YouTube as a Surgical Education Tool - The Colorectal Disease Example
Interview by Zoe Garoufalia with Salomone Di Saverio and Valerio Celentano
Video-based surgical education has been developed over the last few years, especially now in this new COVID reality. More and more trainees and fellows are utilising video material as a surgical education tool; in a way, this has also allowed us to overcome the lack of specialised surgeons performing specific procedures.
Professor Salomone Di Saverio (right) and Mr Valerio Celentano (centre), pioneers in their fields, shared with ESCP their experience with the use of YouTube as a Surgical Education Tool.
Professor Salomone Di Saverio is a well-known colorectal, general surgeon and researcher. Following a laparoscopic surgery fellowship in Bristol, he worked as a consultant surgeon in the Ospedale Maggiore di Bologna, Italy for eight years. In January 2018 he moved to Addenbrookes Hospital in Cambridge working as a substantive consultant in one of the most renowned colorectal units in the UK, before returning to Italy to work at La Sapienza University of Rome where he has been appointed Associate Professor of General Surgery and Director of the General Surgery department at ASUR Marche, AV5, Hospital of San Benedetto del Tronto (AP).
Mr Valerio Celentano is also a well-known consultant colorectal surgeon at Chelsea and Westminster Hospital, London, where he is the colorectal lead for Inflammatory Bowel Disease surgery and Ileoanal Pouch Service and a core member of the endometriosis and colorectal cancer multidisciplinary team. From 2017-2020 Mr Celentano worked as Consultant Colorectal Surgeon at Queen Alexandra Hospital, Portsmouth, leading on surgical treatment of IBD and endometriosis. Prior to becoming a consultant surgeon, he undertook colorectal surgery fellowships in nationally recognized LAPCO training Units in the UK, gaining vast experience in minimally invasive surgery for the treatment of colorectal cancer and IBD (Crohn’s and Ulcerative Colitis). Mr Celentano is actively involved in medical education and surgical training. He holds a Honorary Senior Lectureship at Imperial College London and has a strong interest in research.
Zoe Garoufalia (ZG): Thank you very much for agreeing to speak with the ESCP audience about the use of YouTube in surgical education.
Valerio Celentano (VC): Thank you Zoe and ESCP!
ZG: What is and what should be, in your opinion, the role of videos in surgical education? Why?
Salomone Di Saverio (SDS): Surgical education is a very hard and lifelong learning process. The surgical learning process is influenced from several problems such as restriction of surgical training hours through clinical work during training and increased information to learn. In addition, the advent of minimally invasive procedures, such as laparoscopy and robotic surgery, has increased the complexity of surgical techniques, placing higher educational and technical demands for residents and younger surgeons. Several studies have shown that multimedia-based training (graphics, audio, video, animation and data) can significantly improve surgical performance, specifically converting cognitive input in to long-term memory, to better understand the progress of clinical procedures and improved understanding of complex temporal and spatial events, especially if an instructional video is watched before surgery. I think surgical videos also have the benefit of allowing viewers to connect remotely, learn from different surgeons, review material at any time, and in some cases, interact with the operating surgeon. Furthermore quality in these resources in mandatory and peer-review and journal should be implemented.
ZG: Can surgical videos substitute the traditional in person surgical education?
SDS: No, absolutely! But video characteristics, availability, and thriving spread present the opportunity of complementing current surgical teaching flaws aiming at standardisation, updating and ease-of-access of currently available tools to optimise surgical teaching. It is an addition to traditional education: verbal lectures, theoretical seminars, training in the skill laboratory, verbal feedback by supervisor surgeons, and text reading.
ZG: How can one judge the quality and reliability of the video? Is it safe practice to copy techniques seen online?
SDS: The Internet has a wide variety of accessible videos and there is enormous variability in their quality, which is highly dependent in the source of posting. Also suggesting the creation of a ranking system that clearly distinguishes reliable videos from nonreliable ones. Furthermore I think each surgeon has a unique surgical technique, a product of long years by study, lecture, teacher’s training, and techniques seen online can only be an improvement.
ZG: In 2018 you published the LAP-VEGaS practice guidelines for reporting educational videos - could you please tell us a few words about this? What difference does structured reporting make in terms of education?
VC: The LAParoscopic Video Educational GuidelineS (LAP-VEGaS)1 were developed by an international group of surgical trainers and trainees across different specialties, to address the gap between the quality of online educational content demanded by surgeons and the extreme heterogeneity of the published videos.
Preliminary research demonstrated that surgeons in training consider surgical videos as an essential educational tool2 with approximately 90% of the trainees reporting using videos in preparation for surgery. Interviewed trainees highlighted the need for additional educational content in videos, such as patient and pathology details or audio-written commentary. A surgical video of a well performed procedure might have no educational value without context or explanation. On the other hand, in a pilot study on educational quality of online surgical videos, we evaluated 182 laparoscopic right hemicolectomy videos on several free access sources, and found that less than 20% of the videos underwent a peer review or quality control process prior to publication. Not surprisingly, the majority of the videos demonstrated poor educational content and low safety scores as assessed using the Laparoscopic Competence Assessment Tool (LCAT)4.
This body of research led naturally to the development of consensus guidelines on how to prepare and annotate a surgical video for educational purposes, and I am very grateful to the extraordinary LAP-VEGaS committee for the efforts in driving such a high impact change, testified by the application, to date, of the LAP-VEGaS guidelines in several surgical fields, including colorectal, upper GI and bariatrics, ENT, plastics, gynaecology, urology, paediatrics, general and emergency surgery.
ZG: Could surgical videos be implemented in surgical training curriculum? As an educator yourself, what is your experience on this matter?
VC: When I first approached surgery as a medical student and surgical trainee, many of the operations were performed in open surgery with very limited view of the operating field. Minimally invasive surgery revolutionised surgical training as the entire surgical team can benefit from the exact same view. This is obviously a great opportunity for recording the operation and reviewing it, and for this reason must be part of educational curricula and assessment. During my training I met some extraordinary trainers such as Prof Mark Coleman (Plymouth, UK) and Mr John Griffith (Bradford, UK), who had perfected the art of surgical training. As a fellow, I reviewed all the operations I performed and came back with three minutes of 'what I did well' and 'what I could have done better'. Time consuming, but enormously beneficial. Needless to say, as a trainer myself, I now replicate this structured debriefing with my trainees, facilitated by video recording of the surgery.
ZG: Colorectal Disease Journal has dedicated its YouTube channel to high quality surgical videos - creating a 'library' of a variety of colorectal procedures. As the two people responsible for this section, and the success of its course, what is your experience so far with video submissions and what is the aim of this section?
VC: The Colorectal Disease Video Channel is a growing community (with almost 50,000 subscribers) of surgeons sharing interesting cases, state of the art procedures, and articles for debate. We receive videos worldwide and the implementation of a structured review process really enhanced the focus on educational quality of the submitted videos. We are enormously grateful for the time and expertise of our reviewers.
SDS: I have already had an extremely positive experience with the Colorectal Disease Video Channel and vignette and techniques section in the previous decade when I had submitted several videos to CODI when this section was managed by Prof Rohan Cahil as the Editor. He kindly guided me during those submissions and eventually accepted many of them. At the beginning of 2020 I had the honour and pleasure to take over from Rohan Cahill as the Editor of this section - a great achievement after I've started as an author! My experience as an author has always been greatly positive; CODI and its video section is among the surgical journals with the fastest turnaround for submissions, and I can tell you that I have recently submitted to another journal (cannot disclose which journal) a video vignette describing one of my procedures and technical teaching, and after submitting it July 2021 this video vignette is still under review after more than 7-8 months! We can therefore be proud of our work on the CODI editorial board, with special thanks to my Associate Editor and friend Mr Valerio Celentano!
In my view, the main aim of this section remains to attempt to deliver high quality education and teaching through videos to the young generation of surgeons and surgical trainees, and ultimately to enhance the quality of surgical care for the benefit of our patients.
ZG: Do you foresee any changes in the Colorectal Disease Youtube Channel? What do you advise eligible authors do to prepare their video for submission?
SDS: I can foresee a continuous increase and climbing of the number and quality of the submissions from all five continents with a worldwide contribution to surgical knowledge. I can also foresee and look forward to seeing enhancement in the sub-specialisation and new techniques such as robotic surgery and the teaching by surgical techniques step-by-step. My advice for eligible authors when preparing a video for us is to focus on surgical videos describing techniques step-by-step rather than simple case reports and/or even when presenting a case report, prioritise the aspects of surgical techniques and steps in an how-to fashion
VC: Tell us what you are doing, why you are doing it and what challenges you faced. This way we can all learn.
ZG: Do you have a message to convey to the Young ESCP group regarding their quest to better and more efficient training?
VC: Go prepared to the theatre list, many online video resources can help you better understand what is happening in the operating room. Record and watch the procedures you perform (even if it is just a step). Ask your trainer to review it together.
SDS: Strive to become a passionate surgeon aspiring to become the best you can be and to do the best you can do. Hopefully our attempt of building an educational channel can be your 'virtual' mentor and 'master'!
ZG: Thank you very much for your time and insights.
References:
- Celentano V, Smart N, McGrath J, Cahill RA, Spinelli A, Obermair A, Hasegawa H, Lal P, Almoudaris AM, Hitchins CR, Pellino G, Browning MG, Ishida T, Luvisetto F, Cingiloglu P, Gash K, Harries R, Harji D, Di Candido F, Cassinotti E, McDermott FD, Berry JEA, Battersby NJ, Platt E, Campain NJ, Keeler BD, Boni L, Gupta S, Griffith JP, Acheson AG, Cecil TD, Coleman MG. LAP-VEGaS Practice Guidelines for Reporting of Educational Videos in Laparoscopic Surgery: A Joint Trainers and Trainees Consensus Statement. Ann Surg. 2018 Dec;268(6):920-926.
- Celentano V, Smart N, Cahill RA, McGrath JS, Gupta S, Griffith JP, Acheson AG, Cecil TD, Coleman MG. Use of laparoscopic videos amongst surgical trainees in the United Kingdom. Surgeon. 2019 Dec;17(6):334-339.
- Celentano V, Browning M, Hitchins C, Giglio MC, Coleman MG. Training value of laparoscopic colorectal videos on the World Wide Web: a pilot study on the educational quality of laparoscopic right hemicolectomy videos. Surg Endosc. 2017 Nov;31(11):4496-4504.
- Miskovic D, Ni M, Wyles SM, Kennedy RH, Francis NK, Parvaiz A, Cunningham C, Rockall TA, Gudgeon AM, Coleman MG, Hanna GB; National Training Programme in Laparoscopic Colorectal Surgery in England. Is competency assessment at the specialist level achievable? A study for the national training programme in laparoscopic colorectal surgery in England. Ann Surg. 2013 Mar;257(3):476-82.