across China, with Beijing scoring 91.5 and Tibet scoring 48.0, a gap of 43.5 points. This highlights the ongoing need for medical investment and training in Tibet.
To address these challenges, the Chinese government has implemented various initiatives, including the regular dispatch of medical experts to train local practitioners. Peking Union Medical College Hospital (PUMCH), China’s top hospital, has been sending experts to the Tibet Autonomous Region People’s Hospital (TARPH) since 2015. However, due to the limited resources of local medical colleges in Tibet, anesthesiologists face difficulties in accessing standardized lectures and textbooks, which hinders their ability to improve their medical knowledge. To bridge this gap, a novel approach was adopted: remote video lecture education.
Implementation of Remote Video Lecture Education
The study focused on improving anesthesiology residency training at TARPH through remote video education. Eight chapters from the anesthesiology textbook “Miller’s Anesthesia” were selected for this purpose. These chapters covered critical topics such as anesthesia machines, opioids, respiratory monitoring, airway management, nerve block, obstetric anesthesia, neuro-anesthesia, and acute postoperative pain. Eight senior anesthesiologists from PUMCH were assigned to deliver 40-minute video lectures on these topics, combining theoretical knowledge with clinical practice. This approach was chosen because video-based remote education, while burgeoning in other fields, had not been previously evaluated for anesthesiology education in Tibet.
The study was conducted from March 2018 to September 2018 and involved ten anesthesia residents at TARPH. Each resident was required to complete pre- and post-lecture tests to assess their knowledge levels. The baseline knowledge level was tested the day before the lecture, and a follow-up test was administered the day after. For each lecture, twenty multiple-choice questions (ten for the pre-lecture test and ten for the post-lecture test) were prepared. The scores from these tests were summarized and displayed as mean ± standard deviations. The normality of the data was checked using histograms, and paired t-tests were used to compare the pre- and post-lecture scores.
Results and Analysis
The results of the study demonstrated significant improvements in the residents’ knowledge levels after the video lectures. Post-lecture scores increased significantly in 87.5% of the lectures. The average pre-lecture score across all topics was 4.95 ± 0.47, while the average post-lecture score was 7.60 ± 0.53. This indicates a substantial enhancement in the residents’ understanding of the covered topics.
The specific results for each topic are as follows:
- Anesthesia Machine: Pre-lecture score: 5.60 ± 1.84; Post-lecture score: 7.20 ± 1.40 (P = 0.05)
- Opioids: Pre-lecture score: 3.40 ± 1.35; Post-lecture score: 7.60 ± 1.26 (P < 0.05)
- Respiratory Monitoring: Pre-lecture score: 4.20 ± 1.99; Post-lecture score: 6.20 ± 1.14 (P < 0.05)
- Airway Management: Pre-lecture score: 6.20 ± 1.14; Post-lecture score: 6.80 ± 1.40 (P > 0.05)
- Nerve Block: Pre-lecture score: 6.80 ± 1.69; Post-lecture score: 8.60 ± 0.97 (P < 0.05)
- Obstetric Anesthesia: Pre-lecture score: 3.40 ± 1.90; Post-lecture score: 7.60 ± 1.58 (P < 0.05)
- Neuro-Anesthesia: Pre-lecture score: 5.00 ± 1.05; Post-lecture score: 8.00 ± 1.33 (P < 0.05)
- Acute Postoperative Pain: Pre-lecture score: 5.00 ± 1.41; Post-lecture score: 9.00 ± 1.05 (P < 0.05)
The only topic that did not show a statistically significant improvement was airway management, which had a P-value greater than 0.05. However, the overall results confirm that video lectures are an effective tool for enhancing anesthesiology residency training in remote and underdeveloped regions like Tibet.
Advantages of Remote Video Lecture Education
Remote video lecture education offers several advantages for medical training in regions like Tibet. First, Tibet’s geographical challenges, including its high altitude, low air pressure, and sparse population, make traditional in-person training difficult. Video lectures overcome these barriers by providing access to high-quality education regardless of location. Second, synchronous remote teaching has been successfully applied in medical education elsewhere, and the video lectures produced by PUMCH’s anesthesiology department are accessible and free for all, ensuring their feasibility. Finally, this approach allows TARPH residents to receive direct instruction from senior anesthesiologists at PUMCH, ensuring an equal standard of education.
While the prepared video lectures can be watched repeatedly, which promotes learning, the study also highlights the need for nationwide simultaneous live broadcasts, despite the associated costs of network and hardware infrastructure.
Conclusion
This study represents the first attempt to investigate anesthesiology education in the Qinghai-Tibet Plateau and the use of video lectures to transmit anesthesia knowledge to trainees in TARPH. The results demonstrate that remote video lectures are an effective method for improving anesthesiology residency training in Tibet. By leveraging this approach, the Chinese government and medical institutions can continue to enhance healthcare quality in remote and underdeveloped regions, ultimately benefiting patients and practitioners alike.
doi.org/10.1097/CM9.0000000000000605
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