Enhancing surgical education using video playback: A case study on the influence of video playback on the nature and experience of feedback between supervising surgeons and surgical residents.
Introduction: Feedback about intraoperative performance remains a cornerstone of surgical training, and yet perceptions of feedback quality by supervising surgeons and surgical residents differ. Video playback offers one potential method for more effective feedback to surgical residents. More research is needed to better understand this tool. This study explores the nature of instructional interactions and feedback in the operating room and when using video playback during post-operative review. Methods: Three surgical residents and five supervising surgeons were involved in six laparoscopic cases. Data collected included the intraoperative and video playback conversations between the resident and supervising surgeon and semi-structured interviews exploring the resident and supervising surgeon experience of using video playback as a feedback tool. A combination of deductive, inductive and hermeneutic analytic approaches was used. Data was triangulated to develop the big ideas. Results: Analysis of the intraoperative verbal interactions identified that the majority of these interactions (48%) were instrumental and didactic in nature. By contrast, most interactions during video playback were teaching in nature (65%) and the sessions were dialogic. Video playback was perceived as a valuable tool by residents and supervising surgeons for feedback on surgical performance. Participants valued the exact visual representation of the surgical performance provided by the video as it provided cues for specific feedback. They also perceived the video playback environment to be calm and lower in cognitive load, allowing for optimized learning. Both the residents and supervising surgeons found the video was a useful tool to self- reflect on their own performance. These results were further explored through the lenses of social cognitive theory and cognitive load theory. Conclusions: The two big ideas which emerged from this research were: the environment in which video playback occurred contributed positively to the feedback experience, and feedback using video playback is a dialogic critical visual review of the performance. Video playback provided a surgical learning opportunity outside of the operating room which maintained the contextual verity of the surgical case performed.