Online videos of robotic-assisted cholecystectomies: more harm than good?

BACKGROUND: Many surgeons use online videos to learn. However, these videos vary in content, quality, and educational value. In the setting of recent work questioning the safety of robotic-assisted cholecystectomies, we aimed (1) to identify highly watched online videos of robotic-assisted cholecystectomies, (2) to determine whether these videos demonstrate suboptimal techniques, and (3) to compare videos based on platform. METHODS: Two authors searched YouTube and a members-only Facebook group to identify highly watched videos of robotic-assisted cholecystectomies. Three members of the Society of American Gastrointestinal and Endoscopic Surgeons Safe Cholecystectomy Task Force then reviewed videos in random order. These three members rated each video using Sanford and Strasberg's six-point criteria for critical view of safety (CVS) scoring and the Parkland grading scale for cholecystitis. We performed regression to determine any association between Parkland grade and CVS score. We also compared scores between the YouTube and Facebook videos using a t test. RESULTS: We identified 50 videos of robotic-assisted cholecystectomies, including 25 from YouTube and 25 from Facebook. Of the 50 videos, six demonstrated a top-down approach. The remaining 44 videos received a mean of 2.4 of 6 points for the CVS score (SD = 1.8). Overall, 4 of the 50 videos (8%) received a passing CVS score of 5 or 6. Videos received a mean of 2.4 of 5 points for the Parkland grade (SD = 0.9). Videos on YouTube had lower CVS scores than videos on Facebook (1.9 vs. 2.8, respectively), though this difference was not significant (p = 0.09). By regression, there was no association between Parkland grade and CVS score (p = 0.13). CONCLUSION: Publicly available and closed-group online videos of robotic-assisted cholecystectomy demonstrated inadequate dissection and may be of limited educational value. Future work should center on introducing measures to identify and feature videos with high-quality techniques most useful to surgeons.

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.

Are images worth a thousand words? A preliminary study testing a video for owner education in canine atopic dermatitis.

BACKGROUND: Successful management of canine atopic dermatitis (cAD) is challenging and effective pet owner education is crucial to successful outcomes. However, there are limited proven educational strategies in this area. Our goal was to create an effective and engaging educational tool for owners of dogs with cAD. HYPOTHESIS: Video-based education efficacy would be comparable to traditional verbal delivery. Secondary objectives included assessing client perception of the intervention, and determining if there were clinical benefits for the dogs and improved client adherence to treatment. SUBJECTS: Twenty-nine dogs with cAD and their owners were recruited from a teaching hospital of a European veterinary medicine faculty. MATERIALS AND METHODS: In this 8 week, prospective, randomised controlled study, clients in the control group (CG, n = 13) received verbal education and those in the intervention group (IG, n = 16) watched a video. Client knowledge was assessed at Day (D)0 and D56. Treatment adherence and perceived utility and appeal ratings were measured at D56. Clinical progress was assessed at D0 and D56 using CADESI-04 and PVAS10. RESULTS: The differences found in the means of cAD knowledge score, clinical outcomes, utility and appeal ratings and owners' adherence score between groups were not statistically significant. A significant association between the outcome and the intervention group concerning education success [CG, six of 13 (46.15%); IG, 15 of 16 (93.75%)] was found (p = 0.01). CONCLUSIONS AND CLINICAL RELEVANCE: Video-based instructions positively impacted owners' education and demonstrated their potential as a valuable tool. The authors believe that video-based education could be a time-efficient alternative for initial cAD education in veterinary clinics.

The Effect of Video-Based Education on Anxiety of Patients Receiving Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy.

Patients receiving stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) may have an anxiety due to unknown aspects of the treatment. We aimed to reduce patient anxiety by using video-based education. Forty patients were divided into 2 groups, with one-to-one information session (n = 20) and one-to-one information session plus video-based education (n = 20). The patients completed the State-Trait Anxiety Inventory (STAI) and visual facial anxiety scale before and after information sessions and after treatment. The setup time and disruptions during treatment sessions were recorded for patients receiving treatment with Novalis® and Cyberknife®, respectively. The patient characteristics and STAI scores before education were similar between groups. The anxiety level was significantly lower in group 1 after treatment (median 38, interquartile range (IQR) 27-45) compared to before (median 43, IQR 36-47) (p = 0.003) and after information sessions (median 42, IQR 36-47) (p = 0.004); however, any difference was not observed in anxiety levels between before and after information sessions (p = 0.317). The anxiety level was significantly lower in group 2 after video-based education (median 25, IQR 22-33) and after treatment (median 25, IQR 20-30) compared to before video-based education (median 35, IQR 31-42) (p < 0.001 for both), while there was no significant difference in anxiety levels between after video-based education and after the treatment (p = 0.407). The interruptions during treatment were observed in 9 (60%) patients in group 1 and 6 (40%) patients in group 2 (p = 0.038). Video-based educations significantly reduce patient anxiety before SRS/SBRT and increase their compliance with the treatment.

A Needs Assessment of Video-based Education Resources Among General Surgery Residents.

BACKGROUND: Video-based education (VBE) is an effective tool for knowledge and skill acquisition for medical students, but its utility is less clear for resident physicians. We sought to determine how to incorporate VBE into a general surgery resident operative curriculum. METHODS: We conducted a single-institution, survey-based needs assessment of general surgery residents to determine desired content and format of an operative VBE module. RESULTS: The response rate was 84% (53/63), with 66% senior (postgraduate year ≥3) resident respondents. VBE was the most commonly cited resource that residents used to prepare for an operation (93%) compared with surgical textbooks (89%) and text-based website content (57%). Junior residents were more likely to utilize text-based website content than senior residents (P < 0.01). The three most important operative video components were accuracy, length, and cost. Senior residents significantly preferred videos that were peer-reviewed (P < 0.05) and featured attending surgeons whom they knew (P = 0.03). A majority of residents (59%) believed 5-10 min is the ideal length of an operative video. Across all postgraduate year levels, residents indicated that detailed instruction of each operative step was the most important content of a VBE module. Senior residents believed that the overall indications and details of each step of the operation were the most important contents of VBE for a junior resident. CONCLUSIONS: At this institution, general surgery residents preferentially use VBE resources for operative preparation. A centralized, standardized operative resource would likely improve resident studying efficiency, but would require personalized learning options to work for both junior and senior surgery residents.

#SurgEdVidz: Using Social Media to Create a Supplemental Video-Based Surgery Didactic Curriculum.

BACKGROUND: A general surgery resident may have competing clinical responsibilities that limit the ability to participate in educational didactics. Social media is an alternative delivery method for educational content that can be viewed at a resident's convenience. We sought to assess the feasibility of using social media to provide educational content for surgical residents. MATERIALS AND METHODS: We created a novel, supplemental surgical curriculum consisting of two-minute videos based on the This Week in SCORE modules. Videos were posted to Twitter weekly, indexed with the #SurgEdVidz hashtag and uploaded to YouTube to create a catalog of videos. Twitter and YouTube analytics were used to calculate public viewership and impact. RESULTS: A total of 43 videos were disseminated between January 30, 2019 and January 31, 2020. An average of 6.9 h (SD: 1.4; range: 5.0-10.0) was required to generate each video, including 1.5 h (SD: 0.6; range: 0-2.0) for content review and 5.4 h (SD: 1.1; range: 4.0-8.0) for video production. Between the two platforms, videos generated a total of 51,313 views with an average of 1193 views (SD: 715; range: 412-4096) per video. Account followers are geographically distributed across 28 states, 28 countries, and six continents. CONCLUSIONS: Social media can serve as an effective tool for the distribution of surgical educational content. Twitter, in conjunction with YouTube, allows for rapid dissemination of didactic content packaged into brief videos that is flexible in viewership with low time commitment. Social media offers visibility and engagement beyond the classroom without geographical or temporal borders.

Video-triggered professional learning for general practice trainers: using the 'cauldron of practice' to explore teaching and learning.

Many clinicians who take on a formal role of supervising or teaching trainees need to be taught how to teach and then continuously improve as educators. We describe the research-informed design of a novel professional development intervention that may be perceived by clinical educators as challenging, but being based on the key features of effective professional development is likely to lead to changes in their teaching practices. The video-club brings together a small group of clinical educators who have a shared interest in exploring their educator role and their teaching practices. It supports their learning through collective inquiry, using video-recordings of their authentic teaching practices as stimuli for discussion. A pilot has produced findings that are promising in terms of outcomes and impact. Participants responded to the educational design in the way that was envisioned and engaged with the requisite risk-taking and vulnerability that was necessary for their own learning and promoting learning for others.

Evaluation of crowd-sourced assessment of the critical view of safety in laparoscopic cholecystectomy.

BACKGROUND: Faculty experts (FE) and crowd workers (CW) can assess technical skill, but assessment of operative technique has not been explored. We sought to evaluate if CW could be taught to assess completion of the critical view of safety (CVS) in laparoscopic cholecystectomy. METHODS: We prepared 160 blinded, surgical videos of laparoscopic cholecystectomy from public domain websites. Videos were edited to ≤60 s, ending when a structure was cut/clipped. CW analyzed videos using Global Objective Assessment of Laparoscopic Skills (GOALS) and CVS criteria assessment tools after watching an instructional tutorial. Ten videos were randomly selected from each performance quartile based on GOALS. Five FE rated the 40 videos using GOALS and CVS. Linear mixed effects models derived average CW and FE ratings for GOALS and CVS for each video. Spearman correlation coefficients (SCC) were used to assess the degree of correlation between performance measures. Satisfactory completion of the CVS was defined as scoring an average CVS ≥ 5. Videos with an average GOALS ≥ 15 were considered top technical performers. RESULTS: A high degree of correlation was seen between all performance measures: CVS ratings between CW and FE, SCC 0.89 (p < 0.001); GOALS and CVS ratings SCC 0.77 (p < 0.001) for CW, and SCC 0.71 (p < 0.001) for FE. Sixteen videos were assigned top technical performer ratings by both CW and FE but the average CVS was inadequate (3.8 and 3.6, respectively), and the percentage of satisfactory CVS ≥ 5 was 12.5%. CONCLUSIONS: A high degree of correlation was found between CW and FE in assessment of the CVS. However, in this video analysis, high technical performers did not achieve a complete CVS in most cases. Educating CW to assess operative technique for the identification of low or average performers is feasible and may broaden the application of this assessment and feedback tool.

A video-based educational pilot for basal cell carcinoma (BCC) treatment: A randomized controlled trial.

INTRODUCTION: Several treatment options exist for uncomplicated basal cell carcinoma. Standardized and effective informed consent is difficult in busy dermatology clinics. OBJECTIVE: We investigated whether an educational video depicting 3 treatment options for uncomplicated basal cell carcinoma-excision, electrodessication and curettage, and topical therapy-before standard in-office informed consent affected patient knowledge and consent time compared with standard in-office consent alone. METHODS: Patients were randomized to receive video education plus verbal discussion (video) or standard verbal discussion alone (control). Both groups completed baseline and final knowledge assessments. The primary outcome measure was change in knowledge scores between groups. Secondary outcomes were patient satisfaction, physician satisfaction, and informed consent time. RESULTS: In all, 32 eligible patients (16 control, 16 video) from an academic institution and affiliate Department of Veterans Affairs Medical Center dermatology clinics participated. The video group had significantly greater gains in knowledge compared with the control group (mean ± SD: 9 ± 3.6 vs 2.9 ± 2.2) (P = .0048). There was no significant difference in total consent time between groups. Patients and physicians were highly satisfied with the video. LIMITATIONS: Small sample size and slight methodological difference between recruitment sites are limitations. CONCLUSION: Video-based education for basal cell carcinoma improved patient knowledge with no additional physician time when compared with standard communication.

Fostering Authenticity in Surgical Education: Creating a Safe Space for Medical Students to Practice as Doctors.

Over the past 10 years we have witnessed major changes to the medical education landscape in response to advances in digital technologies. Couple this with the disruptions imposed by the COVID-19 pandemic and we have what could be described as a 'perfect storm.' Rather than hunker down and wait for it to pass, we took it as an opportunity to re-evaluate how we practice surgical education in the fourth year of our 6 year medical programme. In this article, we describe the formation of 6 core principles that function as pivot points in developing a new perspective centered on the importance of engaging and empowering our students as emerging clinicians. From these 6 principles, we designed and developed 3 interventions. Each intervention is discussed in regard to its purpose, operation and overall integration into the program.

Resident Education on the Surgical Treatment of Distal Radius Fractures Using a Point-of-View Camera.

Background: In the coronavirus disease 2019 (COVID-19) era, surgical resident education depends largely on virtual materials. With the help of point-of-view (POV) cameras, educational videos have become widely used for surgical training. A video recorded from the surgeon's POV helps demonstrate the procedure. We made training movies of the surgical approach to distal radius fractures for residents using a head-mounted video recording system with a laser point targeting device (LPTD). Methods: A 15-minnute movie of the trans-flexor carpi radialis approach for distal radius fractures was made. A POV camera was assembled with an LPTD and strapped on the surgeon's head. This enabled maintenance of the surgical field while recording the procedure. A shorter version of the clip was also made to investigate trainee preference. We asked 24 trainees to watch the two versions of the video and complete a short questionnaire. Results: All trainees felt that the movie made with a POV camera was more efficient than existing materials. Only 1 (4.2%) felt that the laser pointer hindered the view. Four of the 23 trainees (16.7%) felt dizzy while watching the video. Of the two versions, 16 trainees (66.7%) preferred the shorter, edited version. The average score for the video was 8.42 out of 10. Conclusions: A video recording system in the operating room that uses an LPTD-POV camera is an efficient way to produce educational material, particularly for surgical residents during the COVID-19 era.

From Videogames to Teaching - Different Camera Perspectives in an Interactive Synchronous Online Tutorial.

The global COVID-19 pandemic has required clinical skills training to be transferred to an online format. An interactive synchronous online tutorial with different camera perspectives was developed. In a survey, 79% of the students preferred the first-person perspective, which allowed students to view the abdominal examination through the examiner's eyes.

A Novel Method for Teaching Laser Peripheral Iridotomy and Selective Laser Trabeculoplasty Using Video Instruction and Model Eyes.

Objective The aim of the study is to describe an inexpensive and easily-constructed model eye for the purpose of teaching laser peripheral iridotomy (LPI) and selective laser trabeculoplasty (SLT) to ophthalmology residents. Methods Easily constructed, inexpensive model eyes were utilized to teach residents SLT and LPI utilizing a remote self-study module. A teaching microscope attachment allowed for video-based instruction and feedback. Results This model eye, used in conjunction with video modules is an effective low-cost teaching tool for laser surgery among ophthalmology residents. Attending ophthalmologists rated the use of these model eyes using surveys and found them to be appropriate teaching tools that could lead to improved knowledge and translate to better patient care. Conclusion Our novel method for teaching glaucoma laser surgery allows residents to learn the principles and theory behind common laser procedures while having the opportunity to practice repetitive procedures on low-cost model eyes.

Interactive Video-Based Passive Drinking and Forced Drinking Education to Reduce Intention to Drink in Adolescents: A Pre-Post Intervention Study.

Passive and forced drinking harm was prevalent but less recognized in Chinese adolescents. We educated adolescents on such harm to reduce their intention to drink. Students (n = 1244) from seven secondary schools in Hong Kong participated in a video-based health talk on passive and forced drinking harm. Paired t-test was used to assess their change in knowledge of passive and forced drinking, and health and social harm of drinking after, the health talk. McNemar's chi-squared test and adjusted multivariable logistic regression (AOR) were used to assess their change in intention to drink and intention to quit. Students were less likely to drink (OR 0.29, 95% CI 0.19-0.42) and more likely to quit drinking (OR 3.50, 1.10-14.6) after the health talk. Increased knowledge of passive drinking was associated with less intention to drink (AOR 0.93, 0.90-0.97), increased knowledge of health harm (adjusted b 0.06, 0.05-0.08), and social harm of drinking (adjusted b 0.12, 0.10-0.16). Similar associations were observed in forced drinking (intention to drink: AOR 0.87, 0.79-0.96; health harm: adjusted b 0.16, 0.12-0.19; social harm: adjusted b 0.36, 0.28-0.43). We showed preliminary evidence that the health talk on passive and forced drinking reduced the intention to drink in adolescents.

Roll the Tape: Implementing and Harnessing the Power of Trauma Video Review.

Trauma video review (TVR) is a powerful technology with a rapidly expanding role in trauma performance improvement, education, and research. Video review is particularly well suited for evaluating elements not found in the medical record such as rapid changes in patient condition, medical decision making, resuscitation tempo, and team leadership. As such, TVR is an ideal tool for general surgery trainee education and as a means to evaluate multiple ACGME Core Competencies and entrustable professional activities. This article describes the development of a TVR program and the novel way in which we have integrated TVR into our resident trauma curriculum.

The use of video for patient information and education: A scoping review of the variability and effectiveness of interventions.

OBJECTIVE: To provide an overview of video interventions used for patient information and education, and of the tools used to evaluate their effectiveness, in order to consider the feasibility of developing generic guidelines and appraisal tools for the use of video in patient care. METHODS: A scoping review was carried out to describe and synthesise emerging knowledge, using thematic analysis of data. Studies focussed upon videos for health professional education were excluded, as were those which consider the impact of videos available via social media. RESULTS: A narrative overview of 65 identified papers provides insight into the range and scope of studies. Common themes emerge, notably the aim of reducing anxiety and the variety of instruments designed to measure this. The use of self-report questionnaires was common, but their design is variable. CONCLUSION: Targeted video-based intervention can improve patient experience and outcomes. High utility guidelines and appraisal tools, transferable between contexts, are needed to facilitate deployments at scale for sustainable outcomes. PRACTICE IMPLICATIONS: Video production guidelines and appraisal tools will be of value to those engaged in video development and deployment. Guidance should be based upon emerging evidence of effectiveness and incorporate an emphasis on reusability.

Lessons Learned from the COVID-19 Pandemic: A Call for a National Video-Based Curriculum for Urology Residents.

The novel coronavirus (COVID-19) pandemic has created many unique challenges in urology resident training. Urologists are operating at a fraction of normal volume to conserve personal protective equipment and prevent viral spread. Many residency programs have organized rotating skeleton crews to perform clinical duties while a portion of residents work from home. In some regions, urology residents have been deployed to emergency rooms, intensive care units, and medical floors to care for COVID-19 patients. With these interruptions in urologic education, many questions remain about how residents will proceed with their clinical and didactic training. During these unprecedented times, many residencies have transitioned their didactic sessions to video-based platforms, allowing educators to reach larger numbers of learners. This perspective addresses how innovative virtual education programs created during the pandemic can be developed into a national video-based curriculum for urology residents, incorporating both didactics and surgical skill training.

Improving Knowledge of Long-Acting Reversible Contraception in an Adolescent and Young Adult Female Population.

OBJECTIVE: To improve adolescent and young adult clients' knowledge of long-acting reversible contraception (LARC) methods by standardizing the education they received at an outpatient clinic. DESIGN: The Plan-Do-Study-Act was used as a framework to implement and evaluate a practice change aimed at improving the contraceptive education provided to adolescent and young women. SETTING/LOCAL PROBLEM: This single-center quality improvement project took place at a community-based clinic in the Northeastern United States where clinicians' practice for contraceptive counseling lacked use of a standardized educational tool. PARTICIPANTS: Thirty female participants between the ages of 14 and 25. INTERVENTION/MEASUREMENTS: A pre- and postintervention survey was used to assess participants' knowledge of LARC methods after viewing an online video. A focus group of clinicians was held to assess their thoughts on the use of the video education. RESULTS: Survey results indicated improved knowledge of participants on all six knowledge points assessed in the survey. Focus group feedback indicated the video education was considered sustainable and desired by clinicians for an additional year and Plan-Do-Study-Act cycle. CONCLUSION: Online, video-based education may be an effective and sustainable way to provide adolescent and young adult clinic clients with evidence-based information on LARC methods to help them make informed decisions about contraception.

The Case of Ty Jackson: An Interactive Module on LGBT Health Employing Introspective Techniques and Video-Based Case Discussion.

Introduction: The Institute of Medicine's 2011 report on lesbian, gay, bisexual, and transgender (LGBT) health and the legalization of same-sex marriage are just two of the numerous milestones that have hastened medical schools' efforts to prepare trainees to address the needs of LGBT community members. Early awareness of sexual diversity through self- and peer introspection and video-based education can help trainees build a foundation towards providing affirming care to LGBT patients. Methods: The Kern model was used to develop, implement, and evaluate an interactive multimodal workshop to provide first-year medical students with a formative introduction to LGBT health. Learning objectives focused on comprehending the spectrum of human sexuality, health issues for LGBT patients, and better practices for promoting affirming care. The module consisted of a PowerPoint presentation, sexuality survey, videos of provider-patient encounters, and community-based resources. Results: The workshop was implemented among 178 first-year medical students in September 2018, with 93% completing the pre-/postworkshop evaluations. Comparison of evaluations showed an increase in confidence in addressing each of the three learning objectives. Over 85% rated the PowerPoint and videos as very good or excellent. Discussion: This workshop was effective in helping first-year medical students appreciate the spectrum of sexual diversity, health issues facing LGBT individuals, and better practices to promote affirming care. The real-time sexuality survey helped trainees appreciate sexual diversity through self-reflection and near-peer sharing. The videos and accompanying discussion provided real-life encounters, along with common pitfalls in and pearls for communicating with LGBT patients.