Video Playback as an Educational Tool for Improving Resident Laparoscopic Performance: A Randomized Controlled Trial.

STUDY OBJECTIVE: In this single-masked randomized controlled study, we evaluate whether watching video recordings of oneself performing Fundamentals of Laparoscopic Skills (FLS) exercises results in an improvement on the 30-point Global Operative Assessment of Laparoscopic Skills (GOALS) assessment among Obstetrics and Gynecology (Ob/Gyn) residents. DESIGN: Twenty-three Ob/Gyn residents in the 2020-2021 academic year completed the FLS exercises while being timed, video recorded, and receiving real-time feedback from an Ob/Gyn faculty member. Baseline GOALS assessment was completed by participants and faculty. After the intervention, all participants then repeated the FLS exercises while being timed and were again scored using the GOALS assessment. Each participant completed the study in a single session. In addition, all participants completed a pre- and post-test survey. SETTING: University of Louisville Laparoscopic Skills Labortaory. PARTICIPANTS: University of Louisville Ob/Gyn residents in the 2020-2021 academic year. INTERVENTION: Twelve participants were randomized to the intervention and were allowed to watch their video recording in addition to receiving verbal feedback whereas the remaining 11 received verbal feedback only. MEASUREMENTS AND MAIN RESULTS: There were significant improvements in faculty (p <.01) and self-reported GOALS scores (p <.01) when comparing both the intervention and control group with baseline scores. The intervention group improved by 3.2 points more than that of the control group based on masked faculty evaluation (95% confidence interval, 1.4-5.0 points; p <.01). The difference was not significant in resident self-scores. Overall time improved for all participants (15:54 ± 0.21 minutes before and 13:13 ± 0.14 minutes after), but this difference was not significant between the 2 groups. Higher postgraduate year (PGY) residents reported significantly more comfort performing laparoscopic tasks, earned higher GOALS score (faculty and self-scores), and completed the first set of exercises in less time. A significant interaction between PGY and intervention was detected with improvement in GOALS score most strongly associated with PGY4 residents (p <.01). CONCLUSION: Although all learners objectively benefit from watching recordings of themselves performing surgical tasks, advanced learners may benefit the most when video recordings are used as an educational tool.

Does Value Vary by Center Surgical Volume for Neonates With Truncus Arteriosus? A Multicenter Study.

BACKGROUND: Truncus arteriosus is a congenital heart defect with high resource use, cost, and mortality. Value assessment (outcome relative to cost) can improve quality of care and decrease cost. This study hypothesized that truncus arteriosus repair at a high-volume center would result in better outcomes at lower cost (higher value) compared with a low-volume center. METHODS: This study retrospectively analyzed a multicenter cohort of neonates undergoing truncus arteriosus repair (2004 to 2015) by using the Pediatric Health Information Systems database. Multivariate quantile, logistic, and negative binomial regression models were used to evaluate total hospital cost, in-hospital mortality, ventilation days, intensive care unit length of stay (LOS), hospital LOS, and days of inotropic agent use by center volume (high-volume >3/year) and age at repair while adjusting for sex, ethnicity, race, genetic abnormality, prematurity, low birth weight, concurrent interrupted arch repair, and truncal valve repair. RESULTS: Of 1024 neonates with truncus arteriosus, 495 (48%) were treated at high-volume centers. Costs at the 75th percentile were lower at high-volume vs low-volume centers by $28,456 (P = .02) at all ages at repair. Patients at high-volume centers had lower median postoperative ventilation days (5 days vs 6 days; P < .001), intensive care unit LOS (13 days vs 19 days; P < .001), hospital LOS (23 days vs 28 days; P = .02), and inotropic agent use (3 days vs 4 days; P = .004). In-hospital mortality did not differ by center volume. CONCLUSIONS: In neonates undergoing truncus arteriosus repair, costs are lower and outcomes are better at high-volume centers, thus resulting in higher value at all ages of repair. Value-based interventions should be considered to improve outcomes and decrease cost in truncus arteriosus care.