'Viewer discretion advised when preparing for surgery' - why YouTube cannot teach you how to do an upper blepharoplasty. An evaluation of the educational potential of surgical videos on blepharoplasty on YouTube.

Over the last years, the layout of surgical training has significantly changed. Surgical residents rely on YouTube videos to prepare for upcoming cases. Eyelid surgery including blepharoplasty ranks among the 5 most often performed cosmetic surgeries. It will be one of those surgeries regularly researched by plastic surgery residents. Therefore, the aim of this study was to evaluate the educational value of the most viewed upper lid blepharoplasty videos on the most popular video broadcasting website, YouTube. A video scoring system consisting of 8 items was developed in accordance with the technical details described in the literature. Video scores were categorized into 3 groups, namely as 'poor', 'moderate; or 'good' in terms of their contribution to surgical education. The first 300 videos were evaluated for the search results for 'blepharoplasty'. After exclusion and summarization of video fragments, a total number of 36 videos were included in the study. Multivariable logistic regression models found no correlation between likes, views, comments and the attributed educational score. The quality of available educational surgical video content varies widely, and surgical trainees need to be critically aware of this as view counts as well as the number of likes and comments will not necessarily relate to videos' educational quality. There is a need for high-quality educational videos.

Improving Resident Performance in Oculoplastic Surgery: A New Curriculum Using Surgical Wet Laboratory Videos.

OBJECTIVE: To develop a new oculoplastic curriculum that incorporates learning theory of skill acquisition. To develop and evaluate the effectiveness of instructional videos for an oculoplastic surgical wet laboratory. DESIGN: Proof of concept, randomized controlled trial. SETTING: New York Eye and Ear Infirmary of Mount Sinai-tertiary care academic institution. PARTICIPANTS AND METHODS: In total, 16 ophthalmology residents were randomly assigned to 1 of 2 groups and given either video and text or text instructions alone for the following 2 procedures: blepharoplasty and eyelid laceration repair. Operating time and esthetic result were measured, and the groups were statistically compared. A brief survey was administered. RESULTS: We developed a new 6 component oculoplastics curriculum that incorporates concepts of the Fitts and Posner skill acquisition model and mental imagery. In the wet laboratory pilot study, the group that watched the video of the laceration repair showed better esthetic grades than the group that received text alone (p = 0.038). This difference was not found for the blepharoplasty (p = 0.492). There was no difference between groups in operating time for the laceration repair (p = 0.722), but the group that watched the blepharoplasty video required more time to complete the task than those that reviewed text only (p = 0.023). In total, 100% of residents reported the videos augmented their learning. CONCLUSIONS: Methods to optimize surgical education are important given limited operating room time in oculoplastics, a subspecialty in which the number of surgeries performed during residency is relatively low. We developed a curriculum based on learning theory and sought to formally test one important aspect, surgical video for wet laboratories. Our pilot study, despite its limitations, showed that wet laboratory surgical videos can be effective tools in improving motor skill acquisition for oculoplastic surgery.

Blepharoptosis repair outcomes from trainee versus experienced staff as the primary surgeon.

PURPOSE: To compare outcomes of conjunctival Müllerectomy with or without tarsectomy versus external levator advancement for correction of upper blepharoptosis when performed by trainee versus staff surgeons. DESIGN: Retrospective, nonrandomized, interventional, consecutive case series. METHODS: Charts of patients undergoing conjunctival Müllerectomy with or without tarsectomy and external levator advancement blepharoptosis repair from January 2006 through December 2009 were reviewed. Main outcome measures included age, gender, preoperative and postoperative use of artificial tears, preoperative and postoperative marginal reflex distance, surgical complications, surgeon (trainee or staff surgeon), and anesthesia time. The Student t test was used for statistical analysis. RESULTS: A total of 170 patients underwent 248 surgeries (154 conjunctival Müllerectomies with or without tarsectomy and 94 external levator advancements). There were 108 female and 62 male patients. Mean patient age was 62 years (range, 3 to 94 years). Forty-one (24%) patients (26 conjunctival Müllerectomies with or without tarsectomy and 15 external levator advancements) underwent concurrent eyelid surgery, such as blepharoplasty. Trainees performed surgery on a total of 88 (35%) eyelids in 60 patients (35%). There was no significant difference in the percentage of cases undergoing concomitant surgery between trainee and staff surgeons (P = .18). The mean postoperative marginal reflex distance difference was 0.53 and 0.59 for trainee and staff surgeons, respectively. Mean overall anesthesia time was 26.8 minutes and 30.3 minutes for trainee and staff surgeons, respectively. Complications, including increase in dry eye or irritative symptoms and reoperation, occurred in 8 (13%) of 60 patients undergoing surgery by a trainee surgeon and in 22 (20%) of 110 patients undergoing surgery by staff surgeon. There was no significant difference in eyelid symmetry (P = .55), mean anesthesia time (P = .14), complication rate (P = .26), or reoperation rate (P = .17) when surgery was performed by a trainee versus a staff surgeon. CONCLUSIONS: There is no significant difference in mean postoperative marginal reflex distance, mean anesthesia time, complication rate, or reoperation rate between either conjunctival Müllerectomy with or without tarsectomy or external levator advancement blepharoptosis repair performed by trainee versus staff surgeons.