Video-based coaching in surgical education: a systematic review and meta-analysis

Propensity score matching analysis of perioperative outcomes during Hub&Spoke training program in hepato-biliary surgery

This study aims to verify the safety and effectiveness of complex surgical procedures like hepato-pancreatic and biliary (HPB) surgery also in General Surgery Units when performing an Hub&Spoke Learning Program (H&S) with a referral center. This approach leads reduction of health migration and related costs for patients and health system granting the same standard of medical and surgical care in Spoke Units. Implementation of H&S through a retrospective analysis of prospectively collected database comparing, after a Propensity Score Matching (PSM) analysis, baseline characteristics and peri-operative outcomes of patients undergone HPB surgery in a referral center (Hub) and in three peripheral centers (Spokes) under the mentoring program. Hub Hospital was represented by the Hepatobiliary and Pancreatic Surgery Center in Pineta Grande Hospital (Castel Volturno, Caserta, Italy), while the Spoke Units were the General Surgery Unit of Padre Pio Hospital (Mondragone, Caserta, Italy), the General Surgery Unit of C.T.O. Hospital (Naples, Italy) and the General and Emergency Surgery Unit of A. Cardarelli Hospital, University of Molise (Campobasso, Italy). During the partnership program, from January 2016 to June 2023, H&S enrolled 298 and 156 consecutive patients respectively. After PSM, data of 150 patients for each group were analyzed. After PSM no differences were found concerning patients baseline characteristics. Hub group selected more often primary liver cancers versus benign lesions and liver metastasis more frequent in the Spoke group. All peri-operative data were superimposable except for blood transfusion, Pringle maneuver and length of hospital stay that were more frequent in the Hub group. We can conclude that the treatment of liver cancers in peripheral centers is possible, safe and effective especially under a H&S. There are some requisites to be successful like experienced surgeon(s), interdisciplinary meetings to discuss and minimum requirements in each hospital such as Intensive Care Unit, interventional radiology and emergency facilities.

A Multicenter, Randomized Controlled Trial to Assess Video-based Surgical Coaching in Gynecology

STUDY OBJECTIVE

To evaluate the effect of video-based coaching on technical skill development in surgical education.

DESIGN

Randomized controlled trial with video-based coaching (intervention group) in addition to standard surgical curriculum or the standard surgical curriculum alone (control group).

SETTING

Laparoscopic vaginal vault closure in the operating room at 3 academic hospitals.

PARTICIPANTS

Senior Obstetrics and Gynecology residents (year 3-5) on their chief resident or gynecologic oncology rotation.

INTERVENTIONS

All residents were recorded performing laparoscopic closure of the vaginal cuff prior to randomization. Surgical coaching sessions followed the Wisconsin Surgical Coaching Framework over 30 minutes on Zoom with one surgical coach. All residents were recorded subsequently performing the same surgical technical skill. Blinded, expert surgeons performed the video assessment using the OSATS, GOALS, and global rating scale. The mean change in operative time and the mean change in video-assessment score between the 2 video-recorded attempts were compared between groups. Qualitative semi-structured interviews were conducted to understand the residents' perspective on video-based surgical coaching.

MEASUREMENTS AND MAIN RESULTS

Twenty residents participated with 10 in the coaching and 10 in the control group. Mean operative time to complete the suturing task was reduced by 32.8% (SD = 21.3%) in the coached group vs 7.2% (SD = 25.1%) in the control group (p = .025). There was no significant change in surgical assessment scores within the coached or control group. Residents identified the core components of a surgical coaching program to include: (1) the resident: focused skill development, (2) the coach: focused on feedback, (3) and the coaching program: a structured activity. Residents envisioned monthly coaching with the opportunity for deliberate practice, the importance of a positive relationship between the coach and coachee, and the importance of faculty development in surgical coaching.

CONCLUSION

Video-based surgical coaching is an effective tool to enhance technical skill development in surgical education.

Preoperative educational briefings: systematic review and novel evidence-based framework

BACKGROUND

The preoperative educational briefing is a focused discussion encompassing trainee goal setting and operative strategy. How to effectively deliver the educational briefing and the associated benefits to surgical learning and performance remain unclear. The aim of this study was to extract common themes from briefing templates, examine the impact on surgical education and performance metrics, and propose an evidence-based, structured framework for future implementation.

METHODS

The MEDLINE, Embase, PubMed, and Web of Science databases were systematically searched for relevant studies that were published between database inception and 15 May 2024. Eligible studies involved surgical trainees and implemented educational briefing in the operating room environment. Results were thematically analysed, identifying 12 outcome measures, organized within Kirkpatrick's model of learning evaluation.

RESULTS

Some 7174 studies were screened, of which 20 met the inclusion criteria. A total of 17 studies compared pre- and post-educational briefing implementation participant surveys focusing on surgical education and performance metrics. A total of 95 statistically significant results were identified, of which 93 demonstrated improvement after the introduction of educational briefing. Benefit was identified in 7 of 7 studies investigating reaction (for example briefing impact), 11 of 13 studies examining learning (for example intraoperative teaching), 12 of 14 studies investigating behaviour (for example goal setting), and 6 of 9 studies examining surgical results (for example trainee autonomy). Thematic analysis of briefing templates demonstrated four key themes, forming the proposed 'Goals, Autonomy, Preparation, and Strategy' ('GAPS') framework for standardized preoperative educational briefing.

CONCLUSION

The implementation of structured preoperative educational briefing significantly improves surgical education and performance outcomes. The 'Goals, Autonomy, Preparation, and Strategy' framework facilitates a deliberate, evidence-based approach to educational briefing for implementation across surgical specialties and healthcare systems.

How to be a Better Surgeon: The Evidence for Surgical Coaching

Surgical coaching has made a positive contribution to surgical training and practice; however, the otolaryngology-head and neck surgery literature is lacking. The operating environment for practicing surgeons, and specifically otolaryngologists, is continually changing due to advancements in technology and new practice patterns. These changes in practice, however, have not come with a coordinating system for operative feedback once surgical training is completed. In this commentary, we explore surgical coaching, its applicability to otolaryngology, and encourage its more widespread acceptance and implementation.

Video-Based Propagation of Tacit Knowledge During Coil Embolization of Intracranial Aneurysms

BACKGROUND

Neuroendovascular treatment of cerebral aneurysms is considered a basic procedure for neurosurgeons and interventional neuroradiologists; however, its critical technical nuances, termed "tacit knowledge," are challenging to impart. This study aimed to evaluate the efficacy of our novel video recording and editing method in enhancing trainees' experience.

METHODS

A wearable camera (wearable recording) and multiple media sources in a hybrid operating room (hybrid recording) were used to capture procedural details such as audio and conversation, thus enabling a re-experience. Trainees condensed both recordings into summary videos, and a supervisor subsequently evaluated them. Six trainees watched the following 3 videos: Video 1, only hybrid recording; Video 2, only wearable recording; and Video 3, both wearable and hybrid recordings synchronized, and then provided semiquantitative evaluations ranging from 0 (not useful at all) to 5 (extremely useful).

RESULTS

We examined 64 unruptured cerebral aneurysm coil embolizations using hybrid wearable recording methods. Video 3 received the highest rating among all participants (5 ± 0 [mean ± standard deviation]), while Videos 1 and 2 received relatively lower ratings (Video 1:3.8 ± 0.7; Video 2:4.2 ± 0.4). The educational impact of video editing across all videos was rated highly (4.4 ± 0.8). The respondents showed diverse opinions on editing time, with some perceiving it as less time-consuming than other surgery video edits (3.4 ± 1.1).

CONCLUSIONS

Our hybrid and wearable recording and editing methods facilitated the propagation of tacit knowledge of coil embolization and enhanced surgical education by enabling more efficient learning of technical tips.

What is the learning effect of video review in postgraduate medical education: a systematic review

BACKGROUND

Video review is a feasible, commonly used learning tool, but current literature lacks a comprehensive review of its impact on learning in postgraduate medical education. This systematic review aims at examining the learning effect of video review of resident performance in clinical practice during postgraduate medical education.

METHODS

A systematic literature search was conducted from May 2023 to July 2023 with an update on 12/12/2023. Databases of MEDLINE (Pubmed), Web of Science, Embase and ERIC (through Webquest) were searched. Eligible articles had to describe the learning effects of video review in clinical practice in postgraduate medical education. The videos had to be actively recorded in a setting where a camera was not normally used for standard patient care. The investigated effect needed to be classified at least as a Kirkpatrick level 2. We iteratively developed a standardized data extraction form to extract study characteristics. The methodological quality of the individual studies was assessed using the Medical Education Research Quality Instrument.

RESULTS

Out of 9323 records after deduplication, 11 studies were included. The designs were randomised controlled trials (n = 4) and single-group pre-test post-tests trials (n = 7). The studies had outcomes related to knowledge and skills (n = 5), resident behaviours (n = 5) and patient outcome (n = 1). All studies reported outcomes regarding learning effect.

CONCLUSIONS

Video review appears to have a positive impact on residents' learning outcomes in postgraduate medical education. However, it is mostly not tailored to the specific learning needs of residents, and there is a lack of information regarding its optimal integration with other learning methods and within distinct clinical contexts. The heterogeneity observed among the included studies makes it challenging to formulate clear recommendations in the use of video.

Coaching for improving clinical performance of surgeons: a scoping review

Surgical coaching has been proven to effectively enhance clinical performance. However, diverse implementation strategies present challenges when initiating new programs. Our scoping review aimed to synthesize the existing literature on surgical coaching, thereby informing the direction of future coaching initiatives. We reviewed published articles in PubMed/Medline and suppletory manuscripts from reference lists. The protocol of our review was registered (osf.io, Z3S8H). Inclusion criteria were studies that provided a detailed description of structured surgical coaching programs aimed at improving clinical performance. Excluded were studies focused on mentoring, teaching, or other forms of coaching that did not align with our specific definition of surgical coaching. We extracted and charted variables such as authors, publication year, geographic region, and others for subsequent analysis. A total of 117 studies were screened, and 11 met our inclusion criteria. Among these, five articles (45%) employed objective metrics to evaluate clinician performance. One study reported on the overall complication rates within 30 days as a measured outcome. Surgeons were the primary coachees in ten of the studies (91%), and the training of coaches was deemed necessary in seven studies (64%). The analyses revealed a preference for expert coaching models (6/11, 55%), video-based coaching (9/11, 82%), and postoperative timelines (7/11, 64%). Various coaching models were identified, including PRACTICE, GROW, and WISCONSIN. As an effective education method, surgical coaching has been conducted in many regions with varied designs. The implementation of structured surgical coaching programs offers substantial benefits for trainers, enhancing efficiency. Future research should focus on generating higher-level evidence, utilizing objective measurement tools, and integrating innovative technologies to further enhance the efficacy of surgical coaching programs.

The Impact of Simulator Training of Vascular Anastomosis and Video Assessment for Surgical Residents

BACKGROUND

The rapid increase of minimally invasive surgery and the shortened training period for surgical residents has resulted in limited opportunities to acquire proficiency in open surgical techniques, such as vascular anastomosis. However, vascular anastomosis remains an essential skill in every surgery for bleeding control. This study aimed to validate the effectiveness of surgical education model for vascular anastomosis and assess the impact on the comprehension, skill, and confidence of surgical residents in performing vascular anastomosis.

METHODS

A total of 21 surgical residents with first to third years of experience at Seoul National University Hospital participated in a 4-week vascular anastomosis training program. The program included an educational lecture and the performance of an end-to-side anastomosis on a procedural model, with evaluations being conducted using the Objective Structured Assessment of Technical Skills (OSATS) and the End-Product Rating Score (EPRS) in pretraining and posttraining surveys.

RESULTS

Significant improvement was observed in the OSATS score (from 9.22 ± 2.4 in week 1 to 12.87 ± 3.1 in week 4; P < 0.001) and the EPRS score (from 12.47 ± 4.1 in week 1 to 17.57 ± 2.2 in week 4; P < 0.001). Additionally, the surgical performance time significantly decreased from 20.99 ± 4.6 min to 16.33 ± 4.2 min (P = 0.019) CONCLUSIONS: Simulator training of in vitro vascular anastomosis, when accompanied by expert-led instruction, can effectively enhance the surgical proficiency, confidence, and overall surgical outcomes of residents, as inferred from the observed improvements in OSATS and EPRS scores. The results suggest that integration of this training model into surgical curricula could be a promising strategy for enhancing vascular surgical training.

Exploring the Knowledge and Utilization of Video-Based Surgical Learning Among Medical Students in a Teaching Hospital in Nigeria: A Mixed-Methods Study

BACKGROUND

The incorporation of video-based resources into medical education has become common practice in many middle- and high-income countries. This study aimed to assess the knowledge, usage, and receptivity of video-based learning among medical students in a resource-limited setting in Nigeria.

METHODS

A mixed-method approach was utilized, involving both quantitative and qualitative data collection among fourth, fifth, and sixth-year medical students. Sampling was conducted via simple random selection, and data were collected using questionnaires and focus group discussions. Quantitative data were analyzed using SPSS version 21 for descriptive statistics, while thematic coding was applied to qualitative data using NVivo.

RESULTS

A majority (79%) were aware of video-based learning, with YouTube being the most used platform. However, barriers such as high data cost (79.7%) and poor internet connectivity (77.2%) limited utilization. Qualitative analysis highlighted the value of flexible, engaging content in learning and restructuring of existing curriculum to maximize the benefits of videos but raised concerns about standardization, patient privacy, and infrastructure.

CONCLUSION

Although students recognize the effectiveness of video-based learning, its integration into medical curricula requires addressing barriers such as internet access and content quality. Institutional support is critical for maximizing its potential.

Impacts of immersive 3D videos on students' surgical learning compared to 2D videos: a randomized controlled trial

BACKGROUND

Unlike other medical specialties, surgery is primarily learned through apprenticeship, by observing surgeons in action during operations. However, the increasing number of medical students and work-hour restrictions limit opportunities for learning in the operating room (OR). These circumstances call for novel technologies, such as immersive video. The objective of this study is to compare knowledge retention, preparedness, and content engagement for surgical learning when watching a surgical video in 3D through a Head-Mounted Display (HMD) versus in 2D video on a conventional screen.

MATERIEL AND METHODS

This randomized controlled trial includes 231 fourth-year medical students. Participants watched the same 12 min surgical video, narrated by an expert, presented either in immersive 3D form through an HMD, or in 2D form through a conventional screen. The students completed three questionnaires (previewing, postviewing, and 1 month later), which included questions on knowledge retention, expected preparedness, content engagement, tool engagement, and self-assessment. Statistical analyses were adjusted by including the confounding factors.

RESULTS

Immediately after the video, the 3D immersive video group showed a significantly lower knowledge retention score compared to the classic video group (P<0.01). Nonetheless, the 3D immersive video group demonstrated better-expected preparedness as a future resident (P=0.019), greater satisfaction (P=0.033), better stimulation (P<0.001), higher involvement (P<0.001), and a greater perceived ability to identify anatomical structures (P<0.001). After 1 month, participants in the immersive video group reported feeling more prepared (P=0.016), more self-confident (P=0.020), more at ease (P=0.023), and less overwhelmed (P<0.01) than those in the 2D video group.

CONCLUSION

Our results showed that 3D surgical immersive video vs. 2D surgical video, enhances the sense of stimulation, satisfaction, involvement, and the perception of having better identified anatomical structures. For early medical school students where access to the OR is limited, this tool appears to a significant step forward in surgical pedagogy. However, the precise understanding of its pedagogical value required further investigation and refinement.

Video-Based Performance Analysis in Pituitary Surgery - Part 2: Artificial Intelligence Assisted Surgical Coaching

BACKGROUND

Superior surgical skill improves surgical outcomes in endoscopic pituitary adenoma surgery. Video-based coaching programs, pioneered in professional sports, have shown promise in surgical training. In this study, we developed and assessed a video-based coaching program using artificial intelligence (AI) assistance.

METHODS

An AI-assisted video-based surgical coaching was implemented over 6 months with the pituitary surgery team. The program consisted of 1) monthly random video analysis and review; and 2) quarterly 2-hour educational meetings discussing these videos and learning points. Each video was annotated for surgical phases and steps using AI, which improved video interactivity and allowed the calculation of quantitative metrics. Primary outcomes were program feasibility, acceptability, and appropriateness. Surgical performance (via modified Objective Structured Assessment of Technical Skills) and early surgical outcomes were recorded for every case during the 6-month coaching period, and a preceding 6-month control period. Beta and logistic regression were used to assess the change in modified Objective Structured Assessment of Technical Skills scores and surgical outcomes after the coaching program implementation.

RESULTS

All participants highly rated the program's feasibility, acceptability, and appropriateness. During the coaching program, 63 endoscopic pituitary adenoma cases were included, with 41 in the control group. Surgical performance across all operative phases improved during the coaching period (P < 0.001), with a reduction in new postoperative anterior pituitary hormone deficit (P = 0.01).

CONCLUSIONS

We have developed a novel AI-assisted video surgical coaching program for endoscopic pituitary adenoma surgery - demonstrating its viability and impact on surgical performance. Early results also suggest improvement in patient outcomes. Future studies should be multicenter and longer term.

Barriers to the adoption of routine surgical video recording: a mixed-methods qualitative study of a real-world implementation of a video recording platform

BACKGROUND

Routine surgical video recording has multiple benefits. Video acts as an objective record of the operative record, allows video-based coaching and is integral to the development of digital technologies. Despite these benefits, adoption is not widespread. To date, only questionnaire studies have explored this failure in adoption. This study aims to determine the barriers and provide recommendations for the implementation of routine surgical video recording.

MATERIALS AND METHODS

A pre- and post-pilot questionnaire surrounding a real-world implementation of a C-SATS©, an educational recording and surgical analytics platform, was conducted in a university teaching hospital trust. Usage metrics from the pilot study and descriptive analyses of questionnaire responses were used with the non-adoption, abandonment, scale-up, spread, sustainability (NASSS) framework to create topic guides for semi-structured interviews. Transcripts of interviews were evaluated in an inductive thematic analysis.

RESULTS

Engagement with the C-SATS© platform failed to reach consistent levels with only 57 videos uploaded. Three attending surgeons, four surgical residents, one scrub nurse, three patients, one lawyer, and one industry representative were interviewed, all of which perceived value in recording. Barriers of 'change,' 'resource,' and 'governance,' were identified as the main themes. Resistance was centred on patient misinterpretation of videos. Participants believed availability of infrastructure would facilitate adoption but integration into surgical workflow is required. Regulatory uncertainty was centred around anonymity and data ownership.

CONCLUSION

Barriers to the adoption of routine surgical video recording exist beyond technological barriers alone. Priorities for implementation include integration recording into the patient record, engaging all stakeholders to ensure buy-in, and formalising consent processes to establish patient trust.

Video-Based Coaching for Laparoscopic Salpingectomy: A Randomized Controlled Trial

OBJECTIVE

To evaluate the effect of video-based coaching on the gynecology resident performance of laparoscopic salpingectomy.

METHODS

PGY-1 and PGY-2 residents were randomized before their gynecology rotations to standard gynecology curriculum (control group) or standard curriculum plus two video-coaching sessions by a fellowship-trained minimally invasive gynecologic surgeon (VBC group). Residents were video recorded intraoperatively performing three unilateral laparoscopic salpingectomies. Participants in the VBC group were coached between the procedures. The primary outcome was the improvement in modified GOALS (Global Operative Assessment of Laparoscopic Skills) and OSA-LS (Objective Structured Assessment of Laparoscopic Salpingectomy) scores, compared with baseline, in the VBC and control groups, with videos independently graded by three blinded minimally invasive gynecologic surgeons. A minimum sample size of 18 participants (nine per group) was needed to achieve 90% power to detect a difference of 5.0 points.

RESULTS

From October 2021 to December 2022, 28 PGY-1 and PGY-2 residents completed the study with 14 participants per group. Baseline characteristics were similar between groups. In the VBC group, modified GOALS scores significantly improved by 3.0 points from video 1 to video 2 ( P =.04) and by 3.2 points from video 1 to video 3 ( P =.02). Modified OSA-LS scores also increased significantly in the VBC group, by 6.1 points from video 1 to video 3 ( P =.02). In the control group, modified GOALS and OSA-LS scores improved from baseline but were not significant ( P =.2, P =.5). Video-based coaching also enhanced resident comfort and confidence in performing laparoscopic surgery.

CONCLUSION

Video-based coaching improves resident performance of laparoscopic salpingectomy and can be used as an adjunct to resident surgical training.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov , NCT05103449.

For Your Eyes Only? The Use of Surgical Videos in Urological Residency Training: A European-wide Survey

Background and objective

Video-based learning may be beneficial in surgical education, both in the preparation for surgery and to evaluate surgical performance. The use of a video is not yet anchored in European urology residency programs, and it is unclear how frequently residents use videos. The purpose of this study is to investigate whether and how urology residents utilize videos to prepare for surgical procedures and evaluate their surgical performance.

Methods

We conducted a European-wide, survey-based, needs assessment among urology residents. The survey was distributed electronically among the participants in the European Urology Residents Education Program 2022 and all the members of the European Society of Residents in Urology.

Key findings and limitations

Seventy-two surveys were completed by the residents of 12 nationalities. Of the residents, 98.6% used videos in preparation, mainly for open, laparoscopic, and robotic procedures. YouTube was by far the most used source. Of the residents, 86% believed that a postsurgical video review would be helpful. In total, 39% of the residents actually had this possibility. Of them, 30% had the opportunity to do this together with a supervisor.

Conclusions and clinical implications

This study demonstrated that European urology residents often use videos to prepare surgical procedures. Considering that the majority of the respondents use YouTube as the main source of videos, this seems not to be formalized within their training. Although most residents would value a postsurgical video review, preferably together with a supervisor, the latter is not available to the majority. We recommend the use of professional, and not public, video channels and easier access to postsurgical video review.

Patient summary

Video-based learning may have an important role in surgical education. Videos often are a source of education for European urology residents to prepare for surgical procedures. Although most residents would appreciate a postsurgical video review or video-based coaching, this is not available to the majority of them.

Video-based compilation of acute pain behaviours in cats

OBJECTIVES

The aim of this work was to create a video-based compilation of acute pain behaviours in cats as an open-access online resource for training of veterinary health professionals.

METHODS

A database comprising 60 h of video recordings of cats was used. Videos were previously recorded after ethical approval and written client consent forms, and involved cats with different types (eg, medical, surgical, trauma, orofacial) and degrees (eg, from no pain to severe pain) of acute pain, before and after surgery or the administration of analgesia. The database included videos of cats of different coat colours, ages, sex and breeds. Video selection was based on a published ethogram of acute pain behaviours in cats. Videos were selected by one observer (SM) according to their definition and quality, followed by a second round of screening by two observers (SM and PVS). Video editing included a standardised template (ie, watermark and titles).

RESULTS

A total of 24 videos (mean length 33 ± 17 s) with each acute pain-related behaviour described in the ethogram were uploaded to an open-access online video-sharing platform (http://www.youtube.com/@Steagalllaboratory) with an individual hyperlink. Videos were provided with a short description of the behaviour for the public.

CONCLUSIONS AND RELEVANCE

This video-based compilation may promote better training of veterinary health professionals on acute pain assessment while improving feline health and welfare and the understanding of cat behaviours.

Comparative analysis of GoPro and digital cameras in head and neck flap harvesting surgery video documentation: an innovative and efficient method for surgical education

BACKGROUND

An urgent need exists for innovative surgical video recording techniques in head and neck reconstructive surgeries, particularly in low- and middle-income countries where a surge in surgical procedures necessitates more skilled surgeons. This demand, significantly intensified by the COVID-19 pandemic, highlights the critical role of surgical videos in medical education. We aimed to identify a straightforward, high-quality approach to recording surgical videos at a low economic cost in the operating room, thereby contributing to enhanced patient care.

METHODS

The recording was comprised of six head and neck flap harvesting surgeries using GoPro or two types of digital cameras. Data were extracted from the recorded videos and their subsequent editing process. Some of the participants were subsequently interviewed.

RESULTS

Both cameras, set at 4 K resolution and 30 frames per second (fps), produced satisfactory results. The GoPro, worn on the surgeon's head, moves in sync with the surgeon, offering a unique first-person perspective of the operation without needing an additional assistant. Though cost-effective and efficient, it lacks a zoom feature essential for close-up views. In contrast, while requiring occasional repositioning, the digital camera captures finer anatomical details due to its superior image quality and zoom capabilities.

CONCLUSION

Merging these two systems could significantly advance the field of surgical video recording. This innovation holds promise for enhancing technical communication and bolstering video-based medical education, potentially addressing the global shortage of specialized surgeons.

Current trends and barriers to video management and analytics as a tool for surgeon skilling

BACKGROUND

The benefits of intraoperative recording are well published in the literature; however, few studies have identified current practices, barriers, and subsequent solutions. The objective of this study was to better understand surgeon's current practices and perceptions of video management and gather blinded feedback on a new surgical video recording product with the potential to address these barriers effectively.

METHODS

A structured questionnaire was used to survey 230 surgeons (general, gynecologic, and urologic) and hospital administrators across the US and Europe regarding their current video recording practices. The same questionnaire was used to evaluate a blinded concept describing a new intraoperative recording solution.

RESULTS

54% of respondents reported recording eligible cases, with the majority recording less than 35% of their total eligible caseload. Reasons for not recording included finding no value in recording simple procedures, forgetting to record, lack of access to equipment, legal concerns, labor intensity, and difficulty accessing videos. Among non-recording surgeons, 65% reported considering recording cases to assess surgical techniques, document practice, submit to conferences, share with colleagues, and aid in training. 35% of surgeons rejected recording due to medico-legal concerns, lack of perceived benefit, concerns about secure storage, and price. Regarding the concept of a recording solution, 74% of all respondents were very likely or quite likely to recommend the product for adoption at their facility. Appealing features to current recorders included the product's ease of use, use of AI to maintain patient and staff privacy, lack of manual downloads, availability of full-length procedural videos, and ease of access and storage. Non-recorders found the immediate access to videos and maintenance of patient/staff privacy appealing.

CONCLUSION

Tools that address barriers to recording, accessing, and managing surgical case videos are critical for improving surgical skills. Touch Surgery Enterprise is a valuable tool that can help overcome these barriers.

Adoption of routine surgical video recording: a nationwide freedom of information act request across England and Wales

Background

Surgical video contains data with significant potential to improve surgical outcome assessment, quality assurance, education, and research. Current utilisation of surgical video recording is unknown and related policies/governance structures are unclear.

Methods

A nationwide Freedom of Information (FOI) request concerning surgical video recording, technology, consent, access, and governance was sent to all acute National Health Service (NHS) trusts/boards in England/Wales between 20th February and 20th March 2023.

Findings

140/144 (97.2%) trusts/boards in England/Wales responded to the FOI request. Surgical procedures were routinely recorded in 22 trusts/boards. The median estimate of consultant surgeons routinely recording their procedures was 20%. Surgical video was stored on internal systems (n = 27), third-party products (n = 29), and both (n = 9). 32/140 (22.9%) trusts/boards ask for consent to record procedures as part of routine care. Consent for recording included non-clinical purposes in 55/140 (39.3%) trusts/boards. Policies for surgeon/patient access to surgical video were available in 48/140 (34.3%) and 32/140 (22.9%) trusts/boards, respectively. Surgical video was used for non-clinical purposes in 64/140 (45.7%) trusts/boards. Governance policies covering surgical video recording, use, and/or storage were available from 59/140 (42.1%) trusts/boards.

Interpretation

There is significant heterogeneity in surgical video recording practices in England and Wales. A minority of trusts/boards routinely record surgical procedures, with large variation in recording/storage practices indicating scope for NHS-wide coordination. Revision of surgical video consent, accessibility, and governance policies should be prioritised by trusts/boards to protect key stakeholders. Increased availability of surgical video is essential for patients and surgeons to maximally benefit from the ongoing digital transformation of surgery.

Funding

KL is supported by an NIHR Academic Clinical Fellowship and acknowledges infrastructure support for this research from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC).

Training the gynecologic oncologists of the future - challenges and opportunities

Several recent advances in gynecologic cancer care have improved patient outcomes. These include national screening and vaccination programs for cervical cancer as well as neoadjuvant chemotherapy for ovarian cancer. Conversely, these advances have cumulatively reduced surgical opportunities for training creating a need to supplement existing training strategies with evidence-based adjuncts. Technologies such as virtual reality and augmented reality, if properly evaluated and validated, have transformative potential to support training. Given the changing landscape of surgical training in gynecologic oncology, we were keen to summarize the evidence underpinning current training in gynecologic oncology.In this review, we undertook a literature search of Medline, Google, Google Scholar, Embase and Scopus to gather evidence on the current state of training in gynecologic oncology and to highlight existing evidence on the best methods to teach surgical skills. Drawing from the experiences of other surgical specialties we examined the use of training adjuncts such as cadaveric dissection, animation and 3D models as well as simulation training in surgical skills acquisition. Specifically, we looked at the use of training adjuncts in gynecologic oncology training as well as the evidence behind simulation training modalities such as low fidelity box trainers, virtual and augmented reality simulation in laparoscopic training. Finally, we provided context by looking at how training curriculums varied internationally.Whereas some evidence to the reliability and validity of simulation training exists in other surgical specialties, our literature review did not find such evidence in gynecologic oncology. It is important that well conducted trials are used to ascertain the utility of simulation training modalities before integrating them into training curricula.

Training for excellence: using a multimodal videoconferencing platform to coach surgeons and improve intraoperative performance

INTRODUCTION

Continuing Professional Development opportunities for lifelong learning are fundamental to the acquisition of surgical expertise. However, few opportunities exist for longitudinal and structured learning to support the educational needs of surgeons in practice. While peer-to-peer coaching has been proposed as a potential solution, there remains significant logistical constraints and a lack of evidence to support its effectiveness. The purpose of this study is to determine whether the use of remote videoconferencing for video-based coaching improves operative performance.

METHODS

Early career surgeon mentees participated in a remote coaching intervention with a surgeon coach of their choice and using a virtual telestration platform (Zoom Video Communications, San Jose, CA). Feedback was articulated through annotating videos. The coach evaluated mentee performance using a modified Intraoperative Performance Assessment Tool (IPAT). Participants completed a 5-point Likert scale on the educational value of the coaching program.

RESULTS

Eight surgeons were enrolled in the study, six of whom completed a total of two coaching sessions (baseline, 6-month). Subspecialties included endocrine, hepatopancreatobiliary, and surgical oncology. Mean age of participants was 39 (SD 3.3), with mean 5 (SD 4.1) years in independent practice. Total IPAT scores increased significantly from the first session (mean 47.0, SD 1.9) to the second session (mean 51.8, SD 2.1), p = 0.03. Sub-category analysis showed a significant improvement in the Advanced Cognitive Skills domain with a mean of 33.2 (SD 2.5) versus a mean of 37.0 (SD 2.4), p < 0.01. There was no improvement in the psychomotor skills category. Participants agreed or strongly agreed that the coaching programs can improve surgical performance and decision-making (coaches 85%; mentees 100%).

CONCLUSION

Remote surgical coaching is feasible and has educational value using ubiquitous commercially available virtual platforms. Logistical issues with scheduling and finding cases aligned with learning objectives continue to challenge program adoption and widespread dissemination.

Interprofessional staff perspectives on the adoption of or black box technology and simulations to improve patient safety: a multi-methods survey

INTRODUCTION

Medical errors still plague healthcare. Operating Room Black Box (ORBB) and ORBB-simulation (ORBBSIM) are innovative emerging technologies which continuously capture as well as categorize intraoperative data, team information, and audio-visual files, in effort to improve objective quality measures. ORBB and ORBBSIM have an opportunity to improve patient safety, yet a paucity of implementation literature exists. Overcoming implementation barriers is critical. This study sought to obtain rich insights while identifying facilitators and barriers to adoption of ORBB and ORBBSIM in alignment with Donabedian's model of health services and healthcare quality. Enrichment themes included translational performance improvement and real-world examples to develop sessions.

METHODS

Interprofessional OR staff were invited to complete two surveys assessing staff's perceptions using TeamSTEPPS's validated Teamwork Perceptions Questionnaire (T-TPQ) and open-ended questions. Descriptive statistics were calculated for quantitative variables, and inductive phenomenological content analysis was used for qualitative.

RESULTS

Survey 1 captured 71 responses from 334 invited (RR 21%) while survey 2 captured 47 responses from 157 (RR 29.9%). The T-TPQ score was 65.2, with Communication (70.4) the highest construct and Leadership (58.0) the lowest. Quality Improvement (QI), Patient Safety, and Objective Case Review were the most common perceived ORBB benefits. Trends suggested a reciprocal benefit of dual ORBB and ORBBSIM adoption. Trends also suggested that dual implementation can promote Psychological Safety, culture, trust, and technology comfort. The need for an implementation plan built on change management principles and a constructive culture were key findings.

CONCLUSIONS

Findings supported ORBB implementation themes from previous literature and deepened our understanding through the exploration of team culture. This blueprint provides a model to help organizations adopt ORBB and ORBBSIM. Outcomes can establish an empirical paradigm for future studies.

Coaching with audiovisual technology in acute-care hospital settings: systematic review

BACKGROUND

Surgical coaching programmes are a means of improving surgeon performance. Embedded audiovisual technology has the potential to further enhance participant benefit and scalability of coaching. The objective of this systematic review was to evaluate how audiovisual technology has augmented coaching in the acute-care hospital setting and to characterize its impact on outcomes.

METHODS

A systematic review was conducted, searching PubMed, Ovid MEDLINE, Embase, PsycInfo, and CINAHL databases using PRISMA. Eligible studies described a coaching programme that utilized audiovisual technology, involved at least one coach-coachee interaction, and included healthcare professionals from the acute-care hospital environment. The risk of bias 2 tool and grading of recommendations, assessment, development, and evaluations (GRADE) framework were used to evaluate studies. Synthesis without meta-analysis was performed, creating harvest plots of three coaching outcomes: technical skills, self-assessment/feedback, and non-technical skills.

RESULTS

Of 10 458 abstracts screened, 135 full texts were reviewed, and 21 studies identified for inclusion. Seventeen studies were conducted within surgical specialties and six classes of audiovisual technology were utilized. An overall positive direction of effect was demonstrated for studies measuring improvement of either technical skills or non-technical skills. Direction of effect for self-assessment/feedback was weakly positive.

CONCLUSION

Audiovisual technology has been used successfully in coaching programmes within acute-care hospital settings to facilitate or assess coaching, with a positive impact on outcome measures. Future studies may address the additive benefits of video over in-person observation and enhance the certainty of evidence that coaching impacts on surgeon performance, surgeon well-being, and patient outcomes.

Effects of coaching on medical student well-being and distress: a systematic review protocol

INTRODUCTION

Medical students experience higher rates of distress and burnout compared with their age-similar peers overall. Coaching has been proposed as one means of combating distress and burnout within the medical profession. The purpose of this systematic review is to synthesise the current evidence on the effects of coaching interventions on medical student well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work and distress, including burnout, anxiety and depressive symptoms.

METHODS AND ANALYSIS

We will conduct a systematic review of interventional and observational comparative studies that assess the effects of coaching interventions on well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work and distress, including burnout, anxiety and depressive symptoms among undergraduate medical students internationally. We will search PubMed (MEDLINE), Embase (OVID), PsycINFO (OVID), Scopus, ERIC, Cochrane Database of Systematic Reviews (OVID) and Cochrane Central Register of Controlled Trials (OVID) from their respective inception dates using the following search terms: (medical students OR medical student OR undergraduate medical education) AND (coach OR coaching OR coaches). Studies in any language will be eligible. Studies that report one or more outcomes of distress or well-being among medical students who receive a coaching intervention will be included. Data on participant and intervention characteristics, outcomes and instruments used will be collected as well as quality/risk of bias assessments. Two reviewers will screen studies against the inclusion criteria and perform data extraction. We will conduct a narrative synthesis, with meta-analysis if evidence permits quantitative pooling of results. Heterogeneity of results across studies according to study design, learner level and study risk of bias will be evaluated, as well as publication bias.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review. Results will be disseminated by publication in a scientific journal.

PROSPERO REGISTRATION NUMBER

CRD42022322503.

Impact of educational video on performance in robotic simulation training (TAKUMI-1): a randomized controlled trial

The use of virtual reality for simulations plays an important role in the initial training for robotic surgery. This randomized controlled trial aimed to investigate the impact of educational video on the performance of robotic simulation. Participants were randomized into the intervention (video) group that received an educational video and robotic simulation training or the control group that received only simulation training. The da Vinci® Skills Simulator was used for the basic course, including nine drills. The primary endpoint was the overall score of nine drills in cycles 1-10. Secondary endpoints included overall, efficiency, and penalty scores in each cycle, as well as the learning curves evaluated by the cumulative sum (CUSUM) analysis. Between September 2021 and May 2022, 20 participants were assigned to the video (n = 10) and control (n = 10) groups. The video group had significantly higher overall scores than the control group (90.8 vs. 72.4, P < 0.001). Significantly higher overall scores and lower penalty scores were confirmed, mainly in cycles 1-5. CUSUM analysis revealed a shorter learning curve in the video group. The present study demonstrated that educational video training can be effective in improving the performance of robotic simulation training and shortening the learning curve.

A systematic review of video-based educational interventions in robotic surgical training

As robotic surgical procedures become more prevalent in practice, there is a demand for effective and efficient educational strategies in robotic surgery. Video has been used in open and laparoscopic surgery to instruct trainees in the acquisition of operative knowledge and surgical skill. Robotic surgery is an ideal application of video-based technology given the access of video recording directly from the console. This review will present the evidence base for video-based educational tools in robotic surgery to guide the development of future educational interventions using this technology. A systematic review of the literature was performed using the key words "video" "robotic surgery" and "education". From a total of 538 results, 15 full text articles were screened. Inclusion criteria were the presentation of an educational intervention using video and the application of this intervention to robotic surgery. The results of 10 publications are presented in this review. Analysis of the key concepts presented in these publications revealed three themes: video as technology, video as instruction, video as feedback. All studies showed a video-based learning had a positive effect on educational outcomes. There are limited published studies looking specifically at the use of video as an educational intervention in robotic surgical training. Existing studies primarily focus on the use of video as a review tool for skill development. There is scope to expand the use of robotic video as a teaching tool through adaptation of novel technology such as 3D headsets and concepts of cognitive simulation including guided mental imagery and verbalisation.

Role of video self-assessment in laparoscopic simulation training: a randomized pilot trial

BACKGROUND

Residency programs have implemented simulation training to compensate for reduced operating room exposure. Video recording is an educational tool that can be utilized for coaching, telepresence, and self-assessment during simulation training. Data is limited on the utility of video recording and self-assessment for laparoscopic training in Ob/Gyn residency programs..

OBJECTIVE

This study aimed to determine the role of video self-assessment as an educational tool in laparoscopic simulation training and to establish the feasibility of our study design for a larger randomized controlled trial.

STUDY DESIGN

This was a prospective pilot study with a parallel, randomized, trial design that occurred in the Department of Obstetrics and Gynecology at the Mount Sinai Hospital. Subject participation took place in a surgical simulation training room. A total of 23 subjects were recruited (7 medical students, 15 residents, 1 fellow) voluntarily. All participants completed the study. All the subjects completed a pretest survey. The surgical simulation room contained a single Fundamentals of Laparoscopic Surgery box trainer and video-recording station. For session #1, each participant performed 2 Fundamentals of Laparoscopic Surgery tasks (A, peg transfer; B, intracorporeal knot tie). Participants were video recorded during session #1 and were randomized to either receive or not receive their video recording. The video group (n=13) and control group (n=10) repeated the Fundamentals of Laparoscopic Surgery tasks 7 to 10 days later (session #2). The primary outcome was percentage change in completion time between sessions. Secondary outcomes were percentage change in peg and needle drops between sessions.

RESULTS

The participant characteristics (video vs control) were as follows: average training level (6.15 vs 4.90 years), self-assessment (1=poor, 10=excellent) of surgical skill (4.8 vs 3.7), and laparoscopic skill (4.4 vs 3.5). Training level was inversely correlated with completion time for tasks A and B (r, -0.79 and -0.87; P<.0001). Less experienced trainees required the maximum time allotted for each task in session #1 (A, 3; B, 13). Regarding the primary outcome, the video group improved less than the control group (A, 16.7% vs 28.3%; B, 14.4% vs 17.3%). After controlling for training level (residents only), the video group improved more in the primary outcome (A, 17% vs 7.4%; B, 20.9% vs 16.5%) and secondary outcomes (A, 0.0% vs -194.1%; B, 41.3% vs 37.6%).

CONCLUSION

Video self-assessment has a potential role in simulation training for obstetrics-gynecology residents. With key improvements, the feasibility of our study design was demonstrated in preparation for a future definitive trial.

The Future of Visual Documentation? Assessing the Use of Videography in Facial Plastic Surgery

Recent technological advancements in the field of portable electronics have facilitated the use of videography as a form of visual documentation in facial plastic surgery. Currently, the degree of video adoption and perceptions relating to its use in plastic surgery are not known. This study aimed to evaluate the current use, perceptions, and barriers regarding the adoption of video in the clinical practice of facial plastic surgery. A cross-sectional study of all American Academy of Facial Plastic and Reconstructive Surgery members was conducted through an e-mail-disseminated 24-item online survey. A total of 164 surgeons responded to the survey. Nearly all surgeons reported routinely employing photography for the documentation and marketing of surgical results. Fewer than 25% of respondents acknowledged using video to document surgical outcomes. Younger surgeons (<10 years in practice) and those in academic practices were significantly more likely to adopt videography (32 vs. 17%, p = 0.042 and 38 vs. 18%, p = 0.027, respectively). Most surgeons regarded video as the superior visual documentation format for dynamic facial expression and as being more difficult to deceptively manipulate. Most frequently cited barriers to adoption included time-consuming capture, file editing/storage requirements, and lack of clear standards. Videography holds favorable potential as the future format of visual documentation in facial plastic surgery due to its ability to capture the full range of dynamic facial expression. Establishing standards and setup guidelines for video capture will be essential in increasing its adoption.

Supplementing Intraoperative Mastoidectomy Teaching With Video-Based Coaching

OBJECTIVES

Video-based coaching might complement general surgery education, but little is known of its applicability for otologic microsurgical teaching. Our purpose was thus to evaluate the content and resident-perceived benefit of video-based coaching for mastoidectomy education.

METHODS

In this mixed-methods pilot design, mastoidectomies were recorded from operative microscopes and reviewed during 30-minute video-based coaching sessions at 2 tertiary care centers. Eight residents and 3 attendings participated. Ten-point Likert-type questionnaires on the extent to which attendings taught 12 topics through 8 techniques were completed by residents after surgical and coaching sessions. Coaching sessions and structured interviews with residents were audio-recorded, transcribed and iteratively coded.

RESULTS

Seven audio-recordings were available for coaching sessions, during which a mean of 2.22 ± 0.5 topics per minute were discussed. Of the 12 teaching topics, technique was discussed most frequently (32%, 0.71 ± 0.2 topics/min), followed by anatomy (16%, 0.31 ± 0.16 topics/min). Of all 8 ratings between coaching and operative sessions, residents indicated a greater extent of discussion of anatomy (median difference, [95% confidence interval (CI)] of 3 [1-4]), progress (2.25 [95% CI, 0.5-4]), technique (3.5 [95% CI, 1.5-5.5]), pitfalls (2.5 [95% CI, 1-3.5]), and summarizing (3 [95% CI, 1-5]). In structured interviews, residents reported improved self-confidence and global perspective.

CONCLUSIONS

Video-based coaching is educationally dense and characterized by perceived richer teaching and promotion of a deeper surgical understanding. It requires no additional resources, can be completed in a short period of time and can be implemented programmatically for any otolaryngologic subspecialty utilizing video-recording capable equipment.

Evolution of the digital operating room: the place of video technology in surgery

PURPOSE

The aim of this review was to collate current evidence wherein digitalisation, through the incorporation of video technology and artificial intelligence (AI), is being applied to the practice of surgery. Applications are vast, and the literature investigating the utility of surgical video and its synergy with AI has steadily increased over the last 2 decades. This type of technology is widespread in other industries, such as autonomy in transportation and manufacturing.

METHODS

Articles were identified primarily using the PubMed and MEDLINE databases. The MeSH terms used were "surgical education", "surgical video", "video labelling", "surgery", "surgical workflow", "telementoring", "telemedicine", "machine learning", "deep learning" and "operating room". Given the breadth of the subject and the scarcity of high-level data in certain areas, a narrative synthesis was selected over a meta-analysis or systematic review to allow for a focussed discussion of the topic.

RESULTS

Three main themes were identified and analysed throughout this review, (1) the multifaceted utility of surgical video recording, (2) teleconferencing/telemedicine and (3) artificial intelligence in the operating room.

CONCLUSIONS

Evidence suggests the routine collection of intraoperative data will be beneficial in the advancement of surgery, by driving standardised, evidence-based surgical care and personalised training of future surgeons. However, many barriers stand in the way of widespread implementation, necessitating close collaboration between surgeons, data scientists, medicolegal personnel and hospital policy makers.

Video-based coaching for surgical residents: a systematic review and meta-analysis

BACKGROUND

Video-based coaching (VBC) is used to supplement current teaching methods in surgical education and may be useful in competency-based frameworks. Whether VBC can effectively improve surgical skill in surgical residents has yet to be fully elucidated. The objective of this study is to compare surgical residents receiving and not receiving VBC in terms of technical surgical skill.

METHODS

The following databases were searched from database inception to October 2021: Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed. Articles were included if they were randomized controlled trials (RCTs) comparing surgical residents receiving and not receiving VBC. The primary outcome, as defined prior to data collection, was change in objective measures of technical surgical skill following implementation of either VBC or control. A pairwise meta-analyses using inverse variance random effects was performed. Standardized mean differences (SMD) were used as the primary outcome measure to account for differences in objective surgical skill evaluation tools.

RESULTS

From 2734 citations, 11 RCTs with 157 residents receiving VBC and 141 residents receiving standard surgical teaching without VBC were included. There was no significant difference in post-coaching scores on objective surgical skill evaluation tools between groups (SMD 0.53, 95% CI 0.00 to 1.01, p = 0.05, I² = 74%). The improvement in scores pre- and post-intervention was significantly greater in residents receiving VBC compared to those not receiving VBC (SMD 1.62, 95% CI 0.62 to 2.63, p = 0.002, I² = 85%). These results were unchanged with leave-one-out sensitivity analysis and subgroup analysis according to operative setting.

CONCLUSION

VBC can improve objective surgical skills in surgical residents of various levels. The benefit may be most substantial for trainees with lower baseline levels of objective skill. Further studies are required to determine the impact of VBC on competency-based frameworks.

A Novel Expert Coaching Model in Urology, Aimed at Accelerating the Learning Curve in Robotic Prostatectomy

INTRODUCTION/BACKGROUND

The surgical residency model assumes that upon completion, a surgeon is ready to practice and grow independently. However, many surgeons fail to improve after reaching proficiency, which in certain instances has correlated with worse clinical outcomes. Coaching addresses this problem and furthers surgeons' education post-residency. Currently, surgical coaching programs focus on medical students and residents, and have been shown to improve residents' and medical students' technical and non-technical abilities. Coaching programs also increase the accuracy of residents, fellows, and attendings in self-assessing their surgical ability. Despite the potential benefits, coaching remains underutilized and poorly studied. We developed an expert-led, face-to-face, video-based surgical coaching program at a tertiary medical center among specialized attending surgeons. Our goal was to evaluate the feasibility of such a program, measure surgeons' attitudes towards internal peer coaching, determine whether surgeons found the sessions valuable and educational, and to subjectively self-assess changes in operative technique.

METHODS/MATERIALS

Surgeons who perform robot-assisted laparoscopic prostatectomies were chosen and grouped by number of cases completed: junior (<100 cases), intermediate (100-500 cases), and senior (>500 cases). Surgeons were scheduled for 3 1-hour coaching sessions 1-2 months apart (February-October 2019), meeting individually with the coach (PS), an expert Urologic Oncologist with thousands of cases of experience performing radical prostatectomy. He received training on coaching methodology prior to beginning the coaching program. Before each session, surgeons selected 1 of their recent intraoperative videos to review. During sessions, the coach led discussion on topics chosen by the surgeon (i.e. neurovascular bundle dissection, apical dissection, bladder neck); together, they developed goals to achieve before the next session. Subsequent sessions included presentation and discussion of a case occurring subsequent to the prior session. Sessions were coded by discussion topics and analyzed based on level of experience. Surgeons completed a survey evaluating the experience.

RESULTS

All 6 surgeons completed 3 sessions. Five surgeons completed the survey; most respondents evaluated themselves as having improved in desired areas and feeling more confident performing the discussed steps of the operation. Discussed surgical principles varied by experience group; when subjectively quantifying the difficulty of surgical steps, the more difficult steps were discussed by the higher experience groups compared to the junior surgeons. The senior surgeons also focused more on oncologic potency, continence outcomes, and more theory-driven questions while the junior surgeons tended to focus more on anatomic and technique-based questions such as tissue handling and the use of cautery and clips. Overall, the surgeons thought this program provoked critical discussion and subsequently modified their technique, and "agreed" or "strongly agreed" that they would seek further sessions.

CONCLUSIONS

Surgical coaching at a large medical center is not only feasible but was rated positively by surgeons across all levels of experience. Coaching led to subjective self-improvement and increased self-confidence among most surgeons. Surgeons also felt that this program offered a safe space to acquire new skills and think critically after finishing residency/fellowship. Themes discussed and takeaways from the sessions varied based on surgeon experience level. While further research is needed to more objectively quantify the impact coaching has on surgeon metrics and patient outcomes, the results of this study supports the initial "proof-of-concept" of peer-based surgical coaching and its potential benefits in accelerating the learning curve for surgeons' post-residency.

Effects of adding video feedback to emotionally focused therapy supervision: A concurrent multiple-baseline across subjects design

Emotionally focused therapy (EFT) is an empirically supported intervention for relationship distress with an established model of supervision. This study examined whether incorporating video feedback (VF) software into EFT supervision would improve therapists' level of development compared to traditional EFT supervision in a university training clinic. A concurrent multiple-baseline across subjects design, along with a thematic analysis of qualitative data, were used in this proof-of-concept study of the new supervision component. Overall, quantitative findings suggested that using VF in EFT supervision resulted in some improvement to therapists' development, while qualitative findings showed that all participants supported the incorporation of VF into EFT supervision. Future research on VF is needed to provide additional insight into the use of video review supervision.

Coaching for Surgeons: A Scoping Review of the Quantitative Evidence

To characterize quantitative studies on coaching interventions for professional surgeons to understand how surgical coaching is defined; examine how different coaching programs are designed, implemented, and evaluated; and identify any relevant research gaps.

Background

Surgical coaching is gaining attention as an approach that could help surgeons optimize performance and improve overall wellbeing. However, surgical coaching programs and definitions of coaching vary widely between studies.

Methods

A systematic literature search of PubMed, Scopus, Web of Science, CENTRAL, clinicaltrials.gov, and WHO ICTRP was conducted according to the PRISMA-ScR framework to identify studies and registered clinical trials written in English. Original quantitative studies on coaching interventions for professional surgeons were included. Characteristics of the coachees, coaching programs, study designs, outcomes, and findings were charted and analyzed.

Results

From 2589 references, 8 studies (6 published; 2 registered trials) met inclusion criteria. Published studies targeted technical or nontechnical skills, included 2-26 surgeons as coachees, and used coaches who were surgeons. Two studies demonstrated that surgeons react positively to coaching. Studies showed inconsistent effects on technical/nontechnical skills. Only two studies measured patient adverse events and reported no significant positive impacts. The registered randomized trials targeted surgeons' physiological parameters or wellbeing and used professional coaches. These trials measure surgeon and patient outcomes.

Conclusions

There is an emerging interest in coaching programs to improve surgeons' performance by targeting their professional skills and personal factors. However, more randomized trials are needed to evaluate the impact of coaching interventions on patient outcomes and surgeon wellness.

The Role of Online Videos in Teaching Procedural Skills in Postgraduate Medical Education: A Scoping Review

OBJECTIVE

The purpose of this scoping review was to outline the extent of available literature including the prevalence of video quality appraisal tools, characterize how online videos were used, and identify the gaps in the literature with implications for future research.

DESIGN

The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews (PRISMA-ScR). Six databases were searched: (1) MEDLINE (Ovid), (2) EMBASE, (3) Cochrane, (4) ERIC, (5) CINAHL PLUS, and (6) Google Scholar for Medical Subject Headings terms online videos, postgraduate health education, and health professional/s.

RESULTS

A total of 6948 articles were identified, of which 78 were included in the review. The articles included were primarily either experimental or observational studies, with most being from North America. Twelve concepts were identified: (1) procedural skills teaching; (2) video assessment; (3) validation of an assessment tool; (4) video feedback; (5) coaching; (6) broadcasting; (7) learner characteristics; (8) video characteristics; (9) video quality; (10) a quality assessment tool; (11) platforms and video library; and (12) health information governance.

CONCLUSIONS

While there is a diverse and growing body of literature on this area, information is lacking about the quality appraisal of online videos.

Telemedicine for Gender-Affirming Medical and Surgical Care: A Systematic Review and Call-to-Action

Telemedicine has facilitated the delivery of affordable and accessible health care. However, little has been discussed about its use in gender-affirming care (GAC). Telemedicine has the potential to overcome many barriers encountered by transgender individuals such as limited geographic access to care and financial constraints, which have both been exacerbated by the COVID-19 pandemic. Telemedicine may also enhance opportunities for training in gender-affirming surgery. A systematic review of the literature on telehealth and GAC was performed. Identified uses of telehealth included: an electronic teleconsultation service, a virtual peer health consultation service, and an open online course on LGBT+ rights and health care for health care providers and laypeople. As the medical and health care communities adjust to the new reality of health care, efforts should be made to effectively incorporate telemedicine into GAC.

Utility of the Simulated Outcomes Following Carotid Artery Laceration Video Data Set for Machine Learning Applications

IMPORTANCE

Surgical data scientists lack video data sets that depict adverse events, which may affect model generalizability and introduce bias. Hemorrhage may be particularly challenging for computer vision-based models because blood obscures the scene.

OBJECTIVE

To assess the utility of the Simulated Outcomes Following Carotid Artery Laceration (SOCAL)-a publicly available surgical video data set of hemorrhage complication management with instrument annotations and task outcomes-to provide benchmarks for surgical data science techniques, including computer vision instrument detection, instrument use metrics and outcome associations, and validation of a SOCAL-trained neural network using real operative video.

DESIGN, SETTING, AND PARTICIPANTS

For this quailty improvement study, a total of 75 surgeons with 1 to 30 years' experience (mean, 7 years) were filmed from January 1, 2017, to December 31, 2020, managing catastrophic surgical hemorrhage in a high-fidelity cadaveric training exercise at nationwide training courses. Videos were annotated from January 1 to June 30, 2021.

INTERVENTIONS

Surgeons received expert coaching between 2 trials.

MAIN OUTCOMES AND MEASURES

Hemostasis within 5 minutes (task success, dichotomous), time to hemostasis (in seconds), and blood loss (in milliliters) were recorded. Deep neural networks (DNNs) were trained to detect surgical instruments in view. Model performance was measured using mean average precision (mAP), sensitivity, and positive predictive value.

RESULTS

SOCAL contains 31 443 frames with 65 071 surgical instrument annotations from 147 trials with associated surgeon demographic characteristics, time to hemostasis, and recorded blood loss for each trial. Computer vision-based instrument detection methods using DNNs trained on SOCAL achieved a mAP of 0.67 overall and 0.91 for the most common surgical instrument (suction). Hemorrhage control challenges standard object detectors: detection of some surgical instruments remained poor (mAP, 0.25). On real intraoperative video, the model achieved a sensitivity of 0.77 and a positive predictive value of 0.96. Instrument use metrics derived from the SOCAL video were significantly associated with performance (blood loss).

CONCLUSIONS AND RELEVANCE

Hemorrhage control is a high-stakes adverse event that poses unique challenges for video analysis, but no data sets of hemorrhage control exist. The use of SOCAL, the first data set to depict hemorrhage control, allows the benchmarking of data science applications, including object detection, performance metric development, and identification of metrics associated with outcomes. In the future, SOCAL may be used to build and validate surgical data science models.

Surgical coaching in obstetrics and gynecology: an evidence-based strategy to elevate surgical education and promote lifelong learning

The American Board of Medical Specialties, of which the American Board of Obstetrics and Gynecology is a member, released recommendations in 2019 reimagining specialty certification and highlighting the importance of individualized feedback and data-driven advances in clinical practice throughout the physicians' careers. In this article, we presented surgical coaching as an evidence-based strategy for achieving lifelong learning and practice improvement that can help to fulfill the vision of the American Board of Medical Specialties. Surgical coaching involves the development of a partnership between 2 surgeons in which 1 surgeon (the coach) guides the other (the participant) in identifying goals, providing feedback, and facilitating action planning. Previous literature has demonstrated that surgical coaching is viewed as valuable by both coaches and participants. In particular, video-based coaching involves reviewing recorded surgical cases and can be integrated into the physicians' busy schedules as a means of acquiring and advancing both technical and nontechnical skills. Establishing surgical coaching as an option for continuous learning and improvement in practice has the potential to elevate surgical performance and patient care.

Coaching interventions among healthcare students in tertiary education to improve mental well-being: A mixed studies review

OBJECTIVES

To consolidate the available evidence regarding healthcare students' experiences of coaching interventions' effect on their mental well-being in tertiary educational institutions.

DESIGN

A mixed studies review.

DATA SOURCES

Seven electronic databases were searched for relevant studies from their inception dates until July 2021: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest Dissertations and Theses Global.

REVIEW METHODS

This review observed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and was guided by Pluye and Hong's (2014) framework for mixed studies review. Quality appraisal of included studies was conducted using the Mixed Methods Appraisal Tool. A convergent qualitative synthesis design for mixed studies reviews was adopted to analyze all findings and thematic analysis was conducted according to Braun and Clarke's (2006) framework.

RESULTS

Three themes and seven subthemes are generated from the 12 included studies. The main themes are: 1) Receiving much-needed help, 2) Unlocking the secrets of success, and 3) Way forward for coaching in healthcare education.

CONCLUSIONS

Many students benefited from the coaching interventions in terms of academic, emotional and psychological support and received guidance in professional development. However, careful preparation of both coaches and students is needed to improve the success of coaching interventions. Future coaching interventions could incorporate both group and individual sessions, assign students to coaches based on their clinical interests and consider conducting online coaching sessions using video calls. Improvement of study rigor would be required to achieve more accurate results. Lastly, future studies should be conducted on healthcare students of more diverse disciplines and cultures to increase results' generalizability.

Feasibility and acceptability of virtually coaching residents on communication skills: a pilot study

BACKGROUND

Developing communication skills is a key competency for residents. Coaching, broadly accepted as a training modality in medical education, has been proven a successful tool for teaching communication skills. Little research is available thus far to investigate virtual coaching on communication skills for telemedicine encounters. The purpose of the study was to test the hypothesis that virtually coaching residents on communication skills is feasible and acceptable. We surveyed 21 resident-faculty pairs participating in a "fully virtual" coaching session (patient, coach, and resident were virtual).

METHODS

We asked 50 neurology resident-faculty coach pairs to complete one "fully virtual" coaching session between May 20 and August 31, 2020. After each session, the resident and coach completed a 15-item survey, including Likert-style scale and open-ended questions, assessing feasibility and acceptability. Descriptive statistics and qualitative content and thematic analyses were performed.

RESULTS

Forty-two percent (21/50) of all eligible residents completed "fully virtual" coaching sessions. The overall survey response rate was 91 % (38/42). The majority of respondents agreed that the direct observation and debriefing conversation were easy to schedule and occurred without technical difficulties and that debriefing elements (self-reflection, feedback, takeaways) were useful for residents. Ninety-five percent of respondents rated the coach's virtual presence to be not at all disruptive to the resident-patient interaction. Virtual coaching alleviated resident stress associated with observation and was perceived as an opportunity for immediate feedback and a unique approach for resident education that will persist into the future.

CONCLUSIONS

In this pilot study, residents and faculty coaches found virtual coaching on communication skills feasible and acceptable for telemedicine encounters. Many elements of our intervention may be adoptable by other residency programs. For example, residents may share their communication goals with clinic faculty supervisors and then invite them to directly observe virtual encounters what could facilitate targeted feedback related to the resident's goals. Moreover, virtual coaching on communication skills in both the in-person and telemedicine settings may particularly benefit residents in challenging encounters such as those with cognitively impaired patients or with surrogate decision-makers.

Video-Based Coaching: Current Status and Role in Surgical Practice (Part 1) From the Society for Surgery of the Alimentary Tract, Health Care Quality and Outcomes Committee

Patient safety and outcomes are directly related to surgical performance. Surgical training emphasizes the importance of the surgeon in determining these outcomes. After training is complete, there is a lack of structured programs for surgeons to audit their skills and continue their individual development. There is a significant linear relationship between surgeon technical skill and surgical outcomes; however, measuring technical performance is difficult. Video-based coaching matches an individual surgeon in practice with a surgical colleague who has been trained in the core principles of coaching for individualizing instruction. It can provide objective assessment for teaching higher-level concepts, such as technical skills, cognitive skills, and decision-making. There are many benefits to video-based coaching. While the concept is gaining acceptance as a method of surgical education, it is still novel in clinical practice. As more surgeons look towards video-based coaching for quality improvement, a consistent definition of the program, goals, and metrics for assessment will be critical. This paper is a review on the status of the video-based coaching as it applies to practicing surgeons.

Challenges to the orthopedic resident workforce during the first wave of COVID-19 pandemic: Lessons learnt from a global cross-sectional survey

BACKGROUND

The COVID-19 pandemic has caused unprecedented concerns on the safety, well-being, quality of life(QOL), and training of the orthopedic resident physician workforce worldwide. Although orthopedic residency programs across the globe have attempted to redefine resident roles, educational priorities, and teaching methods, the global orthopedic residents' perspective with regards to their safety, well-being, QOL, and training, taking into account regional variances remains unknown.

METHODS

A 56-item-questionnaire-based cross-sectional survey was conducted online during the COVID-19 pandemic involving 1193 orthopedic residents from 29 countries across six geographical regions to investigate the impact of the COVID-19 pandemic on the well-being, safety, and training of orthopedic residents at a global level, as well as to analyze the challenges confronted by orthopedic residency programs around the world to safeguard and train their resident workforce during this period.

RESULTS

The total response rate was 90.3%(1077/1193). Time spent on residency-training activities decreased by 24.7 h/week (95% CI, -26.5 to -22.9,p < 0.001), with 50.2% (n = 541) residents performing duties outside their residency curriculum. 80.5% (n = 869) residents had no prior experience working in infectious outbreaks. A greater percentage of residents from Middle East, Asia and Europe were redeployed to the COVID-19 frontlines, p < 0.001. Only 46.5% (n = 491) and 58.4% (n = 600) of residents underwent training in critical care or PPE (Personal Protective equipment) usage, respectively; 28.5% (n = 302) residents (majority from Africa, Middle East, South America) reported lack of institutional guidelines to handle infectious outbreaks; 15.4% (n = 160) residents (majority from Africa, Asia, Europe) had concerns regarding availability of PPE and risk of infection. An increase in technology-based virtual teaching modalities was observed. The most significant stressor for residents was the concern for their family's health. Residents' QOL significantly decreased from 80/100 (IQR 70-90) to 65/100 (IQR 50-80) before and during the pandemic, p < 0.001.

CONCLUSIONS

The COVID-19 pandemic has significantly impacted the safety, well-being, QOL, and training of the global orthopedic resident physician workforce to different extents across geographical regions. The findings of this study will aid educators, program leaderships, and policy makers globally in formulating flexible, generalizable, and sustainable strategies to ensure resident safety, well-being, and training, while maintaining patient care.

Surgical coaching applied to laparoscopic TME for continuous professional development in rectal surgery: proof of concept

BACKGROUND

Coaching is maturing as a strategy for surgeons' continuous professional development in different types of surgery. Laparoscopic total mesorectal excision (LAP TME) is one of the recognized difficult procedures in colorectal surgery. Aim of this trial is to introduce the surgical coaching as a tool for a continuous technical education of LAP TME for cancer in a consultant surgeon carrier.

METHODS

Twelve Italian colorectal surgeons were enrolled as trainees in the AIMS Academy rectal cancer surgical coaching project and attended a face-to-face 90-min surgical coaching on a pre-edited 45-min-long video of a laparoscopic proctectomy according to pre-determined guidelines. At the end of the coaching, all mentors were asked to fill a questionnaire evaluating the trainee's skills. All trainees had to fill a post-coaching questionnaire addressing the appropriateness of the coaching with respect to their actual level.

RESULTS

Trainees were more confident in performing the extra-pelvic part of the surgical procedures compared to the intra-pelvic dissection. The most challenging steps according to the trainees were the seminal vesicles identification and the pelvic floor dissection. Mentors found the trainees quite confident in the approach to the vascular structures, lymphadenectomy, stapler utilization and bleeding control. The sharpness and the efficacy of the dissection, the dissection of the surgical planes and the anastomosis fashioning were reported at a lower level of confidence. The higher grade of satisfaction reported by the trainee came from the attention that the mentors demonstrated towards them, from the availability of the mentors to take into consideration the surgical issues raised and from the willingness to apply the suggestions received during their next proctectomies.

CONCLUSIONS

The surgical coaching applied to LAP TME should be considered as an innovative tool for continuous professional development.

Power of the collective: A review of multimodal internet-based surgical education resources in the 21st century

Electronic resources have changed surgical education in the 21st century. Resources spanning from digital textbooks to multiple choice question banks, online society meetings, and social media can facilitate surgical education. The COVID pandemic drastically changed the paradigm for education. The ramifications of Zoom lectures and online surgical society meetings will last into the future. Educators and learners can be empowered by the many available electronic resources to enhance surgical training and education.

Educational value of surgical telementoring

Educating surgeons is a time‐consuming process. In addition to theoretical knowledge, the practical tasks of surgical procedures must be mastered. Translation of such knowledge from mentor to mentee may be efficiently done by surgical telementoring (ST). This is a review on surgical telementoring. Recent technological advances have made this tool in surgical education more available and applicable but future applications of ST have to be wisely guided by high‐quality trials.