Attendance.

The foremost benefit of the virtual nature of VMDTMs has been the removed need to schedule rooms for the meeting, thereby facilitating convenient remote access for participants [19, 43]. This benefits the meeting itself by impacting clinician attendance as, since the advent of the virtual format, participant attendance in board meetings has reportedly increased [19, 43, 44]. However, one study, that assessed responses from a national VMDTM, reported sub-optimal attendance in the national VMDTM owing to irregular meeting times and a lack of resources [49].

Scheduling and time allotment.

Three studies evaluated perceptions regarding the schedule of VMDTMs. Participants were satisfied with the day and time of the meeting across these studies [5, 38, 41]. Similarly, participants were also content with the frequency of the meetings [28, 41]. Several studies evaluated the time allotted for case discussions which was reportedly adequate across many studies [5, 7, 28, 29, 35, 38].

Preparation for the meeting.

Preparing for the meeting is an important aspect of VMDTMs. One study reported that most radiologists spent 1–4 hours per week preparing for the VMDTM [19]. This aspect was deemed time-consuming in two studies [46, 49], but was adequate for participants in another study [28]. However, overall VMDTMs possess a considerable time-saving benefit [17, 39, 43]. In comparison to IMDTMs, Olver et al. reported that VMDTMs do not affect physicians’ workload [30]. Similarly, Mohamedbhai et al. reported that the time efficiency in VMDTMs is comparable to that in IMDTMs [23].

Chairing the meeting.

Opinions regarding chairing the meeting varied. A few participants in the study by Bonanno N et al. found it easier because of less people spoke simultaneously [19]. However, when compared to IMDTMs, overlap during conversations may exist, and may pose a considerable hurdle for trainees [21]. Although a majority of the study by Mohamedbhai et al. reported that chairing is difficult in VMDTMs compared to IMDTMs [23], participants found leadership in VMDTMs adequate [17, 39, 49].

Clarity of roles.

Rosell et al. evaluated participants’ perception of their roles during VMDTM meetings, and although a majority agreed that their roles are clear [42], there is still a need to further clarify roles better in VMDTMs as evaluated in a subsequent study by the same author [49].

Meeting minutes.

Recording meeting outcomes may be more difficult when compared to IMDTMs [23]. However, clear guidelines about recording meeting minutes can help circumvent this hurdle [42]. One study evaluated the importance of meeting minutes and reported that participants almost always used them to stay updated [28]. In another study, the written format was the most popular method for documenting meeting notes [5].

Usefulness in discussing complex cases.

The most frequently discussed sub-theme of VMDTMs was their usefulness in discussing complex cases [18, 45, 46, 49]. According to one study, discussing routine cases, which have established guidelines, is counterproductive to the meeting and can even irritate participants [45]. Participants were satisfied with the selection of cases for discussion in the VMDTMs in two studies [39, 46]. VMDTMs also provide support to physicians in making difficult clinical decisions [39] and allow peer review of management plans [30].

Case discussion.

It is well-established that discussions in VMDTMs provide case-specific information that impacts patient management [18, 24, 28, 38, 40, 47]. Discussing cases in VMDTMs helps reduce redundancies in patient management [40]. According to multiple studies, the clinical decision process [27] and the comprehensiveness of recommendations [7, 19, 21] are almost similar between VMDTMs and IMDTMs.

Presentations and meetings were smooth during VTBs and rated highly in two studies [29, 35]. In the same studies, participants were well satisfied with the knowledge of their fellow participants [35] and that of the presenter [29].

Decision-making.

Two studies reported that consensus was frequently reached in VMDTMs [20, 35], and, according to one study, there is no difference between IMDTMs and VMDTMs in reaching a consensus [46]. However, one study reported that the level of consensus was slightly lower for VMDTMs compared to in-person meetings [48]. Amongst the evaluated studies, we saw no difference between VMDTMs and IMDTMs in decision-making [7, 17, 23]. In one study, decision-making in VMDTMs scored slightly lower than in IMDTMs, but scores were high for both formats [47].

As reported in one study, VMDTMs made use of information from clinical studies during VMDTMs in comparison to IMDTMs [40]. Thus, the quality of information used to manage cases was better in VMDTMs when compared to IMDTMs, likely because data from clinical studies was used [40]. Similarly, another study that conducted an anthropological analysis, saw that participants used scientific evidence to support decision-making in VMDTMs, compared to multiple ways of knowing in IMDTMs [50].

Availability of information and specialties.

Availability of background patient information was reportedly adequate for a productive discussion in VMDTMs in multiple studies [41, 42, 46, 47]. Three studies evaluated the contribution and role of pathology and radiology in VMDTMs [5, 41, 50]. In two studies, a majority of respondents rated the contribution of both fields to the meeting highly [5, 50]. Savage et al. commented on the quality of radiology and pathology information, rating it highly [41].

Participants were satisfied with the number of specialties on board during VMDTMs [7]. Delaney et al. reported that participants believed that attendance significantly aids case management [50]. Schroeder et al. reported that VMDTM participants were more experienced and better qualified when compared to IMDTMs [40].

Teamwork.

The level of satisfaction of participants with the level of teamwork in VMDTMs was high in many studies [7, 19, 22, 29, 35, 41, 42, 48]. Participants felt involved as they were called upon to contribute [42]. They also expressed satisfaction with the equitable distribution of discussion among specialties [7, 35, 48]. However, in one study the participants felt that the virtual nature negatively impacts the quality of teamwork during VTB meetings [23]. Up to 44% felt that teamwork is worse in VMDTMs, compared to IMDTMs [23].

Participants in two studies reported that interaction between specialties in VMDTMs was adequate [7, 41]. In a recent study, engagement of specialties was reportedly better in VMDTMs compared to IMDTMs [17]. More than 70% of respondents in one study reported that discussion was also adequately shared between specialists, and more than 88% agreed that VMDTMs did not limit the number of specialties that can be present on board [7]. Furthermore, VMDTMs support isolated physicians who otherwise would not be able to access a multidisciplinary discussion forum [30].

Communication.

VMDTMs allow better communication among physically distant healthcare providers [40]. Up to 70% of respondents in one study opined that VMDTMs improve coordination between hospitals and private clinics [40]. When seeking recommendations from various specialties, VMDTMs provide a comparable level of ease as IMDTMs [21]. VMDTMs also improve communication between specialties [18, 19, 38], but in comparison to IMDTMs, it may be worse [23]. While a significant majority of participants in another study noted the similarity in communication between VMDTMs and IMDTMs, up to 42% in the same study expressed a preference for IMDTMs due to enhanced communication quality [27].

Amongst the biggest impacts of the virtual format is the inability to be physically present with other members. The impersonal nature of the virtual format prevents participants from catching on non-verbal cues which can lead to misunderstandings [17, 19, 43, 50]. According to a study, the impersonal nature also hinders the ability to assess the ability of other physicians [30].

Networking.

VMDTMs are a good platform for physicians to meet other specialties [18]. VMDTMs also bring healthcare providers together over geographically distant sites fostering valuable opportunities for professional networking [49]. However, maintaining these working relationships with members is difficult [19], which is seen in particular with new members of the team [17, 19, 43]. When compared to IMDTMs, networking with other specialties is difficult [21] and interpersonal relationships deteriorate [23] in VMDTMs.

Interaction with the case presenter was assessed in two studies and was rated highly [29, 35]. A considerable majority agreed that the presenter encouraged questions and input from the VTB team [29, 35].

Educational value.

Almost all studies highlighted the usefulness of VMDTMs for their educational value [17, 18, 20, 27–30, 33–35, 39, 41, 42, 46, 49]. In only one study a majority of participants (48%) reported that training in VMDTMs was worse than in IMDTMs [23]. Despite this, approximately 44% of respondents within the same study said that the training is on par or superior to that in ITBs [23].

It is the extensive scientific discussion of cases and the multidisciplinary nature of VMDTMs that provide advanced training to its members [39]. In doing so, VMDTM discussions encourage critical thinking [29, 35]. Many studies reported that attending VMDTMs helped improve individual [27, 33, 42, 49] and team competency [42, 49]. In two studies, more than 80% of respondents reported that they perceived an increase in knowledge after attending VMDTMs [33, 40].

The periodical and continued occurrence of VMDTMs provides a consistent means of medical education to attending participants [28, 29]. The educational nature of VMDTMs is appropriate for their consideration as CMEs [18, 33]. In one study, participants received CME credits for attending VMDTMs, and getting CMEs was equally easy between VMDTMs and IMDTMs for participants [21].

VMDTMs at the national level allow physicians from low-volume centers to see cases that they would not typically encounter in their clinical practice [49]. Similarly, low-volume centers are exposed to numerous cases that would otherwise be outside their purview, and this helps increase physician experience [49]. Furthermore, the presence of varying experts provides information that, at times, may not be available elsewhere in other educational sources [29, 35]. Where time consumed reviewing literature for the meeting can be viewed as a potential drawback, it, too, inadvertently serves to increase clinical knowledge [46].

Impact on clinical practice.

VMDTMs are beneficial for clinical practice [39] as case discussions allow participants to reflect on their practice [35]. Two studies saw that VMDTMs offered clinical tips to attending physicians [29, 35], which in turn impacted their practice [29, 30, 35, 37]. Furthermore, VMDTMs make physicians confident about their management plans [26, 36].

Accessing patient data and other resources.

Accessing imaging data was smooth for 71–86% of respondents in two studies [7, 19]. VMDTMs do not limit access to patient information [7, 47]. In one study, VMDTMs scored higher than IMDTMs in the domain of the provision of physical resources for the meeting [47]. Sending pathology samples for review in VMDTMs is also easy, as reported in one study [28]. However, transferring case-related information may be time-consuming [49].

Imaging quality.

The quality of case-related imaging has reportedly been good over the years, even as far back as the year 1999 [5, 19, 21, 23, 27, 41]. When compared to IMDTMs, up to 70% of participants in three studies found image quality equal to or even better than IMDTMs [19, 23, 27]. Good image quality translates to easier image review as reported in a study where trainees found it significantly easier than other participants (e.g. staff) to review case images in VMDTMs when compared to IMDTMs [21].

Audio and video quality.

Audio and video quality was the most commonly evaluated technological feature of VMDTMs. Participants were satisfied or highly satisfied with the audio and video quality across all studies that evaluated these features [5, 22, 29, 34, 35, 50]. In three studies, video and audio quality was rated very highly [5, 34, 35]. In the remaining three studies, although not in the majority, a considerable proportion of respondents were unsure about or not satisfied with the video and audio quality [22, 29, 50].

Data security.

Data security in VMDTMs is equal to IMDTMs, as reported by up to 68–80% of participants across two studies [23, 27]. This is unlike the results from an older study in 2000 where patient confidentiality in VMDTMs was deemed “concerning” [30].

Technical support.

Only one study evaluated technical support for VMDTMs, where it was rated adequate by participants [39]. When missing, the lack of technical support can be a significant barrier for participants [17, 19, 39].

Technological barriers.

Improving technological structure is one of the most important changes to improve VMDTMs [43, 44], as shortcomings in this domain may hinder participation [7]. The major technological challenge was connectivity across most studies [17, 19, 21, 30, 43, 46, 49]. Other issues evaluated in the included studies were viewing images [19, 30], viewing presentations [21], issues with audio [21], and lack of technical support [19].

Opportunity for clinical trial recruitment.

The most commonly discussed feature of VMDTMs was their potential to facilitate the recruitment of patients for clinical trials [17, 18, 37, 41, 46, 49]. Around 44–77% of participants across three studies agreed that VMDTMs allow clinical trial recruitment [18, 37, 46]. However, up to 40% of participants in two studies were unsure about this feature [18, 41]. In one of these studies, the majority (38%) disagreed [41]. In another study, participants stated that there was limited focus on clinical trial recruitment, and instead highlighted that time dedicated to research protocols could generate new research initiatives [49]. In comparison to IMDTMs, VMDTMs offer no further benefit for clinical trial recruitment [17].

Consideration of patient comorbidity and perspectives.

Only the studies by Rosell et al. commented on the consideration of patient comorbidity and patient views during the VMDTMs [42, 49]. Although more than 70% of participants in the study in the year 2019 agreed that comorbidity and perspectives are considered [42], the study in the year 2020 reported limited consideration of patients’ comorbidities [49].

Benefits for patients.

While VMDTMs allow physicians to generate meticulous management plans, they also positively impact patients. Evidence suggests that VMDTMs boost patients’ confidence in the management plan [36]. Furthermore, VMDTMs also help provide patients with information about clinical trials and guidelines [18]. Moreover, where VMDTMs help physicians connect over geographical distances, they offer an alternative solution to patients who may be reticent about seeking care at a different medical care facility [46].