Video Commentary: Rapid-Fire Assessment of Surgical Cognitive Skills

We describe the use of "Video Commentary", an assessment using a set of operative videos, to assess trainees' surgical cognitive skills (operative knowledge, spatial awareness, and surgical insight).

The Video Commentary assessment has been routinely administered to Postgraduate Year (PGY) 1-5 general surgery residents since 2014 as part of a biannual multistation, OSCE-type exam at Mayo Clinic, Rochester, MN. Video Commentary is a rapid-fire, 6-minute assessment, where trainees watch a series of 20 to 30 second operative video clips and comment on them as they play. Each clip varies in procedure, approach, difficulty, and complexity. The combination of video clips differs according to trainees' PGY level except for a few videos that overlap among PGY groups. The name of the procedure is provided at the beginning of each clip with a countdown timer showing in the corner of the screen. A comprehensive checklist is used to score trainees' performance in real-time.

Assessment of trainees of different levels and staff surgeons show a positive correlation with the experience level (p = 0.0001). The assessment provides a safe alternative to assess trainees in the operating room and encourages them to become more effective communicators. With the use of technology, large video databases can be created to provide just-in-time tailored feedback to the trainees.

Video Commentary can serve as a time and resource-efficient assessment of trainees' surgical cognitive skills and insight. The use and demand of real-time commentary on operative videos may provide a viable approach to help surgeon educators determine trainees' baseline, progression, and readiness to advance.