Utilizing Intraprocedural Interactive Video Capture With Google Glass for Immediate Postprocedural Resident Coaching

Which, how, and what? Using digital tools to train surgical skills; a systematic review and meta-analysis

Background

Digital tools like digital box trainers and VR seem promising in delivering safe and tailored practice opportunities outside of the surgical clinic, yet understanding their efficacy and limitations is essential. This study investigated Which digital tools are available to train surgical skills, How these tools are used, How effective they are, and What skills they are intended to teach.

Methods

Medline, Embase, and Cochrane libraries were systematically reviewed for randomized trials, evaluating digital skill-training tools based on objective outcomes (skills scores and completion time) in surgical residents. Digital tools effectiveness were compared against controls, wet/dry lab training, and other digital tools. Tool and training factors subgroups were analysed, and studies were assessed on their primary outcomes: technical and/or non-technical.

Results

The 33 included studies involved 927 residents and six digital tools; digital box trainers, (immersive) virtual reality (VR) trainers, robot surgery trainers, coaching and feedback, and serious games. Digital tools outperformed controls in skill scores (SMD 1.66 [1.06, 2.25], P < 0.00001, I2 = 83 %) and completion time (SMD -1.05 [-1.72, -0.38], P = 0.0001, I2 = 71 %). There were no significant differences between digital tools and lab training, between tools, or in other subgroups. Only two studies focussed on non-technical skills.

Conclusion

While the efficacy of digital tools in enhancing technical surgical skills is evident - especially for VR-trainers -, there is a lack of evidence regarding non-technical skills, and need to improve methodological robustness of research on new (digital) tools before they are implemented in curricula.

Key message

This study provides critical insight into the increasing presence of digital tools in surgical training, demonstrating their usefulness while identifying current challenges, especially regarding methodological robustness and inattention to non-technical skills.

Use of Extended Reality in Medical Education: An Integrative Review

Extended reality (XR) has emerged as an innovative simulation-based learning modality. An integrative review was undertaken to explore the nature of evidence, usage, and effectiveness of XR modalities in medical education. One hundred and thirty-three (N = 133) studies and articles were reviewed. XR technologies are commonly reported in surgical and anatomical education, and the evidence suggests XR may be as effective as traditional medical education teaching methods and, potentially, a more cost-effective means of curriculum delivery. Further research to compare different variations of XR technologies and best applications in medical education and training are required to advance the field.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01698-4.

Video-based coaching for surgical residents: a systematic review and meta-analysis

BACKGROUND

Video-based coaching (VBC) is used to supplement current teaching methods in surgical education and may be useful in competency-based frameworks. Whether VBC can effectively improve surgical skill in surgical residents has yet to be fully elucidated. The objective of this study is to compare surgical residents receiving and not receiving VBC in terms of technical surgical skill.

METHODS

The following databases were searched from database inception to October 2021: Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed. Articles were included if they were randomized controlled trials (RCTs) comparing surgical residents receiving and not receiving VBC. The primary outcome, as defined prior to data collection, was change in objective measures of technical surgical skill following implementation of either VBC or control. A pairwise meta-analyses using inverse variance random effects was performed. Standardized mean differences (SMD) were used as the primary outcome measure to account for differences in objective surgical skill evaluation tools.

RESULTS

From 2734 citations, 11 RCTs with 157 residents receiving VBC and 141 residents receiving standard surgical teaching without VBC were included. There was no significant difference in post-coaching scores on objective surgical skill evaluation tools between groups (SMD 0.53, 95% CI 0.00 to 1.01, p = 0.05, I² = 74%). The improvement in scores pre- and post-intervention was significantly greater in residents receiving VBC compared to those not receiving VBC (SMD 1.62, 95% CI 0.62 to 2.63, p = 0.002, I² = 85%). These results were unchanged with leave-one-out sensitivity analysis and subgroup analysis according to operative setting.

CONCLUSION

VBC can improve objective surgical skills in surgical residents of various levels. The benefit may be most substantial for trainees with lower baseline levels of objective skill. Further studies are required to determine the impact of VBC on competency-based frameworks.

Video Coaching in Surgical Education: Utility, Opportunities, and Barriers to Implementation

OBJECTIVE

This review discusses the literature on Video-Based Coaching (VBC) and explores the barriers to widespread implementation.

DESIGN

A search was performed on Scopus and PubMed for the terms "operation," "operating room," "surgery," "resident," "house staff," "graduate medical education," "teaching," "coaching," "assessment," "reflection," "camera," and "video" on July 27, 2021, in English. This yielded 828 results. A single author reviewed the titles and abstracts and eliminated any results that did not pertain to operative VBC or assessment. All bibliographies were reviewed, and appropriate manuscripts were included in this study. This resulted in a total of 52 manuscripts included in this review.

SETTING/PARTICIPANTS

Original, peer-reviewed studies focused on VBC or assessment.

RESULTS

VBC has been both subjectively and objectively found to be a valuable educational tool. Nearly every study of video recording in the operating room found that subjects, including surgical residents and seasoned surgeons alike, overwhelmingly considered it a useful, non-redundant adjunct to their training. Most studies that evaluated skill acquisition via standardized assessment tools found that surgical residents who underwent a VBC program had significant improvements compared to their counterparts who did not undergo video review. Despite this evidence of effectiveness, fewer than 5% of residency programs employ video recording in the operating room. Barriers to implementation include significant time commitments for proposed coaching curricula and difficulty with integration of video cameras into the operating room.

CONCLUSIONS

VBC has significant educational benefits, but a scalable curriculum has not been developed. An optimal solution would ensure technical ease and expediency, simple, high-quality cameras, immediate review, and overcoming entrenched surgical norms and culture.

Video Technologies for Recording Open Surgery: A Systematic Review

Video recording of surgical procedures is an important tool for surgical education, performance enhancement, and error analysis. Technology for video recording open surgery, however, is limited. The objective of this article is to provide an overview of the available literature regarding the various technologies used for intraoperative video recording of open surgery. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines using the MEDLINE, Cochrane Central, and EMBASE databases. Two authors independently screened the titles and abstracts of the retrieved articles, and those that satisfied the defined inclusion criteria were selected for a full-text review. A total of 2275 publications were initially identified, and 110 were included in the final review. The included articles were categorized based on type of article, surgical subspecialty, type and positioning of camera, and limitations identified with their use. The most common article type was primary-technical (29%), and the dominant specialties were general surgery (22%) and plastic surgery (18%). The most commonly cited camera used was the GoPro (30%) positioned in a head-mount configuration (60%). Commonly cited limitations included poor video quality, inadequate battery life, light overexposure, obstruction by surgical team members, and excessive motion. Open surgery remains the mainstay of many surgical specialties today, and technological innovation is absolutely critical to fulfill the unmet need for better video capture of open surgery. The findings of this article will be valuable for guiding future development of novel technology for this purpose.