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Educationally Optimized Videos Impact on Trainee Cadaveric Surgical Performance: A Multicenter Randomized Trial
Daniel A London, MD, MS
1; Julia AV Nuelle, MD
1; Stephanie L Choo, MD
1; Sebastien Lalonde, MD
1; Marie T. Morris, MD
2; Ryan P. Calfee, MD, MSc
31University of Missouri, Columbia, MO; 2Washington University School of Medicine, St. Louis, MO; 3Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO
Hypothesis:
Previous research has identified specific criteria to include in a surgical technique video to optimize its educational value for trainees. However, it is unknown if such "optimized” videos improve surgical learning. We hypothesized that an optimized surgical technique video would improve performance compared to "typical” preparatory material when trainees perform an open carpal tunnel release (CTR).
Methods:
We conducted a randomized, single-blind, study involving 25 surgical trainees at two institutions. Participants first wrote a narrative explaining how to complete a CTR and then performed a CTR to the best of their ability in a cadaveric specimen. Fellowship-trained hand surgeons assessed participants via validated CTR performance metrics, including a narrative assessment checklist, a cadaveric assessment checklist that accounts for all surgical steps, a global rating scale assessment, and a summative P-score assessment. Trainees were then randomized to either having access to an optimized CTR technique video or being allowed to prepare using "typical” material to which they had access. Up to 30 minutes was allowed for review of these materials. Participants then wrote a second narrative and performed a second CTR on a new cadaveric specimen that the same blinded evaluator assessed. Categorical data were compared with chi-square tests. Participant performance was calculated by the difference in score percentage from their two attempts. Continuous data were normally distributed and analyzed by independent sample t-tests. Mann-Whitney U tests analyzed ordinal data. An a priori sample size estimate determined that 10 participants per group were needed to detect a clinically meaningful difference in all of our assessment metrics.
Results:
Randomization resulted in similar groups according to trainee year, institution, hand surgery experience, and baseline performance scores (Table 1). Both groups improved their performance after having 30 minutes of preparatory time (Table 2). The group randomized to the optimized surgical video did not demonstrate statistically significant or likely clinically relevant improvement as assessed by their greater improvement in cadaveric performance (0.3%), global rating scale (2.6%), and average P-scale rating (0.4 levels) compared to the "typical” preparation group (Table 2).
Conclusions:
For CTR, an optimized surgical video does not result in significantly improved surgical performance compared to typical preparation materials. This result questions if the extra time required to create an optimized video is truly needed for trainees to have a beneficial educational experience. Future studies should investigate if optimized videos demonstrate greater benefits for less common and/or more complex procedures.
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