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Guidelines for Using the Cardiothoracic Operation as a Teaching Instrument
When planning to record or broadcast an operation, surgeons must pay special attention to the needs and rights of the patient.
A patient’s informed consent for participating as a subject in a live or taped broadcast must be obtained directly by the operating surgeon.
The attending surgeon must take all necessary steps to protect the patient’s privacy and to ensure confidentiality of all medical information, prior to, during, and in all follow up after the operation.
Recorded broadcasts, either edited or unedited, may be preferable to live surgery broadcasts.
Teaching surgical techniques by live surgery observation in the surgeon’s home operating room is a time honored, acceptable practice.
Live surgery broadcasts should be educational in nature and surgeons should not participate in live surgery broadcast to the public using any medium, including television and the Internet.
Live surgery broadcasts become progressively less acceptable with more rigid scheduling constraints, increasing complexity of the operation, decreasing educational value of the procedure, greater intensity of the surgeon’s interaction with the audience, and less familiarity of the surgeon with the operating room environment. On these grounds, live surgery broadcasts are subject to the following conditions:
Cardiothoracic surgeons should not participate in live surgery broadcasts when rigid broadcast schedules constrain the operation’s starting time or duration or when a specific predetermined operation must be fit into a specific time frame. Operations selected for live surgery broadcasts are most acceptable when the operation focuses solely on a particular patient who has a condition that warrants live broadcast. There may be additional value to having concurrently available recorded material, that can be presented to the audience in lieu of live broadcast, during periods of or scenarios within the live operation which may not be ideal for broadcast or during times when any potential distraction must be further minimized. This supplemental material may also enhance the educational value of the live broadcast.
The operating surgeon should be thoroughly familiar with and experienced in the procedure being broadcast and with the specific medical devices and tools being demonstrated. Innovative operations and rare procedures that the surgeon has never or only occasionally performed previously should not be broadcast because they lack educational value and increase the need for the surgeon’s undivided attention.
Operations of greater educational value to the surgeons in the audience should be chosen over operations of lesser educational value. Operations are inappropriate for live broadcast if intended to show that an operation can be done rather than to demonstrate to others how to do it.
Cardiothoracic surgeons should not participate in broadcasts of operations that have a major purpose of aggrandizement of the surgeon or of the surgeon’s operating facility.
Whenever possible, surgery should be broadcast from the surgeon’s home operating room. When this is not possible, the operative facility should be configured as closely as possible to the surgeon’s home operating room environment. Only highly experienced operating room staff who are fluent in the surgeon’s preferred languages should participate, preferably the surgeon’s own staff. The surgeon must ensure that the video crew does not interfere with the progress of the operation, whether filming is intended for live or recorded broadcast.
Because discussion with a remote audience during an operation may distract the surgeon, discussions should be one-way, from surgeon to audience. If a two-way discussion is demonstrably essential to the educational value, questions and comments from the audience should be controlled, for example, relayed through a moderator at the meeting site and/or a moderator at hospital, who alone can communicate with the surgeon. Ideally such a moderator should be very familiar with the type of operation being performed as this would streamline and optimize the amount and quality of the communication with the operating surgeon and thereby further minimize any potential distraction. Prior to the start of the procedure, the surgeon or moderator should inform the audience that scenarios may arise during which questions may not be able to be answered immediately.
The operating surgeon has a responsibility to ensure completion of the following requirements before each broadcast:
The operating facility, if not in the surgeon’s home institution, should be suitable for the conduct of the operation to be broadcast.
A preoperative conference should be held with the principal parties, including the operating surgeon and key medical and technical (filming) staff, to review the ethical guidelines and safety standards under which the operation will be performed.
A reliable mechanism should be in place for the audience to receive follow-up reports on the outcome of the operation within 24 hours and the status of the patient 30 days after the broadcast, again ensuring protection of patient privacy.
Cardiothoracic surgeons should not participate in any capacity in live surgery programs that violate these guidelines.
Amended by the Board of Directors, December 2019