Evaluating the effect of online surgical education on intraoperative cholangiogram interpretation: a pilot study

Web-based educational tools can support practitioners in their early years of surgical training. Such tools may be an alternative platform to meet the changing needs in surgical training and professional development and may help explain complex surgical principles providing a structured learning platform that is relevant in the day-to-day surgical operating room setting. We investigated the impact of an online surgical education initiative on inter-observer variability and accuracy of IOC interpretation.

A convenience sample of seven surgical observers evaluated 100 IOCs before and after an online surgical series to evaluate their interpretation. The online video series characterized IOCs using nine key elements. The seven observers were surgical trainees of varying experience, from first-year surgical trainees to surgical fellows, within a metropolitan hospital in Melbourne, Australia.

Inter-observer variability improved within six of nine key elements following the online tutorial. The accuracy of three out of these interpretations also significantly improved following the tutorial. Inter-observer agreement of proximal biliary opacification improved from moderate (kappa (κ) = 0.491) to good (κ = 0.725), with an improvement in accuracy from 95% to 99% (P = 0.009). Similarly, inter-observer agreements of cystic duct leaks dramatically improved from no agreement (κ = -0.089) to moderate agreement (κ = 0.548), with detection rates improving from 67% to 82% (P < 0.05).

Through an innovative pilot online surgical education, inter-observer agreement and overall accuracy in the key elements of IOC interpretation improved. A larger multicenter study evaluating the effect of online surgical education on intraoperative cholangiogram interpretation is justified.