Viewer discretion advised: is YouTube a friend or foe in surgical education?

The use of videos in preparation for pediatric otolaryngology cases-a national survey

OBJECTIVE

1) Review surgical preparation methods for pediatric otolaryngology fellows and fellowship directors, focusing on surgical video usage.

STUDY DESIGN

Cross sectional survey.

METHODS

Structured survey querying preparation methods for surgical cases was distributed to current pediatric otolaryngology fellows and fellowship program directors (FD's).

RESULTS

84 surveys were distributed (47 fellows, 37 FD). Overall response rate was 44% (37/84); fellow response rate was 55% (26/47) and FD response rate was 30% (11/37). Most respondents used videos (84%) and textbooks (95%) to prepare for surgery; fellows were more likely than FD's to use videos (96% vs. 55%, p < 0.01). 89% of respondents used YouTube to prepare; C-videos was the next most common platform used (27%). Fellows were more likely to have used YouTube than FD's (100% vs 63%, p < 0.01). 45% of FD's did not know or did not think their fellows use videos to prepare for cases. Mean helpfulness of surgical videos on a 5 point scale was 3.41 (95% CI 3.0-3.8). Videos were considered most helpful for illustrating technical portions of cases (51%), visualizing the case (27%) and reviewing anatomy (24%). Survey respondents mentioned poor quality (59%) and irrelevance to a particular institutions approach (19%) as weaknesses of available surgical videos.

CONCLUSIONS

Surgical videos are commonly used by pediatric otolaryngology fellows to prepare for cases, and can assist in building anatomic knowledge and illustrating technical details of complex cases. YouTube is the most commonly utilized platform accessed by fellows, but poor quality and limited generalizability may restrict the usefulness of current video resources.

LEVEL OF EVIDENCE

4.

Evaluating YouTube as a Source of Patient Information for Functional Endoscopic Sinus Surgery

OBJECTIVE

To evaluate the quality of information presented on YouTube regarding functional endoscopic sinus surgery (FESS) for patients.

METHODS

YouTube was searched using FESS-specific keywords under the setting of "relevance." The first 50 videos from each keyword were reviewed and analyzed by 2 independent physician reviewers. Videos not related to FESS and duplicates were excluded. Outcome measures included the modified DISCERN score (range 0-5), the Journal of the American Medical Association (JAMA) benchmark criteria (range: 0-4), a novel scoring checklist for FESS assessing usefulness (range: 0-16), and the Video Power Index (VPI). Intraclass correlation coefficient (ICC) was calculated.

RESULTS

Of the 200 videos identified, 95 videos were analyzed after exclusions. Videos had an average VPI of 40.8 and SD 133.2. Average scores from the 3 objective checklists among all videos were low: modified DISCERN: 1.91, SD: 1.15; JAMA benchmark: 1.91, SD: 0.76; and FESS score: 3.54, SD: 1.77. The ICC between the 2 independent reviewers was excellent for all 3 checklists. We noted significant positive Pearson correlation between all 3 checklist scores (P < .001). In between-group comparisons of mean scores, there was significantly higher DISCERN and JAMA scores for videos from university/professional organizations, as compared to videos from medical advertising/for-profit companies and independent users. There were no significant differences in FESS scores noted between the 3 groups.

CONCLUSION

There were overall low scores across the modified DISCERN, JAMA benchmark criteria, and FESS scoring checklists, reflecting the poor quality of YouTube videos as a source of patient information for FESS.

Learning inguinal hernia repair? A survey of current practice and of preferred methods of surgical residents

Purpose

During surgical residency, many learning methods are available to learn an inguinal hernia repair (IHR). This study aimed to investigate which learning methods are most commonly used and which are perceived as most important by surgical residents for open and endoscopic IHR.

Methods

European general surgery residents were invited to participate in a 9-item web-based survey that inquired which of the learning methods were used (checking one or more of 13 options) and what their perceived importance was on a 5-point Likert scale (1 = completely not important to 5 = very important).

Results

In total, 323 residents participated. The five most commonly used learning methods for open and endoscopic IHR were apprenticeship style learning in the operation room (OR) (98% and 96%, respectively), textbooks (67% and 49%, respectively), lectures (50% and 44%, respectively), video-demonstrations (53% and 66%, respectively) and journal articles (54% and 54%, respectively). The three most important learning methods for the open and endoscopic IHR were participation in the OR [5.00 (5.00–5.00) and 5.00 (5.00–5.00), respectively], video-demonstrations [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively], and hands-on hernia courses [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively].

Conclusion

This study demonstrated a discrepancy between learning methods that are currently used by surgical residents to learn the open and endoscopic IHR and preferred learning methods. There is a need for more emphasis on practising before entering the OR. This would support surgical residents’ training by first observing, then practising and finally performing the surgery in the OR.

Electronic supplementary material

The online version of this article (10.1007/s10029-020-02270-y) contains supplementary material, which is available to authorized users.

IVORY Guidelines (Instructional Videos in Otorhinolaryngology by YO-IFOS): A Consensus on Surgical Videos in Ear, Nose, and Throat

Objectives/Hypothesis

Otolaryngology instructional videos available online are often of poor quality. The objective of this article was to establish international consensus recommendations for the production of educational surgical videos in otolaryngology.

Study Design

DELPHI survey.

Methods

Twenty‐seven international respondents participated in this study from 12 countries. Consensus was reached after three rounds of questionnaires following the Delphi methodology. The proposals having reached the 80% agreement threshold in the third round were retained.

Results

The main recommendations are as follows: 1) Ethics: patients must be anonymized and unrecognizable (apart from plastic surgery if necessary). A signed authorization must be obtained if the person is recognizable. 2) Technical aspects: videos should be edited and in high‐definition (HD) quality if possible. Narration or subtitles and didactic illustrations are recommended. 3) Case presentation: name of pathology and procedure must be specified; the case should be presented with relevant workup. 4) Surgery: surgical procedures should be divided into several distinct stages and include tips and pitfalls. Pathology should be shown if relevant. Key points should be detailed at the end of the procedure. 5) Organ‐specific: type of approach and bilateral audiometry should be specified in otology. Coronal plane computed tomography scans should be shown in endonasal surgery. It is recommended to show pre‐ and postoperative videos in voice surgery and preoperative drawings and photos of scars in plastic surgery, as well as the ventilation method in airway surgery.

Conclusions

International recommendations have been determined to assist in the creation and standardization of educational surgical videos in otolaryngology and head and neck surgery.

Level of Evidence

5 Laryngoscope, 131:E732–E737, 2021

Evaluation of Online Videos of Laparoscopic Sleeve Gastrectomy Using the LAP-VEGaS Guidelines

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgical procedure worldwide. Educational videos of LSGs are available from online sources with YouTube® being the most popular online video repository. However, due to the unrestricted and uncontrolled nature of YouTube®, anyone can upload videos without peer review or standardization. The LAP-VEGaS guidelines were formed to guide the production of high-quality surgical videos. The aim of this study is to use the LAP-VEGaS guidelines to determine if videos of LSGs available on Youtube® are of an acceptable standard for surgical educational purposes.

METHODS

A YouTube® search was performed using the term laparoscopic sleeve gastrectomy. Appropriate videos were analysed by two individuals using the sixteen LAP-VEGaS guidelines.

RESULTS

A total of 575 videos were found, of which 202 videos were included and analysed using the LAP-VEGaS guidelines. The median video guideline score was 6/16 with 89% of videos meeting less than half of all guidelines. There was no correlation between the LAP-VEGaS score and view count.

CONCLUSIONS

There is an abundance of laparoscopic sleeve gastrectomy educational videos available on YouTube®; however, when analysed using the LAP-VEGaS guidelines, the majority do not meet acceptable educational standards for surgical training purposes.

Home Surgical Skill Training Resources for Obstetrics and Gynecology Trainees During a Pandemic

Resources are available for remote laparoscopic and basic surgical training, including core skills, psychomotor, visual–spatial, and cognitive, to improve gaps in surgical training during the coronavirus disease 2019 (COVID-19) pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has created a unique educational circumstance in which medical students, residents, and fellows find themselves with a gap in their surgical training. We reviewed the literature, and nine categories of resources were identified that may benefit trainees in preventing skill decay: laparoscopic box trainers, virtual reality trainers, homemade simulation models, video games, online surgical simulations, webinars, surgical videos, smartphone applications, and hobbies including mental imagery. We report data regarding effectiveness, limitations, skills incorporated, cost, accessibility, and feasibility. Although the cost and accessibility of these resources vary, they all may be considered in the design of remote surgical training curricula during this unprecedented time of the COVID-19 pandemic.

Using Technology to Maintain the Education of Residents During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic presents a unique challenge to surgical residency programs. Due to the restrictions recommended by the Centers for Disease Control and Prevention and other organizations, the educational landscape for surgical residents is rapidly changing. In addition, the time course of these changes is undefined.

METHODS

We attempt to define the scope of the problem of maintaining surgical resident education while maintaining the safety of residents, educators, and patients. Within the basic framework of limiting in-person gatherings, postponing or canceling elective operations in hospitals, and limiting rotations between sites, we propose innovative solutions to maintain rigorous education.

RESULTS

We propose several innovative solutions including the flipped classroom model, online practice questions, teleconferencing in place of in-person lectures, involving residents in telemedicine clinics, procedural simulation, and the facilitated use of surgical videos. Although there is no substitute for hands-on learning through operative experience and direct patient care, these may be ways to mitigate the loss of learning exposure during this time.

CONCLUSIONS

These innovative solutions utilizing technology may help to bridge the educational gap for surgical residents during this unprecedented circumstance. The support of national organizations may be beneficial in maintaining rigorous surgical education.

Is Youtube a potential training source for total extraperitoneal laparoscopic inguinal hernia repair?

BACKGROUND

The aim of this study is to evaluate the quality of the most commonly viewed total extraperitoneal laparoscopic inguinal hernia repair (TEP) videos on Youtube, which is the largest social and medical media broadcasting service, concerning educational purposes.

METHOD

A search with the keyword "total extraperitoneal laparoscopic inguinal hernia repair" was performed on Youtube. The first 120 videos among the search results were downloaded and 55 of them were included in the study. A scoring system developed by the authors according to the recent literature was utilized for evaluation of the videos. Video demographics were evaluated for the quality and upload source.

RESULTS

Among the enrolled videos, video quality was rated as good in 13 (23.6%), as moderate in 22 (40%), and as poor in 20 (36.4%). Video length, presence of narration, number of likes, and comments were significantly higher in the good group. Upload source was an academic center in 14 (25.5%), a community hospital in 22 (40.0%), and a physician in 19 (34.5%). The mean video score of the academic center group (8 ± 4.095) and community hospital group (8.64 ± 3.259) was significantly higher than the physician group (5.47 ± 2.632) (p = 0.010). Video quality was not correlated with total views or views per day.

CONCLUSION

Total extraperitoneal laparoscopic inguinal hernia repair procedure videos uploaded to Youtube demonstrate considerable heterogeneity in terms of educational quality and the number of good quality videos is significantly low. This heterogeneity is attributed to the lack of peer review process for the evaluation of educational quality of the videos. Therefore, a physician intending to learn and practice a surgical procedure properly (TEP repair in this situation) should not consider a broadcasting service without a peer review process as a reliable training source.

Vascular surgery presence in carotid endarterectomy YouTube videos

OBJECTIVE

YouTube videos have become a common resource for trainees to learn about surgical procedures. Carotid endarterectomy (CEA) is one example procedure that may be performed by multiple specialties and with a variety of techniques. Little is known about educational content and the representation of vascular surgeons in these videos. We sought to compare the educational quality of CEA YouTube videos, techniques demonstrated, and prevalence of each specialty.

METHODS

YouTube was programmatically searched for the terms "carotid endarterectomy," "carotid endarterectomy surgery," "carotid endarterectomy technique," "carotid endarterectomy CEA," and "carotid artery surgery." Videos that met inclusion criteria were analyzed for surgical technique, procedural steps, surgeon specialty, video length, and date. Videos were determined to have high-quality educational content if the video included English-language captions or narration and demonstrated key steps of the procedure: division of the common facial vein; exposure of the common, external, and internal carotid arteries; vascular control and clamping; and arteriotomy, endarterectomy, and arteriotomy closure.

RESULTS

Forty-six videos met inclusion criteria. Vascular surgery was associated with 12 (26.1%) CEA videos, cardiac surgery with 13 (28.3%), and neurosurgery with 14 (30.4%). Surgeon specialty was unknown for seven (17.4%) videos. Eight videos were high quality, of which vascular surgery was associated with three (37.5%). Conventional endarterectomy was the most common technique demonstrated, whereas a total of seven videos demonstrated eversion technique. Vascular and cardiac surgeons were more likely to demonstrate patch angioplasty than neurosurgeons, who exclusively performed primary closure (P < .05). Compared with cardiac surgeons, vascular surgeon CEA videos had more views (25,956 ± 9613 vs 1200 ± 368; P < .05) and were more likely to be published by user accounts with an academic affiliation (11 vs 6; P < .05). Vascular surgery videos were older than videos by cardiac surgeons (6.0 ± 1.1 years vs 3.0 ± 0.5 years; P < .05) and neurosurgeons (6.0 ± 1.1 years vs 3.1 ± 0.8 years; P < .05).

CONCLUSIONS

Despite more views, the field of vascular surgery is under-represented in YouTube videos demonstrating CEA. Vascular surgery videos tend to be older and make up a minority of high-quality videos. As more learners turn to YouTube for information about surgical procedures, vascular surgeons should expand their online presence through the production and collection of high-quality videos for trainees.

Making surgery safer in an increasingly digital world: the internet-friend or foe?

PURPOSE

The internet has resulted in huge efficiency gains in health care, the ability to deal with massive data accumulation and better manage patient data. However, potential and real pitfalls exist, including breeches in security of data and patient confidentiality, data storage issues, errors, and user interface issues.

METHODS

A MEDLINE review was performed using MeSH terms "health care" and "information technology." Cross-referencing was used to explore the different opportunities and challenges the internet has to offer.

RESULTS

As health professionals, we are fast adopting technologies at our fingertips, such as WhatsApp and video capabilities, into our clinical practice to increase productivity and improve patient care. However, the potential security breaches are significant for the health professional and health service. Further, electronic medical records have theoretical advantages to improve patient care, reduce medication errors, and expedite referrals. The downside is a less personalized approach to patient care, as well as the potential for these systems to be even more cumbersome. In regard to the acquisition of knowledge, there is no doubt the internet is our friend. Health care professionals as well as patients have unlimited resources for learning, including podcasts videos, apps, simulators, and wearable devices. Unfortunately, this comes with a risk of misinformation and poorly referenced data with little to no regulation of content.

CONCLUSION

In this increasing digital world, it is our task as health care providers to embrace these new technologies but develop guidelines and control systems to minimize the pitfalls.

YouTube as a source of patient information for abdominal aortic aneurysms

OBJECTIVE

Patients are increasingly referring to the Internet after a diagnosis of vascular disease. This study was performed to quantitatively define the accuracy and reliability of information on YouTube regarding abdominal aortic aneurysms (AAA).

METHODS

A systematic search of YouTube was conducted using multiple AAA-specific keywords. The default YouTube search setting of "relevance" was used to replicate an average search attempt, and the first 50 results from each keyword search were reviewed and analyzed by two independent reviewers. Descriptive characteristics, Journal of the American Medical Association Score, modified DISCERN score, Video Power Index, and a novel scoring system for the management of AAAs, the AAA-Specific Score (AAASS), were used to record data. Inter-rater agreement was analyzed using intraclass correlation coefficient estimates and the Kruskal-Wallis test was used for intergroup comparisons.

RESULTS

Fifty-one videos were included for analysis. The mean Journal of the American Medical Association Score, DISCERN, and AAASS values among videos were 1.74/4.00 (standard deviation [SD], 0.84), 2.37/5.00 (SD, 0.97), and 6.63/20.00 (SD, 3.23), respectively. Of all the included videos, 78% were educational in nature, 14% were patient testimonials, and 8% were news programs. Based on the AAASS, the majority of analyzed videos fell into the poor category (41%), followed next by the very poor (31%), moderately useful (25%), very useful (2%), and exceptional (0%) categories. Videos by nonphysicians were significantly more popular (P < .05) than vascular surgeon sources.

CONCLUSIONS

Although variable in source and content, the completeness and reliability of information offered on YouTube for AAA diagnosis and treatment is poor. Patients watching YouTube for information on their AAA diagnosis are receiving an incomplete and perhaps misleading picture of available diagnostic and treatment options. Given that vascular surgeons are likely to be affected by unrealistic treatment expectations from patients accessing online materials regarding AAA, it is important to acknowledge the nature of content on these platforms.

Estimating the quality of YouTube videos on pulmonary lobectomy

Background

YouTube is a valuable source of medical videos, but the quality of the videos is difficult to determine. This study aimed to estimate the quality by characteristics of the surgeon and by view rate.

Methods

The term, "pulmonary lobectomy", as a keyword was searched for on the YouTube search engine with the filter set to sort videos by view rate. The data of the first 100 videos were gathered and analyzed. A search was performed for any surgeon who was featured in a video or who posted a live video on Scopus to ascertain the h-index and lung-related publication history.

Results

There were approximately 8,650 videos that were found using "pulmonary lobectomy" as the search term. In the top 100 videos, there were 79 live surgical videos, 12 academic informational videos, 5 patient interviews, and 4 other miscellaneous videos. A primary surgeon was identified in 54 of the 79 (68%) live surgeries, with the majority of these surgeons having an adequate academic affiliation such as an h-index and academic publications.

Conclusions

There are a large amount of YouTube videos on pulmonary lobectomy with acceptable quality, and these videos may have great potential to improve surgical education. But trainees should critically examine the quality of video content. Furthermore, these surgical videos should be improved in quality before they can be used in medical teaching.

Educational value of surgical videos on YouTube: quality assessment of laparoscopic appendectomy videos by senior surgeons vs. novice trainees

Background

To prepare for surgery, surgeons often recur to surgical videos, with YouTube being reported as the preferred source. This study aimed to compare the evaluation of three surgical trainees and three senior surgeons of the 25 most viewed laparoscopic appendectomy videos listed on YouTube. Additionally, we assessed the video conformity to the published guidelines on how to report laparoscopic surgery videos (LAP-VEGaS).

Methods

Based on the number of visualization, the 25 most viewed videos on laparoscopic appendectomy uploaded on YouTube between 2010 and 2018 were selected. Videos were evaluated on the surgical technical performance (GOALS score), critical view of safety (CVS), and overall video quality and utility.

Results

Video image quality was poor for nine (36%) videos, good for nine (36%), and in high definition for seven (28%). Educational content (e.g., audio or written commentary) was rarely present. With the exception of the overall level of difficulty, poor consistency was observed for the GOALS domains between senior surgeons and trainees. Fifteen videos (60%) demonstrated a satisfactory CVS score (≥ 5). Concerning the overall video quality, agreement among senior surgeons was higher (Cronbach’s alpha 0.897) than among trainees (Cronbach’s alpha 0.731). The mean overall videos utility (Likert scale, 1 to 5) was 1.92 (SD 0.88) for senior examiners, and 3.24 (SD 1.02) for trainee examiners. The conformity to the LAP-VEGaS guidelines was weak, with a median value of 8.1% (range 5.4–18.9%).

Conclusion

Laparoscopic videos represent a useful and appropriate educational tool but they are not sufficiently reviewed to obtained standard quality. A global effort should be made to improve the educational value of the uploaded surgical videos, starting from the application of the nowadays-available LAP-VEGaS guidelines.

Electronic supplementary material

The online version of this article (10.1186/s13017-019-0241-6) contains supplementary material, which is available to authorized users.