Video-Based Assessment of Surgical Skill in Orthopaedic Surgery: A Technique Guide to Capturing Critical Surgical Detail

Abstract

Introduction: Surgical skills are critical to assess in residency programs. These observations often occur in the clinical settings, which are limited by patient safety and potential bias. High fidelity simulated cadaveric surgery can account for some of these shortcomings. Professional video offers a promising avenue to both anonymize and effectively evaluate surgical skill. The objective of this study were to describe the technique for professional video capture of simulated, open orthopaedic surgeries and to assess construct validity by comparing objective performance scores from the videos with the learner's stage of training.

Methods: In 2022, one experienced surgeon and 3 trainees (post graduate year [PGY]-4, PGY-3, PGY-2) were recruited from a residency program to perform 2 moderately challenging surgeries (open reduction and internal fixation of both bone forearm and talus fractures), with fractures simulated using an osteotome. Videographers positioned cameras at various positions throughout a skills laboratory. Total costs were calculated. Statistical analysis was performed to compare evaluator scores of participants' actual level of training.

Results: The simulated surgeries were recorded, edited for optimal viewing angles, and anonymized by blurring faces and voice over technology. Seventeen local teaching faculty were recruited to evaluate the videos. The videos were shortened on average 65 minutes for critical steps to be represented in the final production (i.e., Bone reduction, dissection of neurovascular structures, radiographic images, etc.) The full cost to produce the 8 surgical videos was $48,934.00 Canadian dollars. The final data set had 61 observations, with a range of 13 to 17 observations per participant. There was a 19.7% error rate, meaning the videos were generally 80% accurate in predicting the year of training.

Conclusions: The discriminative ability of the videos was better at detecting true "novice" and "expert" surgeons but less accurate between the middle years of training. A larger, multicentered study with more participants is needed to draw any further conclusions.

Fig. 1

Fracture created using an osteotome through dorsal incision of both bone forearm fracture.

Fig. 2

Graphic showing an overhead view of the room layout during the S-OSCE. S-OSCE = Surgical observed structured clinical examinations.

Fig. 3

A photograph of the room set up at the time of the S-OSCE. S-OSCE = Surgical observed structured clinical examinations.

Fig. 4

Participant performing surgical fixation of both bone forearm fracture with an assistant and scrub nurse.

Fig. 5

Average surgeon scores based on year of training/experience.