S9B-02 SESSION 9B: FACE RESEARCH - PART II USING AUGMENTED REALITY TO REMOTELY TEACH CLEFT SURGERY: BUILDING LONG- TERM INTERNATIONAL CAPACITY AND SUSTAINABILITY

Abstract

Introduction: Building capacity and long-term sustainability for global cleft care requires continued presence. Augmented Reality (AR) is a novel technology that permits a remote yet “hands-on” virtual interactive presence. A 2014 multi-center proof-of-concept investigation demonstrated AR is safe, reliable, and accurate/precise. Here, we investigate AR’s efficacy in building capacity/sustainability of comprehensive cleft care at one international center. Methods: A 12-month AR-based curriculum was designed and approved by the Ministry of Health in Trujillo, Peru. Global Smile Foundation and PROXIMIE, L.L.C. provided logistical/technical partnerships; grant support was provided by CPF and PSF. Three semi-annual site visits engaged Peruvian colleagues in evidence-based didactics, on-site cleft surgery, and familiarization with the AR platform. Each month, AR was used to remotely guide cleft repairs in Trujillo, Peru. Quarterly assessments by Peruvian and U.S. surgeons utilized Lickert Surveys and VAS Questionnaires. Results: Two surgeons were recruited, serving a population of over 3,000,000. Neither had specialized cleft training. Mulliken’s technique for unilateral/bilateral nasolabial repair was taught during site visits and remote sessions. Sustained gains in seven areas of cleft care were demonstrated by self-reporting and by assessment of the remote surgeon. Site visits preferentially augmented capacity for anatomic diagnosis, principles of repair, and intra-operative decision-making. Remote sessions preferentially developed capacity for cleft anthropometry, operative anatomy, and operative efficiency. 18 months after completion of AR-based curriculum, no child with cleft lip required transfer to tertiary care center (Lima, Peru) because of diagnosis or severity of cleft lip; 6 patients were transferred for treatment of additional congenital anomalies. Conclusion: A curriculum combining on-site training and AR-based “hands-on” remote teaching can build sustained capacity of comprehensive cleft care in under-resourced international areas. Specific needs assessments and established partnerships/trust are pre-requisites. We plan to next test the efficacy of an AR-based curriculum in developing sustained international capacity for NasoAlveolar Molding (NAM).