Isreb Siddek, Attwood Stephen, Hesselgreaves Hannah, McLachlan John, Illing Jan
Department of Health Services Research, Durham University, Stockton on Tees, Durham, United Kingdom.
Department of Health Services Research, Durham University, Stockton on Tees, Durham, United Kingdom.
J Surg Educ. 2021 Jan-Feb;78(1):1-8. doi: 10.1016/j.jsurg.2020.07.014. Epub 2020 Aug 5.
UK surgical training currently faces the challenge of expanding surgical skills in a context of reduced training opportunities. Video-review in theatre offers the potential to gain more from each learning opportunity and to enhance feedback.
This was a designed-based study to test the feasibility of using synchronized video-review as a reflective tool to enhance surgical training and to gain a deeper understanding of intraoperative feedback.
Ten supervised laparoscopic cholecystectomy operations were video-recorded using a synchronized split screen, to show trainees' actions, instrument manipulation, and interactions with other theatre staff. This was followed up by joint review of the operation-recording by both the trainee and supervisor. Video-review sessions were audio-recorded along with the consultant and Specialist Registrar interviews after the review session. Audio recordings were thematically analyzed. Supervisors completed the Procedure-Based Assessment forms, twice: post operation and post video-review to check potential trainers' enhanced insight. Forms were analyzed to note any changes and to triangulate the findings.
Overall trainee and supervisor feedback was positive. Trainees and supervisors reported the video-review added value in terms of reflection-on-action. It removed the stress of conducting/supervising the operation in real time and focused the attention on feedback. Satisfaction was reported across trainee levels with both scrubbed and unscrubbed supervisors. Audio-visual review allowed trainees to understand the feedback better and to identify new targets beyond those gained from the verbal feedback during the procedure. It also facilitated appraisal of the trainer's teaching.
This study established the feasibility of using synchronized video-review as a reflection-on-action tool to potentially enhance surgical training by improving feedback. It identified trainees' difficulty in processing intraoperative feedback due to mental overload from the operation. It showed the limitations of current verbal feedback practice, using Procedure-Based Assessment forms, with regard to enhancing technical and nontechnical skills due to denial and memory fading.
英国外科培训目前面临着在培训机会减少的情况下扩大外科技能的挑战。术中视频回顾有可能从每个学习机会中获得更多收获并加强反馈。
这是一项基于设计的研究，旨在测试使用同步视频回顾作为一种反思工具来加强外科培训并更深入了解术中反馈的可行性。
使用同步分屏对十例有监督的腹腔镜胆囊切除术进行视频记录，以展示学员的操作、器械操作以及与手术室其他工作人员的互动。随后学员和带教老师共同回顾手术记录。视频回顾环节进行了音频录制，回顾结束后还对顾问医生和专科住院医生进行了访谈。对音频记录进行了主题分析。带教老师两次填写基于操作的评估表：术后和视频回顾后，以检查潜在培训者的洞察力是否有所增强。对表格进行分析以记录任何变化并对结果进行三角验证。
学员和带教老师的总体反馈是积极的。学员和带教老师报告称，视频回顾在行动反思方面增加了价值。它消除了实时进行手术/监督手术的压力，并将注意力集中在反馈上。不同水平的学员对洗手和未洗手的带教老师都表示满意。视听回顾使学员能够更好地理解反馈，并确定手术过程中口头反馈之外的新目标。它还促进了对培训者教学的评估。
本研究确定了使用同步视频回顾作为行动反思工具通过改善反馈来潜在加强外科培训的可行性。它指出学员由于手术导致的精神负担过重，在处理术中反馈方面存在困难。它显示了当前使用基于操作的评估表进行口头反馈实践在增强技术和非技术技能方面的局限性，因为存在否认和记忆消退的问题。
