Videotape Review Program To Enhance Resident Training in Laparoscopic Inguinal Hernia Repairs

Ryota Tanaka, MD, PhD, Yalini Vigneswaran, MD, John Linn, MD, JoAnn Carbray, BA, Woody Denham, MD, Stephen Haggerty, Michael Ujiki, MD. Department of Surgery, Section of Minimally Invasive Surgery, NorthShore University HealthSystem

INTRODUCTION: The purpose of this study was to determine if a standardized video review program for residents can improve clinical operative performance scores.

METHODS: Participation was voluntarily offered to surgical residents at all levels of training rotating on the minimally invasive service at our institution. Surgical residents were randomized to either the video review group or no video review group. Every participant in the video review group underwent video reviews with a coach for thirty minutes once a week during their one-month rotation. Throughout the month a blinded trained observer evaluated the performance of all participants in the operating room using validated assessment tools, the Global Operative Assessment of Laparoscopic Skills-Groin Hernia (GOALS-GH) and visual analogue scale (VAS). The amount of time that the resident spent as chief surgeon was recorded for each case. Participants were additionally surveyed with confidence of the skills questionnaires at the beginning and the end of the month. One-way analysis of variance was used to compare scores between the video and the no video review groups. Within each group GOALS-GH and VAS scores were also compared between scores during the first 10 days of the month and those during the last 10 days of the month. Differences were considered statistically significant for p values less than 0.05.

RESULTS: A total of 10 residents were randomized to the video review group (n=5) or the no video review group (n=5). We observed significantly higher GOALS-GH scores at the end of the month in the video review group as compared to the no video review group (fig. 1; p= 0.01). All participants in the video group had improvement of scores at the end of the month with statistically significant improvement in one of the five items, hernia sac identification and reduction (p=0.03). The video review group demonstrated significant improvement in VAS at the end of the month (p =0.01) whereas the no video review group showed a decline in VAS. The video review group had a significant increase in both the fraction of time the residents spent as chief surgeon (p=0.002) and in confidence questionnaire scores (p=0.04).

CONCLUSION: Video review with a coach proved to be beneficial for residents when learning laparoscopic inguinal hernia repairs as demonstrated on GOALS-GH, VAS and self-reports of acquired skills. We conclude systematic video review is a good supplemental tool in the resident surgical training curriculum.image

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