A Potential Shift in OR Management

A remote digital supervision and training platform could help address a critical training crisis.

Health care systems worldwide face a growing structural challenge: surgical training is becoming increasingly resource-intensive as the demand for trained surgeons grows. Aging populations require more complex surgical interventions, and the traditional model of one-on-one mentorship is becoming difficult to sustain. A single experienced surgeon can typically dedicate a meaningful amount of time to only one or two trainees at a time, which limits the rate at which intermediate trainees can progress toward independence.

The MedHub OP Supervisor (Super Code Doctors) is designed to address this challenge. By enabling experienced surgeons to provide real-time advisory feedback and supporting location-independent supervision, the system offers a scalable approach to surgical education, which could be a meaningful step toward a more sustainable model for training the next generation of surgeons.

Integrated Supervision and Support

The MedHub OP Supervisor was created to allow experienced surgeons to provide feedback on surgical procedures as they are performed by trainees. Key capabilities of this digital platform (Figure 1) include the following:

• Real-time video transmission that provides supervisors with a continuous view of the surgical field across one or more ORs, including the visual field and programming monitors of excimer and femtosecond laser systems;
• Real-time advisory audio feedback delivered via a dedicated single-ear headset, which allows supervisors to convey concise guidance during critical procedural steps without interrupting workflow or potentially causing listening patients under local anesthesia anxiety;
• Seamless application programming interface integration with hospital information and practice management systems, which enables the retrieval of patient data and the direct attachment of surgical video recordings to the corresponding patient records. The underlying network operates on a decentralized, encrypted overlay architecture that requires no modifications to institutional fire wall or network address translation configurations;
• An integrated telephone line to reach a supervisor directly in critical situations with mobile app access to the video and audio connections;
• Comprehensive on-premises video and audio documentation for quality assurance and structured educational review, with no transmission to external cloud services; and
• Enhanced training capabilities for surgical team development.

Evidence From Practice: Beta Phase Success

Our beta implementation, recently published in the Journal of Cataract & Refractive Surgery,¹ demonstrated immediate integration into routine workflow without prolonging operative time. The system was implemented within a high-volume cataract surgery fellowship program. During the implementation phase, no increase in intraoperative complication rates was observed, and no procedure required interruption due to a technical malfunction.

Fellows reported that real-time advisory feedback supported their intraoperative decision-making without increasing their cognitive load. Supervisors reported being able to identify developing challenges during key procedural steps and provide timely corrective input, which frequently allowed adjustment before escalation and reduced the need for physical takeover while maintaining safety oversight.

Training: Multiplying Surgical Expertise Across Institutions

The MedHub OP Supervisor has the potential to change the practical economics of surgical training. By allowing real-time advisory feedback to be provided directly to the trainee in the OR (Figure 2), the platform could provide four advantages for surgical education.

No. 1: One Supervisor for Multiple Trainees

Although the optimal supervisor-to-trainee ratio is not yet known and further research is required, the MedHub OP Supervisor could allow a single experienced surgeon to advise several intermediate trainees across different ORs. In that situation, a qualified surgeon should be available on-site to provide immediate physical intervention if required.

No. 2: Preemptive Advisory Input

Supervisors could identify developing challenges during critical procedural steps and provide timely corrective input, which might reduce the need for in-person takeover while maintaining safety oversight.

No. 3: Location Independence

The physical presence of supervising surgeons would not be required in the OR. Experienced specialists could mentor trainees at satellite hospitals or geographically distinct sites, provided that appropriate local surgical backup were available. This could expand access to expert training.

No. 4: Comprehensive Video and Audio Documentation

Procedures could be recorded securely on the premises and made available for postoperative analysis and structured educational review. Trainees and supervisors would be able to review complete recordings to identify decision points and opportunities for technical refinement, supporting structured feedback and continuous quality improvement.

Implications for Cataract Surgery

During beta testing, the MedHub OP Supervisor demonstrated practical value for cataract surgery.¹ Remote advisory supervision was successfully integrated into a high-volume fellowship program, supporting the application of this model in an established training context. The level of remote advisory supervision was adjusted according to the supervising surgeon's assessment of the fellow's competence, with direct intervention occurring only when requested or deemed necessary.

By enabling one supervisor to oversee multiple trainees concurrently, the model showed potential benefits for high-volume training environments. Future research must include a quantitative evaluation of takeover rates, complication metrics, learning curve progression, and resource utilization. The ideal implementation model remains to be defined.

The current setup has enabled one supervisor to oversee four intermediate surgeons in real time. The overall complication rate decreased by one-third because the trainees were able to contact their supervisor in seconds for advice. The supervisor's time in the OR decreased by approximately 70%. In 3 years, more than 10,000 lens-based surgeries have been performed with the beta version and the commercially available platform. Further studies are required to evaluate whether one supervisor can observe and give feedback to more than four intermediate fellows simultaneously. We currently think that, depending on the trainees' skill level, six to eight would be the maximum.

Looking Forward

The MedHub OP Supervisor is designed to augment-not replace-human expertise. The supervising surgeon remains the decision-maker; the platform provides the video, audio, and documentation infrastructure that enables remote supervision and structured educational review. Future iterations might incorporate protected analytics environments and AI-assisted procedural analysis to enhance monitoring capabilities and structured feedback.

By supporting both immediate clinical excellence and long-term workforce development, the system could address two pressing health care challenges.