Watching surgical tapes: video playback as an educational tool for improving resident laparoscopic performance

Abstract

In this single masked, randomized controlled study, we evaluate if watching video recordings of oneself performing Fundamentals of Laparoscopic Skills (FLS) exercises results in an improvement on the 30-point Global Operative Assessment of Laparoscopic Skills (GOALS) assessment among Obstetrics & Gynecology (Ob/Gyn) residents. Participants were randomized to verbal feedback only (control) or verbal feedback and watching their video recording (intervention). Each participant completed the five FLS exercises using a laparoscopic box trainer while being timed, video recorded and receiving real-time feedback from an Ob/Gyn faculty member. Baseline GOALS assessment was completed by participants and faculty evaluator. Participants randomized to the intervention were allowed to watch their video recording and the faculty evaluator was masked to this randomization. All participants then repeated the FLS exercises while being timed and this was again scored using the GOALS assessment. In addition, all participants completed a pre- and post-test survey to gauge their laparoscopic comfort level. Two-sample t-test was used to assess within-group differences in overall GOALS scores and exercise times while Wilcox Rank Sum test was used for within-group comparisons of survey responses. Between-group analysis for change in GOALS scores, exercise times and survey responses was performed using the Mann-Whitney test. Differences in variables across Post Graduate Year (PGY) levels were evaluated using ANOVA and Kruskal-Wallis tests. Twenty-three Ob/Gyn residents in the 2020-2021 academic year completed the study; 12 were randomized to the intervention and 11 received verbal feedback only. Relative to baseline, there were significant within-group improvements in the faculty (p<0.01) and self-reported GOALS scores (p<0.01). Between the groups, the intervention group improved by 3.2 points more than the control group based on masked faculty evaluation (95% CI 1.4 to 5.0 points, p<0.01). This between-group difference was not significant in resident self-scores. Overall time improved for all participants (15:54 ± 0.21 minutes pre and 13:13 ± 0.14 minutes post) but this difference was not significant between groups. Higher PGY residents reported significantly more comfort performing laparoscopic tasks, earned higher GOALS score (faculty and self-scores), and completed the first set of exercises in less time. A significant interaction between PGY and intervention was detected using 2-way ANOVA with between-group improvement in GOALS score most strongly associated with PGY4 residents (p<0.01). This suggests that while all learners objectively benefit from watching recordings of themselves performing surgical tasks, advanced learners may benefit the most when video recordings are used as an educational tool.