Video Coaching in Surgical Education: Utility, Opportunities, and Barriers to Implementation

How We Do It: Video-Based Assessment Conference for Intraoperative Decision Making in Pediatric Surgery

OBJECTIVE

To demonstrate our experience with establishing a video-based assessment conference (VBA) for rare and complex procedures in a pediatric surgery fellowship program.

DESIGN

We share our experience in establishing a VBA conference in our Division of Pediatric Surgery from case selection, methods of operative video recording, equipment, and editing, and the structure of how cases are presented in conference.

SETTING

Pediatric Surgery Fellowship at the Johns Hopkins Children's Center in Baltimore, MD.

PARTICIPANTS

Pediatric surgery faculty, pediatric surgery fellows, general surgery residents, medical students, and nurse practitioners at Johns Hopkins participated in the conferences. Medical students and faculty were responsible for video recording and editing.

CONCLUSIONS

Allowing VBA of operative cases can improve comprehensive learning in technically challenging and rare cases seen in pediatric surgery. Our paper shares one methodology of establishing a successful VBA conference.

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.

Video Killed the Radio Star-A Meta-Analysis on Video-Based Coaching to Improve Surgical Skill

BACKGROUND

The surgical trainee of today completes their postgraduate training with significantly less exposure than their mentors. The enforced reduced working hours, along with other factors, have created a gap in surgical training. Video-based coaching (VBC) provides an opportunity to improve the surgical technical skill without needing to increase surgical volume. The aim on this study is to investigate the effect of VBC on the surgical technical skill.

METHODS

A systematic review of randomized controlled trials was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Bias was assessed for using The Cochrane Collaboration's tool for assessing risk of bias. The study was prospectively registered in the Open Science Framework (https://osf.io/sp8rb). Multiple subgroup analyses and meta-analyses were carried out, with results reported as standardized mean differences (SMDs) in performance scores and presented as forest plots.

RESULTS

A total of 15 studies comprising 382 participants were included in the final analysis. From these 15 studies, 201 participants received VBC following a range of surgical procedures. On meta-analyses, the average performance scores for VBC were significantly higher than the controls (SMD 0.71, 95% CI 0.37, 1.04, Z = 4.15, and p < 0.0001) as were the average change scores from baseline to final performance (SMD 0.98 [95% CI 0.61, 1.35, Z = 5.19, and p < 0.0001]). Furthermore, the overwhelming majority of VBC participants across the studies found VBC to a be useful training tool.

CONCLUSIONS

This review represents the most comprehensive assessment of the impact of VBC in surgery and demonstrates it to be an effective training tool in improving surgical technical skill acquisition. Training bodies around the world should now look at how best to formally integrate VBC into conventional surgical training.

Video recording in GI endoscopy

The current approach to procedure reporting in endoscopy aims to capture essential findings and interventions but inherently sacrifices the rich detail and nuance of the entire endoscopic experience. Endoscopic video recording (EVR) provides a complete archive of the procedure, extending the utility of the encounter beyond diagnosis and intervention, and potentially adding significant value to the care of the patient and the field in general. This white paper outlines the potential of EVR in clinical care, quality improvement, education, and artificial intelligence-driven innovation, and addresses critical considerations surrounding technology, regulation, ethics, and privacy. As with other medical imaging modalities, growing adoption of EVR is inevitable, and proactive engagement of professional societies and practitioners is essential to harness the full potential of this technology toward improving clinical care, education, and research.

Enhancing Pedicle Screw Fixation Training: A Novel Approach Using Head-mounted Devices for Video-assisted Debriefing

BACKGROUND

Video-assisted debriefing (VAD) is promising for medical skill training, but its effectiveness requires further exploration. The aim of this study was to investigate the effectiveness of point-of-view VAD in spinal surgery training.

METHODS

Forty surgical residents were randomly divided into control and video-assisted (VA) groups, both of which underwent pedicle screw fixation procedures while being graded by a consulting surgeon in terms of their technical skills (primary outcome). On the second day, both groups received verbal debriefing and coaching from a senior consultant surgeon; for the VA group, this step was performed while watching a recorded point-of-view video of the procedure alongside the resident surgeon. Both groups then underwent a new testing round and participated in a questionnaire survey regarding their debriefing experience.

RESULTS

After the debriefing session, the residents in the VA group had significantly greater technical skills than those in the control group (37 ± 9.7 vs. 25 ± 8.5, P < 0.001). The VAD method was better than the traditional method in terms of steps such as recognizing anatomical structures, piloting holes in the bone, tapping, screw insertion and judging the location of the pedicle screws.

CONCLUSIONS

VAD is more effective than traditional verbal debriefing for improving residents' surgical skills, particularly for obtaining a more comprehensive understanding of anatomical structures, imitating detailed surgical techniques as well as promoting initiative. However, in terms of mastery of surgical skills, VAD is not significantly beneficial for tactile perception of the surrounding tissue, indicating that a certain amount of practice is still necessary.

Adapting Surgical Coaching: Feasibility and Perceptions of Intraoperative Resident Peer Coaching

INTRODUCTION

Surgical coaching is utilized to enhance technical, nontechnical, and teaching skills. This study aims to evaluate the feasibility and benefit of a resident peer coaching program.

METHODS

Chief residents (postgraduate year 5) acted as coaches for junior residents (postgraduate year 1-3, "coachees"). All participants completed the Harvard Surgical Coaching for Operative Performance Enhancement curriculum. The coaching structure included 1) preoperative goal setting, 2) unscrubbed intraoperative observation, and 3) postoperative debrief. Upon completion, residents were surveyed to assess their experience. Descriptive and thematic analyses were performed.

RESULTS

There were 22 participants (6 coaches, 16 coachees). Five (83.3%) coaches and 14 (87.5%) coachees reported the program was useful, citing dedicated reflection outside the operating room, in-depth feedback, and structured self-assessment with increased accountability. Thirteen (81.3%) coachees reported perceived improvement in technical skills and 12 (75%) within nontechnical skills. All coaches felt they benefited and improved their ability to provide feedback. When asked how coaching compared to usual methods of operative feedback, 14 (87.5%) coachees and 5 (83.3%) coaches reported it was better, with only 1 coachee reporting it was worse. Benefits over typical operating room teaching included more feedback provided, more specific feedback, and the benefit of peer relationships. Twelve (54.5%) residents cited difficulty with coordinating sessions, but 21 (95.5%) reported that they would participate again.

CONCLUSIONS

Implementation of a resident peer surgical coaching program is feasible. Both coaches and coachees perceive significant benefit with improvement in technical, nontechnical, and feedback delivery skills. Given preference over other methods of operative feedback, expansion of peer coaching programs is warranted.

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.

Application of Anchored Instructional Method in Cardiac Surgery ICU Nursing Education

BACKGROUND

This study investigated the impact of applying the anchored teaching mode with nursing interns on the cardiac surgery intensive care unit (CSICU).

METHOD

A total of 110 interns were divided into a control group (taught through traditional methods) and an experimental group (taught using the anchored teaching mode). The anchored mode, emphasizing student-centered learning, included creating scenarios, identifying problems, using self-directed and collaborative learning, and evaluating outcomes.

RESULTS

Our study found that the experimental group showed significantly higher scores in emergency response ability, nursing skills, and teaching effectiveness compared with the control group at graduation.

CONCLUSION

The findings suggest that implementing the anchored teaching mode can effectively enhance the education of nursing interns on the CSICU, emphasizing the need for further research across different departments and types of hospitals. [J Contin Educ Nurs. 2024;55(7):359-364.].

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.

One-shot skill assessment in high-stakes domains with limited data via meta learning

Deep Learning (DL) has achieved robust competency assessment in various high-stakes fields. However, the applicability of DL models is often hampered by their substantial data requirements and confinement to specific training domains. This prevents them from transitioning to new tasks where data is scarce. Therefore, domain adaptation emerges as a critical element for the practical implementation of DL in real-world scenarios. Herein, we introduce A-VBANet, a novel meta-learning model capable of delivering domain-agnostic skill assessment via one-shot learning. Our methodology has been tested by assessing surgical skills on five laparoscopic and robotic simulators and real-life laparoscopic cholecystectomy. Our model successfully adapted with accuracies up to 99.5 % in one-shot and 99.9 % in few-shot settings for simulated tasks and 89.7 % for laparoscopic cholecystectomy. This study marks the first instance of a domain-agnostic methodology for skill assessment in critical fields setting a precedent for the broad application of DL across diverse real-life domains with limited data.

Video-Based Education Improves Sampling (Grossing) Confidence in Pathology Trainees

CONTEXT.—

Pathology resident education has a steep learning curve. Specimen sampling (grossing) is a procedural task, and procedural fields add video materials to their curricula to familiarize trainees with procedure(s), reduce errors, and improve patient care. Our team applied this strategy to develop original in-house sampling videos for our program.

OBJECTIVES.—

To evaluate the effect of in-house sampling videos on resident sampling confidence.

DESIGN.—

Sampling videos covering all major organ systems (AMOS) were created for our postgraduate year 1 (PGY1) trainees. Videos were hosted on a Northwestern cloud server for on-demand access. Trainees completed 3 surveys (0, 6, 12 months) evaluating sampling confidence comparing those who used in-house videos as an educational supplement with those who did not use the videos.

RESULTS.—

Sampling confidence significantly improved at 6 and 12 months (P < .001) across AMOS and PGY levels. When compared with those who did not use in-house sampling videos, trainees who supplemented their education with in-house sampling videos had significantly higher confidence ratings across AMOS and PGY levels at the start of the study (P < .001) and at 6 months (P = .004). Sampling confidence significantly improved for PGY1 trainees at 6 and 12 months (P < .001); for PGY2 and PGY3 trainees, confidence significantly improved at 6 months (P < .001). When evaluated by organ-specific analyses, sampling and teaching confidence improved across all organ systems and, except for the gastrointestinal system, reached significance at 12 months for all PGY levels.

CONCLUSIONS.—

Sampling videos, when used as a supplement to the existing curriculum, significantly improved trainee confidence.

Analysis of the Quality of Parotidectomy Videos on YouTube Using the IVORY-Grading-System

OBJECTIVE

The aim of this study was to evaluate the quality and the educational content of YouTube videos showing parotidectomy.

METHODS

We searched for videos displaying parotidectomy on YouTube. To rate parotidectomy videos, we introduced the "Instructional Videos in Otorhinolaryngology by YO-IFOS (IVORY)-grading-system (GS)" derived from the IVORY Guidelines, which pose established consensus recommendations for the production of educational surgical videos in otolaryngology. The videos were rated using the IVORY-GS, and the total score was tested for statistical association with views, likes, likes/dislikes-ratio, age, and length of the videos for validation of the IVORY-GS.

RESULTS

Overall, 50 parotidectomy videos were identified. Sixty-eight (68%) of the videos showed a superficial parotidectomy. The mean IVORY-GS total score was 24.9 (out of a maximum of 44 points). Video education quality was rated as moderate in 22% and high in 4%. There was a statistically significant correlation between the total score and the number of views (p = 0.03), the total score and the number of likes (p < 0.01), and the total score and the likes/dislikes ratio (p < 0.01). A higher total score was a significant predictor of more likes (p = 0.01) and a higher likes/dislikes ratio (p < 0.01).

CONCLUSION

Our modification of the IVORY Guidelines is otolaryngology-specific, suitable, and recommended to evaluate parotidectomy videos. To date, most videos are of poor educational quality. Future efforts in otolaryngology surgical video education could focus on the establishment of an online video platform.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:2631-2637, 2023.

Validation of a multidisciplinary virtual reality (VR) robotic surgical curriculum

The objective is to identify whether trainees demonstrate improvement in a standardized knot-tying task as assessed by Global Evaluative Assessment of Robotic Skills (GEARS) score after completion of a virtual reality (VR) robotic curriculum. An IRB-exempt prospective study was conducted with surgical trainees from August 2021 to February 2023. Participants initially performed a baseline robotic suturing task in which they were instructed to tie interrupted square knots in 10 min. Participants then completed a virtual reality simulation curriculum involving 23 exercises until they achieved 90% proficiency on all tasks. Participants then repeated the suturing task. Pre- and post-curriculum suturing tasks were recorded, de-identified, and scored by expert graders using a GEARS score. Trainees from three academic centers were invited to participate. Medical students (MS1-MS3) and surgical residents from gynecology, urology, and general surgery were invited to participate. Twenty-five trainees completed the pre-curriculum suturing task, the VR curriculum, and the post-curriculum suturing task. Trainees demonstrated significant improvement in their post-test GEARS score by 2.43 points (p < 0.05) and were able to tie three additional knots within 10 min after completion of the curriculum (p < 0.05). Trainees also demonstrated a faster time to complete first knot (114 s improvement, p < 0.05) after completion of the curriculum. All participants agreed or strongly agreed that completion of the robotic curriculum helped them feel more comfortable using the robotic console, and improved their robotic surgical skills. Surgical trainees and medical students with limited prior robotic surgical experience demonstrated objective improvement after completion of a standardized VR curriculum.

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.

Intraoperative video recording in otolaryngology for surgical education: evolution and considerations

BACKGROUND

Otolaryngology is a surgical speciality well suited for the application of intraoperative video recording as an educational tool considering the number procedures within the speciality that utilize digital technology. Intraoperative recording has been utilized in endoscopic surgeries and in evaluating technique in mastoidectomy, myringotomy and grommet insertion. The impact of intra-operative video recording in otolaryngology education is vast in creating access to surgical videos for preparation outside the operating room to individualized coaching and assessment. The purpose of this project is to highlight the role of intraoperative video recording in otolaryngology training and elucidate the challenges and considerations associated with implementation.

METHODS

Related publications between 1999 to 2022 were reviewed from PubMed and Embase databases utilizing search terms "intraoperative videography," "video recording surgery," "otolaryngology," and "surgical education." 109 articles were screened independently by HB and SK, by title and abstract then full text review. 28 articles from the original search and 6 from the secondary reference review were included.

RESULTS

The application of intraoperative video recording is evident in otolaryngology surgeries including endoscopic sinus surgery, laryngeal surgery, and other endoscopic procedures. There have been significant advancements in recording tools, including devices that can capture the surgeon's perspective. The considerations and challenges identified with utilizing this educational tool were categorized into different themes including ethics/consent, regulation, liability, data, technology, and human resources.

CONCLUSION

Intra-operative video recording has been demonstrated to have significant impact within otolaryngology education. It is critical to elucidate the challenges and considerations involved to utilize this educational tool effectively. Future directives will see video-based performance analytics providing comparative metrics to encourage precise coaching of surgical residents.