Optimizing video review for general surgery residents: a prospective observational study

Surgical video review is increasingly used to support self-reflection and technical skill development. However, little is known about which aspects of video review are the most effective for general surgery residents. We hypothesize that senior residents would find self-review most helpful while junior residents would benefit more from guided review with an attending coach.

In this single institution prospective cohort study, residents reviewed hepatocystic triangle dissection videos cropped from laparoscopic cholecystectomy operations captured on OR Black Box where the resident was the primary surgeon during this portion of the case. Over one-hour sessions, residents completed four structured video review modalities: standardized public video, peer video, self-review, and attending coach-guided review. Attending coaches were fellowship-trained MIS faculty with surgical education training. Outcomes included perceived usefulness (5-point Likert-type scale) and modified Objective Structured Assessment of Technical Skills (mOSAT) scores.

Thirteen residents (5 seniors, 38.5% completed PGY 3-year or more) participated, having completed a mean of 72.2 (SD 36.7) laparoscopic cholecystectomies. Attending coach-guided review was rated most helpful (mean = 4.9/5), followed by self-review (4.2/5), peer video (3.3/5), and standardized public video (2.9/5). Differences across modalities were significant (ANOVA F(3,48)=6.53, p < 0.001). Junior residents tended to overestimate their performance compared to blinded coach assessment significantly more than senior residents (- 4.4 vs 1.8, p = 0.038).

Attending coach-guided video review is perceived as most useful by residents at all levels. The time investment of attending coaches appears worthwhile, as both junior and senior residents benefit most from guided expert reflection. Incorporating structured video review sessions with attending coaches could enhance surgical residency training in technical skills, decision-making, and self-assessment.