Randomized trial of the effect of video feedback on the acquisition of surgical skills

Background: Constructive feedback provides a mechanism for reinforcing learning during the acquisition of surgical skills. Feedback is usually given verbally, and sometimes documented, after direct observation by a trained assessor. The aim was to evaluate video recording as an effective modality for enhancing feedback, in comparison with standard verbal feedback alone. Methods: This was a prospective, blinded, randomized clinical trial comparing standard verbal feedback plus video with standard verbal feedback alone. Validated pro formas for assessment were used and quality control was performed by independent expert assessors. Trial participants were recorded on video performing the surgical skill, and returned the next day to perform the skill again following video and standard verbal feedback (group 1) or standard verbal feedback alone (group 2). Results: Forty-eight participants were divided equally between the two groups. There was a significant improvement in the mean overall procedure score for group 1 of 2.875 from a maximum achievable score of 20 (P = 0.003), but not for group 2. There were significant improvements in the specific domains of instrument familiarity, needle handling, skin handling and accurate apposition, again all in group 1. The only significant improvement in group 2 was in an organized approach to the task, also observed in group 1. Knot-tying security deteriorated after feedback in group 2 but not in group 1. Conclusion: The addition of video feedback can improve the acquisition of surgical skills, and could be incorporated into formal surgical curricula.