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How well does the virtual format of oncology multidisciplinary team meetings work? An assessment of participants’ perspectives and limitations: A scoping review

  • Muhammad Abdul Rehman ,

    Roles Conceptualization, Data curation, Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing

    Affiliation Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan

  • Unaiza Naeem,

    Roles Data curation, Methodology, Supervision, Writing – original draft

    Affiliation Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan

  • Anooja Rani,

    Roles Data curation, Writing – original draft

    Affiliation Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan

  • Umm E. Salma Shabbar Banatwala,

    Roles Data curation, Writing – original draft

    Affiliation Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan

  • Afia Salman,

    Roles Data curation, Writing – original draft

    Affiliation Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan

  • Muhammad Abdullah Khalid,

    Roles Data curation, Writing – original draft

    Affiliation Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan

  • Areeba Ikram,

    Roles Data curation

    Affiliation Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan

  • Erfa Tahir

    Roles Writing – original draft, Writing – review & editing

    Affiliation Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan



Virtual multidisciplinary team meetings (VMDTM) provide a standard of care that is not limited by physical distance or social restrictions. And so, when the COVID-19 pandemic imposed irrefutable social restrictions and made in-person meetings impossible, many hospitals switched to the VMDTMs. Although the pandemic might have highlighted the ease of VMDTMs, these virtual meetings have existed over the past decade, albeit less in importance. Despite their recent importance, no review has previously assessed the feasibility of VMDTMs through the eyes of the participants, the barriers participants face, nor their comparison with the in-person format. We undertook this scoping review to map existing literature and assess the perspectives of VMDTM participants.

Material and methods

We searched MEDLINE, Embase, CINAHL, and Google Scholar from inception till July 1st, 2023 to select studies that evaluated the perspectives of participants of VMDTMs regarding the core components that make up a VMDMT. Four authors, independently, extracted data from all included studies. Two authors separated data into major themes and sub-themes.


We identified six core, intrinsic aspects of a VMDTM that are essential to its structure: (1) organization, (2) case discussion and decision-making, (3) teamwork and communication, (4) training and education, (5) technology, and (6) patient-related aspect. VMDTMs have a high overall satisfaction rating amongst participants. The preference, however, is for a hybrid model of multidisciplinary teams. VMDTMs offer support to isolated physicians, help address complex cases, and offer information that may not be available elsewhere. The periodical nature of VMDTMs is appropriate for their consideration as CMEs. Adequate technology is paramount to the sustenance of the format.


VMDTMs are efficient and offer a multidisciplinary consensus without geographical limitations. Despite certain technical and social limitations, VMDTM participants are highly satisfied with the format, although the preference lies with a hybrid model.

1 Introduction

In oncology, the growing complexity of cancer care necessitates a collaborative approach to management. Tumor boards or oncology multidisciplinary teams have proven effective platforms in this respect, by marshaling the collective expertise of a diverse group of specialists, such as medical oncologists, surgical oncologists, radiation oncologists, pathologists, radiologists, and others [1]. Before the 1990s, cancer cases in the United Kingdom were primarily managed by general medical practitioners, with a limited number of patients receiving consultation from specialized oncologists, leading to a lamentable disparity in cancer care [2]. This radically changed after the Calman-Hine report was published in 1995, which established multidisciplinary team meetings (MDTM) as the cornerstone of cancer management [3].

With the rise of telemedicine, virtual MDTMs (VMDTM) have emerged as a promising solution for geographical barriers, allowing experts from different institutions to collaborate in the virtual sphere [4]. Though VMDTMs are not a new concept [5], they have expanded in popularity in recent years. The COVID-19 pandemic, in particular, served as an impetus for caregivers who sought ways to continually provide optimal patient care while adhering to social distancing [6, 7]. Many hospitals transitioned to VMDTMs, and this virtualization continues to gain traction [2, 8]. Therefore it is not illogical to state that the movement toward virtual tumor boards is an offshoot of the COVID-19 pandemic [6].

Studies integrating available literature to offer a broad map of VMDTMs are scarce. Prior reviews have evaluated VMDTMs in the context of specific cancer [4], and MDTMs in general without primarily focusing on the virtual format [911], or in regional oncology networks [12]. Thus, a comprehensive, all-encompassing study examining the perspectives of participating physicians themselves regarding VMDTMs, not limited to a particular geography, is notably absent from the existing literature. Furthermore, no study has previously assessed the effectiveness of VMDMTs in comparison to in-person MDTMs (IMDTMs).

Therefore, to map existing literature regarding VMDTM effectiveness through participant experience, from when it was first described, and through the COVID-19 pandemic to date, we conducted a scoping review of the literature. Scoping reviews are a relatively new form of systematic research to synthesize evidence, and the distinction from a systematic review is often confusing [13]. Scoping reviews map literature and provide a broad view of the topic by listing the volume of available literature, and study characteristics, and lay the groundwork for a more focused and contemporary systematic review [13, 14]. Scoping reviews often do not offer an assessment of quality or risk of bias for individual studies unless warranted by the primary objective [13, 15].

This knowledge gap is particularly salient given the increasing integration of VMDTMs in oncological practice, especially during the COVID-19 pandemic. And so, with this scoping review, we aim to fill the knowledge gap by exploring the following primary questions:

  1. What are the perspectives harbored by VMDTM participants on the effectiveness of individual, core intrinsic components of a VMDTM?
  2. What are the barriers and enabling factors for VMDTM participants?
  3. What are participant perspectives regarding VMDTM core components in comparison to the in-person format?

2 Materials and methods

We conducted this scoping review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines [16]. The PRISMA-ScR checklist is present in S1 File.

2.1 Search strategy and study selection

We searched MEDLINE, Embase, CINAHL, and Google Scholar from inception till July 1st, 2023. The search string is listed in S2 File. A citation search was also performed by going through the reference lists of the short-listed articles to identify other relevant studies.

Studies were screened based on titles, abstracts, and full text by two authors (MAR and UN). Any difference in opinion was resolved through discussion between the authors (MAR and UN). If the difference in opinion persisted, another author (AR) of this review was consulted for clarification.

2.2 Inclusion/exclusion criteria

By the scoping nature of this review, we report all articles that assessed participants’ opinions regarding any intrinsic aspect of VMDTMs. There was no limit on the study design to be eligible, except for case reports, which were deemed insufficient to evoke an accurate opinion regarding the workings of the VMDTM.

The inclusion criteria were satisfied by articles reporting all three of the following: (1) any intrinsic feature or aspect of VMDTMs, (2) VMDTMs used for oncological case discussions, and (3) an evaluation by the persons participating in the VMDTM. The exclusion criteria were (1) case reports, (2) non-oncological VMDTMs, and (3) studies that did not evaluate an intrinsic feature of VMDTMs. Studies that were excluded during full-text evaluation are listed in S3 File.

2.3 Data extraction

After studies were shortlisted for inclusion in this review, four authors (USB, AS, AK, AI), independently, read each paper. All data that was reported through feedback from VMDTM participants and relevant to the intrinsic dynamics of a VMDTM were extracted (e.g. the quality of case discussion). Where authors could not ascertain whether a particular result was relevant to the intrinsic workings of a VMDTM or not, a fifth author (MAR) was consulted. Where the fifth author (MAR) could also not judge whether the result was relevant to the workings of a VMDTM, the result was included in the study. Data reported through review of records, or conclusions drawn by authors in the discussion of papers was not extracted.

2.4 Theme and sub-themes

The studies included in this review made use of different methods and individual surveys to assess their populations which offered varying information after the data extraction process. The extracted data was assessed and owing to the varying study designs employed by the studies, data coding was deemed unfeasible. Therefore, we used inductive reasoning (MAR, UN) to broadly classify the extracted data into broadly encompassing themes and sub-themes.

3 Results

3.1 Study characteristics

We discovered a total of 36 papers using our search criteria. The number of studies at each stage of the screening process is shown in Fig 1.

Fig 1. PRISMA flowchart.

This figure shows the number of studies retrieved at each stage of the search strategy.

Study designs of included studies were mostly observational cross-sectional studies (n = 15) [7, 1730]. Other study designs were retrospective review of records with a cross-sectional survey (n = 12) [5, 3141], meeting observations with cross-sectional survey (n = 1) [42], mixed-method design (n = 3) [4345], embedded study design (n = 1) [46], randomized controlled trials (n = 2) [47, 48], descriptive qualitative synthesis using free-text cross-sectional surveys (n = 1) [49], and an anthropological analysis (n = 1) [50]. A detailed summary of study characteristics is shown in Table 1. Further description of populations in included studies is described in S4 File.

A total of 10 studies evaluated feedback from VMDTMs during COVID-19 [7, 18, 19, 2123, 25, 43, 44] or after the end of the pandemic [17]. There were 18 studies published between 2023 and 2020 [7, 1727, 3133, 43, 44, 49], 4 between 2019 and 2015 [28, 34, 42, 45], 6 studies between 2014 and 2010 [3538, 40, 46], 4 studies between 2009 and 2005 [39, 41, 47, 48], and 3 between 2004 and 2000 [29, 30, 50]. One study was published in 1999 [5]. Most studies had populations from VMDTMs based in the United States of America (n = 10) [5, 18, 21, 25, 26, 33, 35, 37, 38, 46], followed by the United Kingdom (n = 8) [7, 17, 22, 23, 43, 44, 47, 48]. The distribution of these studies is described in the S5 File.

3.2 Theme identification

Across the range of studies included in this review, we identified six major themes that define the intrinsic mechanisms of a VMDTM: (1) organization, (2) case discussion and decision-making, (3) teamwork and communication, (4) education and training, (5) technology, and (6) patient-centered aspect. A thematic segregation of results from each study is shown in Table 2. Additional findings in the included studies are shown in S6 File.

Table 2. Theme-wise segregation of findings in included studies.

3.2.A Organization

A total of 21 studies evaluated one or more organizational aspects of the VTB [7, 17, 19, 21, 23, 25, 27, 28, 34, 35, 38, 39, 4244, 46, 49]. Overall, VMDTMs may be equally organized as IMDTMs [27] if not more [17, 23].


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].

3.2.B Case discussion and decision-making

A total of 27 studies evaluated perceptions regarding one or more aspects related to case discussions and decision-making during VMDTMs [5, 7, 1721, 23, 24, 2730, 3335, 3842, 4550]. Various differing aspects were evaluated across studies.

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].


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].

3.2.C Teamwork and communication

A total of 20 studies assessed perceptions regarding teamwork and communication [7, 1719, 2123, 27, 29, 30, 35, 38, 4043, 4750].


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].


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].


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].

3.2.D Education/training

Of the studies included in this study, a total of 20 studies evaluated the educational importance of VMDTMs [17, 18, 20, 21, 23, 2630, 3337, 3942, 46, 49].

Educational value.

Almost all studies highlighted the usefulness of VMDTMs for their educational value [17, 18, 20, 2730, 3335, 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].

3.2.E Technology

A total of 23 studies evaluated the technological aspect of VMDTMs [5, 7, 17, 19, 2123, 2730, 3336, 39, 4244, 46, 47, 49, 50]. Overall satisfaction with technology in VMDTMs was evaluated in four studies where a majority of participants were satisfied across all four studies [23, 36, 42, 46]. Around 77–88% of respondents in three studies said that technological problems barely affected VMDTMs [23, 36, 46]. Despite high overall satisfaction with technology in VMDTMs, technological issues exist and can be a significant hurdle for VMDTMs [28, 43, 44]. Furthermore, the switch to a virtual format can cause participants short-term difficulties, which subside once participants become familiar with the format [22].

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].

3.2.F Patient-centered aspect

A total of 12 studies commented on patient-related aspects of VMDTMs [17, 18, 20, 23, 27, 30, 36, 37, 41, 42, 46, 49].

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].

4 Discussion

To the best of our knowledge, this is the first overall review to assess the feasibility and acceptance of VMDTMs by assessing the perspectives of meeting participants. Across all included studies, we recognized and assessed six core components of a VMDTM which have been previously described for MDTMs [11]. We observed a high level of satisfaction with the overall dynamics of the VMDTM across many studies [7, 19, 21, 22, 24, 26, 27, 2933, 3538, 40, 46, 47, 49, 50]. However, preference was reserved for a hybrid model of MDTMs [17, 19, 23, 4345].

Despite a high level of acceptance for VMDTMs, the format was limited in certain aspects as described in Table 3. Lack of reimbursement was a barrier to attendance for isolated or community-based physicians. This is supported by prior literature where the equipment cost VMDTMs defer physicians from attending VMDTMs [12]. It is important to highlight that VMDTMs may be more cost-effective than IMDTMs in the long term [51, 52].

Table 3. Limitations for VMDTMs reported across included studies.

Well-functioning technology is crucial to a VMDTM and its inadequacy is a major limitation that could make VMDTMs unsustainable [7, 19, 30, 43]. The major technological issue highlighted in our studies was poor connectivity or limited bandwidth. Limited bandwidth prevents the proper functioning of audio and video components simultaneously, so, a bandwidth of 2 Mbps has been previously recommended [12].

Although multiple studies reported that a majority of participants agree that VMDTMs allow recruitment for clinical trials, not all participants were convinced about this feature [18, 37, 46]. A considerable portion of respondents were neutral to support this feature [18, 37, 46], and two studies disagreed with this capability [41, 49]. The limited number of studies and the conflicting data put this feature in doubt.

MDTMs have proven their merit in providing and impacting management decisions [12, 53]. The same was seen in our review [18, 24, 28, 38, 40, 47]. The most frequently reported feature was their usefulness in discussing complex cases [18, 45, 46, 49]. The study by van Huizen et al. reported that discussing routine cases was detrimental to the concept of a VMDTM [45], which was similar to previously reported literature where discussing all cases was considered inefficient to the concept of an MDTM [5456].

VMDTMs were not limited in their level of peer review [30] their meeting depth [7, 19], or decision-making [20, 35]. Schroeder et al. reported that VMDTMs incorporated data from clinical studies to make management decisions [40]. This was supported by Delaney et al. who saw that scientific evidence was used in VMDTMs compared to multiple ways of knowing in ITBs [50]. This feature of VMDTMs makes them reliable and more clinically oriented than IMDTMs.

The multidisciplinary nature of VMDTMs makes them an excellent learning platform. All the studies that evaluated the educational potential of VMDTMs, saw that almost all participants saw VMDTMs as fit for one or more educational aspects [17, 18, 20, 2730, 3335, 39, 41, 42, 46, 49]. So much so, that their consideration for CME credits was advocated for. Multidisciplinary teams have been CME accredited previously [57] and consideration of VMDTMs may also be appropriate.

Furthermore, by overcoming geographical distances, VMDTMs allow remote centers to witness more cases than they normally would [49]. Nation-wide referrals help physicians see cases from across the country that they normally would not see in their locations [49]. This unparalleled benefit over IMDTMs highlights complex and challenging cases that are rare to encounter for low-volume centers.

There are multiple limitations to this study. The varying methods of reporting data limit the uniformity of data throughout the included studies. In addition, this study is limited to the subjective opinion and acceptance of the virtual format.

Despite these limitations, this study provides a strong summary that is based on several VMDTM members and their experiences. Therefore, our study forms the basis for future modifications and gives a genuine insight into the workings of a contemporary VMDTM.

5 Conclusion

Where VMDTMs connect physicians across borders, offer clinical support to isolated physicians, and offer solutions to clinical questions that do not have answers elsewhere, they are limited in certain aspects. The impersonal nature is detrimental to a candid atmosphere. More importantly, when the fundamental technological pillar, that allows the virtual format to exist, is weak, the sustainability of VMDTMs becomes doubtful. Yet, institutions that meet the necessary criterion may experience a smooth, and in some cases, a VMDTM better than its in-person counterpart. The popularity of VMDTMs has grown tremendously throughout the pandemic further focused assessments of VMDTMs’ core components must be made to better streamline the VMDTM experience.

Supporting information

S1 File. PRISMA ScR checklist.

This file contains the PRISMA ScR checklist.


S2 File. Search string(s).

This file contains the individual search strings used for each database to perform the literature search for this study.


S3 File. List of excluded studies.

This file contains the list of studies that were excluded, along with their reasons for exclusion, after full-text review.


S4 File. Composition and percentage responses.

This file highlights further characteristics of included studies, their populations, and VMDTM composition.


S5 File. Distribution of included studies.

This file shows the country/region-wise distribution of populations in included studies.


S6 File. Additional findings.

This file shows additional findings in included studies.



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