K. M. McKendy1, L. Lee1, J. R. Grushka1, A. N. Beckett1, K. A. Khwaja1, P. Fata1, T. S. Razek1, D. L. Deckelbaum1 1McGill University,General Surgery / Surgery,Montreal, QC, Canada
Introduction:
When preparing to perform a case in the operating room, surgical residents often review the steps of procedures using surgical atlases. Videos of surgical procedures are an emerging teaching modality. While video footage is more readily available for laparoscopic cases, high quality videos of open surgical cases are scarce. Moreover, many videos are created without using rigorous methodology. The aim of our study was to validate the use of instructional videos as an educational tool in surgery. We began by looking at open tracheostomy, since this procedure is relatively straightforward and frequently performed at our institution.
Methods:
Cognitive task analysis (CTA) was used to elaborate a list of the key steps of an open tracheostomy. Six experts were interviewed and asked to describe how they perform an open tracheostomy. The interviews were transcribed and analyzed, and a list of the 10 key steps and each of their sub-steps was elaborated. The experts were then asked to rate the importance of each sub-step using a Likert scale. An instructional video of an open tracheostomy case was then created, underscoring the steps and decision-making points emphasized by the expert panel using CTA. To establish proof of concept of the utility of these instructional videos, a pilot study was conducted with PGY-1 and 2 surgical residents. The residents were randomized to either view the video or read a text of the video narration, and then tested on their knowledge of the critical steps of the procedure. Critical steps were identified through CTA using a weighted scale. Results were analyzed using an independent sample t-test. For additional feedback on the quality and utility of the video, those randomized to the video group were subsequently asked to complete a questionnaire on its educational value.
Results:
64 PGY-1 and 2 surgical residents from all surgical subspecialties were enrolled in the study. Of these, 40 completed the test: 20 residents from the video group and 20 from the text group. While there was no significant difference between the average scores of the video and text group, 93% of residents who were randomized to the video group agreed that the video was a useful learning tool and that it helped prepare them for the operating room. In addition, 92% agreed or strongly agreed that they would watch the video rather than reviewing the content in a textbook, and 100% felt that their knowledge of relevant anatomy had improved with the video.
Conclusion:
This study illustrates the use of CTA in the creation of an instructional surgical video on open tracheostomy. The results of this pilot study suggest that surgical videos are an excellent adjunct to the educational armamentarium of surgical trainees.