Kennedy A, Lee A, Ambinder D et al: Video-based coaching as an educational platform for urological residency training: a pilot study. Urol Pract 2021; doi: 10.1097/UPJ.0000000000000211.

Surgical competency requires technical skills as well as cerebral decision making skills.¹ Traditionally, these skills have been developed in the operating room (OR) via large volumes of operative cases.² However, operative experience is currently limited by duty hour restrictions, conservative management practices, increasing numbers of fellows, and an expanding array of surgical techniques to learn.^3–5 Surgical training may be augmented by didactic lectures, web-based courses, simulation, grand rounds, video-based coaching (VBC), and other training formats. Simulation labs, while effective, may be limited in their implementation by cost and accessibility.^6,7 Didactic lectures, web-courses, and other training modalities are limited in their ability to facilitate interactive discussion.

Video-based coaching is a promising modality to supplement contemporary surgical training. Video as a learning medium is very familiar to surgeons; a recent survey of residents and specialists found that 98% of residents have used videos displaying surgical technique to prepare for surgery.⁸

A recent investigation in general surgery observed attending surgeons reviewing video of a previously performed operative case with the same residents involved in the case. Teaching points, defined as constructive commentary offered by attending surgeons, were compared between the audio in the operating room and the audio for the video review session. Video review sessions demonstrated an increased number of teaching points when compared to the instruction given in the operating room, indicating educational value on behalf of the residents.⁹ However, the time needed to review an entire case via video offers challenges to implement given current work-hour restrictions.

Figure. Total cumulative teaching points made per hour across all 4 cases separated by overall categories (A) and by case (B).

In our recently published study, we implemented VBC in a modified format.¹⁰ To assess the effectiveness of short time duration VBC, post-graduate year 2 to 5 urology residents and 4 attending urological surgeons at an academic tertiary care center were recruited for this study. Audio and video were recorded for 4 distinct urological procedures. Residents were asked to select time frames representing approximately 10 minutes of operative footage. Segments of video were then reviewed with both attendings and residents present at monthly urology grand rounds. The timing and content of the discussion varied based on the interest of the participating residents and attendings. Recordings of audio from both the OR and grand rounds were then coded by independent trained raters who identified and categorized teaching points spoken by attending physicians. Broad categories included information, operative technique, questioning, response to resident interaction, and unrelated commenting. A single statement could be coded for multiple categories if applicable.

Teaching points were compared between the OR and VBC sessions. There were greater than 4 times more teaching points per hour delivered in VBC when compared to the OR (see table). Across all broad categories, more teaching points were made per hour in VBC than in the OR (see figure). In both VBC and the OR, informative comments and comments on operative technique were most emphasized.

VBC allows for the verbal exploration of the reasoning behind taking a specific action in surgery, something that is often not addressed in the operating room. Further, VBC requires minimal preparation prior to a session and can take as little as 10 minutes to complete. Therefore, this modality enhances surgical understanding with little compromise to other aspects of training. However, it is important to state that VBC does not replace traditional OR learning; tactile skills learned in the simulation lab and in the OR cannot be replicated during VBC.

In a short time window, VBC can increase conversation in the areas of intraoperative decision making, situational awareness, surgical technique, and open-ended questions. We found that not only was this easily implemented in educational conferences that already take place, but it offered an additional learning experience for junior residents who have less experience in the operating room to ask questions and understand self-evaluation of operating room performance.