Abstract
PurposeSurgical education videos currently all use a single point of view (POV) with the trainee locked onto a fixed viewpoint, which may not deliver sufficient information for complex procedures. We developed a novel multiple POV video system and evaluated its training outcome compared with traditional single POV.MethodsWe filmed a hip resurfacing procedure performed by an expert attending using 8 cameras in theatre. 30 medical students were randomly and equally allocated to learn the procedure using the multiple POV (experiment group [EG]) versus single POV system (control group [CG]). Participants advanced a pin into the femoral head as demonstrated in the video. We measured the drilling trajectories and compared it with pre-operative plan to evaluate distance of the pin insertion and angular deviations. Two orthopedic attendings expertly evaluated the participants’ performance using a modified global rating scale (GRS). There was a pre-video knowledge test that was repeated post-simulation alongside a Likert-scale questionnaire.ResultsThe angular deviation of the pin in EG was significantly less by 29% compared to CG (p = 0.037), with no significant difference in the entry point’s distance between groups (p = 0.204). The GRS scores for EG were 3.5% higher than CG (p = 0.046). There was a 32% higher overall knowledge test score (p<0.001) and 21% improved Likert-scale questionnaire score (p = 0.002) after video-learning in EG than CG, albeit no significant difference in the knowledge test score before video-learning (p = 0.721).ConclusionThe novel multiple POV provided significant objective and subjective advantages over single POV for acquisition of technical skills in hip surgery.
Highlights
The angular deviation of the pin in EG was significantly less by 29% compared to CG (p = 0.037), with no significant difference in the entry point’s distance between groups (p = 0.204)
Surgical education has traditionally been on an apprenticeship model in which residents are given increasing autonomy while performing live surgical cases at the discretion of a supervising surgeon [1, 2], but in the past decades there has been a dramatic reconfiguration of surgical training driven by (i) increased public awareness of iatrogenic errors and lawsuits [3], (ii) restriction of duty hours due to the European Working Time Directive (EWTD) and American Accreditation Council for Graduate Medical Education, with an estimated 80% decrease in dedicated operating time as a result of EWTD [4, 5], (iii) an emphasis on efficient use of theatre time due to cost pressures [6,7]
Adjunctive methods of acquiring surgical skills away from the operating room are necessary without compromising patient safety
Summary
Surgical education has traditionally been on an apprenticeship model in which residents are given increasing autonomy while performing live surgical cases at the discretion of a supervising surgeon [1, 2], but in the past decades there has been a dramatic reconfiguration of surgical training driven by (i) increased public awareness of iatrogenic errors and lawsuits [3], (ii) restriction of duty hours due to the European Working Time Directive (EWTD) and American Accreditation Council for Graduate Medical Education, with an estimated 80% decrease in dedicated operating time as a result of EWTD [4, 5], (iii) an emphasis on efficient use of theatre time due to cost pressures [6,7]. Developing surgical training methods away from the operating theatre is being considered. Orthopedic trainees practice technical skills on cadavers and sawbones. These teaching techniques are limited by the expense and short supply of cadavers, and the lack of high-fidelity of sawbones. Virtual reality (VR) simulators have provided trainees with the opportunity to practice and overcome the learning curve in a high-fidelity, safe and controlled environment without compromising patient safety [9,10,11,12,13]. Adjunctive methods of acquiring surgical skills away from the operating room are necessary without compromising patient safety
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