Synchronized Video-Review as a Tool to Enhance Reflection and Feedback: A Design-Based Feasibility Study

Abstract

Introduction: 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.

Aim: 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.

Method: 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.

Results: 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.

Discussion: 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.

Keywords: audio-visual; laparoscopic; reflection; surgical skills; training; video.