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PEER TO PEER LEARNING AND SHARING
Record your operative technique to share with others. In a world of increasing online educational content, become a better surgical educator by having high-quality video of your innovative procedures to educate peers and learners. When trying to explain complex surgical procedures words are just not enough! Videos of your surgical technique will complement verbal and written instructions to keep audiences engaged and better convey the techniques being taught.
Ahmet A, et al. Synchronized Video-Review as a Tool to Enhance Reflection and Feedback: A De-sign-Based Feasibility Study. J Surg Ed 2018. 75:1150-1158
A systematic review which concluded that video-based education is effective according to the recent literature. Video should be used in addition to standard techniques in surgical education.
Mota P, et al. Video-Based Surgical Learning: Improving Trainee Education and Preparation for Surgery. J Surg Ed 2017. 75:828-835
Questionnaire study showing that video-based learning is currently a hallmark of surgical preparation among residents and specialists.
AK Rapp, MG Healy, ME Charlton, JN Keith, ME Rosenbaum, MR Kapadia. YouTube is the most frequently used educational video source for surgical preparation. J Surg Educ 2016. 73:1072-1076
A survey study showing that most respondents reported using videos to prepare for surgery. YouTube was the preferred source. Posting surgical videos to YouTube may allow for maximal access to learners who are preparing for surgical cases
Chauvet P, et al. What Is a Good Teaching Video? Results of an Online International Survey. Journal of Minimally Invasive Gynecology (2020) 27, 738−747.
82 % of respondents indicated that the benefits of teaching videos are “extremely important" or “very important”.
Green JL, et al. The Utilization of Video Technology in Surgical Education: A Systematic Review.
J Surg Res 2019, 235, pp. 171-180.
A systematic review of the literature, with recommendations that surgical training programs incor-porate schematics and imaging into video, supplement video with other education tools, and utilise audio in video. For video review, it recommends that residents review video preoperatively and postoperatively for learning and that surgeons review video postoperatively for assessment.
Cathcart P, et al. Achieving Quality Assurance of Prostate Cancer Surgery During Reorganisation of Cancer Services, European Urology, 2015, Volume 68, Issue 1,Pages 22-29, https://doi.org/10.1016/j.eururo.2015.02.028.
The implementation of a quality improvement programme in a urological service which incorporated monthly peer review of individual surgeon outcomes including the assessment of edited surgical video clips improved quality of care in terms of consistency of patient selection and outcomes of surgery
ACCELERATE SURGICAL LEARNING
Routine recording of your surgical procedures will enable review of your procedures both by yourself, and by your mentors and peers. This will allow you to accelerate and refine your surgical technique. Away from the theatre environment with its many distractions and cognitive demands, the ability to review video footage of your surgery in your own time will lead to recognition of technical errors, inefficiencies and insights that will ultimately lead to improved surgical performance. Video can also be shared with mentors, both local and remote, to obtain feedback.
Singh P, et al. A randomized controlled study to evaluate the role of video-based coaching in train-ing laparoscopic skills. Ann Surg. 2015 May;261(5):862-9. doi: 10.1097/SLA.0000000000000857
A randomised study of video-based coaching. Coached novice surgeons showed enhanced quality of laparoscopic surgical performance. They concluded that video-based coaching is a feasible method of maximizing performance enhancement from every clinical exposure.
Hu YY, et al. Complementing Operating Room Teaching With Video-Based Coaching. JAMA Surg. 2017 Apr 1;152(4):318-325. doi: 10.1001/jamasurg.2016.4619.
Video-based coaching is a novel and feasible modality for supplementing intra-operative learning. Objective evaluation demonstrates that video-based coaching may be particularly useful for teach-ing higher-level concepts, such as decision making, and for individualising instruction and feed-back to each resident
Isreb S, et al. Synchronized Video-Review as a Tool to Enhance Reflection and Feedback: A Design-Based Feasibility Study. Journal of Surgical Education 2021. Volume 78, Issue 1, p18. https://doi.org/10.1016/j.jsurg. 2020.07.014.
This study established the feasibility of using synchronized video-review as a reflection-on-action tool to enhance surgical training by improving feedback. It identified trainees ’difficulty in processing intra-operative feedback due to mental overload from the operation. It showed the limitations of current verbal feedback practice, using Procedure-Based Assessment forms, with regard to enhancing technical and nontechnical skills due to denial and memory fading.
Liao CH, et al. Video Coaching Improving Contemporary Technical and Nontechnical Ability in Laparoscopic Education. J Surg Ed 2019. 77: p652-660
This study randomised video-coaching (VC) versus conventional teaching methods to teach residents to perform laparoscopic procedures. It found that VC can help surgeons build their expertise using a more accessible method. Additionally, VC can shorten the learning curve and improve self-efficacy, thereby contributing to surgeons ’education.
Crawshaw BP, et al. Failing to Prepare Is Preparing to Fail: A Single-Blinded, Randomized Controlled Trial to Determine the Impact of a Preoperative Instructional Video on the Ability of Residents to Perform Laparoscopic Right Colectomy. Diseases of the Colon and Rectum, 2016. 59, Is-sue 1, Pages 28 - 341.
Randomised study showing that the simple addition of a brief, narrated pre-procedural video to general surgery resident case preparation significantly increased trainee ability to successfully per-form a laparoscopic right colectomy.
Green JL, et al. The Utilization of Video Technology in Surgical Education: A Systematic Review.
J Surg Res 2019, 235, pp. 171-180
A systematic review of the literature recommending that surgical training programs incorporate schematics and imaging into video, supplement video with other education tools, and utilise audio in video. For video review, it is recommend that residents review video preoperatively and postoperatively for learning and that consultant surgeons review video postoperatively for assessment.
Hamad GG, et al. Postoperative video debriefing reduces technical errors in laparoscopic surgery. Am J Surg 2007, 194(1), P110-114.
Postoperative video debriefing is an effective educational tool for reducing adverse events during a complex laparoscopic procedure.
OBJECTICE ASSESSMENT OF SURGICAL COMPETENCY
In an era of competency-based training, video footage of your surgical procedures will serve as evidence of competency. Direct observation of procedural skills or DOPS has become a standard tool in surgical education. However, it is not always practical or convenient to have a trainer available to observe your performance of surgical procedures. Video recording will allow assessment of surgical performance to be more widely used. It will also add objectivity to such assessments by allowing a wider range of trainers, including those located remote from your hospital, to make such assessments.
Birkmeyer, J. D. et al. Surgical skill and complication rates after bariatric surgery. N Engl J Med. 2013. 369, 1434–1442.
A landmark study. Peer review of video footage of twenty surgeons performing laparoscopic bariatric surgery showed that the technical skill of practicing bariatric surgeons varied widely, and greater skill was associated with fewer postoperative complications and lower rates of reoperation.
Naik ND, et al. Personalized video feedback improves suturing skills of incoming general surgery trainees. Surgery, 163 (2018), p921-926.
A study showing that narrated feedback of videos of surgical tasks performed by residents resulted in improved surgical performance by objective assessment.
Matsuda T, et al. The endoscopic surgical skill qualification system in urological laparoscopy: a novel system in Japan. J Urol. 2006 Nov;176(5):2168-72; discussion 2172. doi:
The Japanese Urological Association has established a skill certification system based on review of unedited video footage of laparoscopic urological procedures.
Mori T, et al. Skill accreditation system for laparoscopic gastroenterologic surgeons in Japan. Minim Invasive Ther Allied Technol. 2010;19(1):18-23. doi: 10.3109/13645700903492969
The Japan Society for Endoscopic Surgery has established an Endoscopic Surgical Skill Qualification System whereby non-edited videotapes were assessed by two judges in a double-blinded fash-ion with strict criteria. Surgeons assessed by this system as qualified experienced less frequent com-plications when compared to those who failed.
Vaughn CJ, et al. Peer video review and feedback improve performance in basic surgical skills. Am J Surg. 2016 Feb;211(2):355-60. doi: 10.1016/j.amjsurg.2015.08.034.
This study showed that video review and feedback provided by peers led to improved performance in basic surgical skills.
Vaughn CJ, et al. Peer video review and feedback improve performance in basic surgical skills. Am J Surg. 2016 Feb;211(2):355-60. doi: 10.1016/j.amjsurg.2015.08.034.
This study showed that video review and feedback provided by peers led to improved performance in basic surgical skills.
RECORD-KEEPING
The routine recording and archiving of your surgical procedures will be useful as an aid to surgeon recall and operation reports when future man-agement decisions need to be made around the care of your patients. When contemplating redo or complex further surgery, we have found the viewing of the index surgical procedure to be invaluable. In addition, video footage of surgery can serve as part of a defence against potential claims of surgical malpractice in the event of surgical complications or post-procedural unsatisfactory outcomes.
van Dalen ASHM, et al. Legal perspectives on black box recording devices in the operating envi-ronment. Br J Surg. 2019. 106(11):1433-1441. doi: 10.1002/bjs.11198.
Desai N, et al. Developing a database of high definition endoscopic videos and images in your institution. Endoscopy 2013; 45: 370 – 376.
Koninckx PR, et al. The digital operating room and the surgeon. Gynecol Surg 2013; 10: 57–62.