A Novel Technology Platform for Surgical Video Coaching in Orthopaedic Training: Our Initial Experience and Resident Feedback Chris A. Anthony MD, Geb Thomas PhD, Xiaoxing Liu MS, Matt Karam MD University of Iowa Department of Orthopaedic Surgery and Rehabilitation

Background

MethodsAll patients (n=7) gave informed consent to have their surgical proce-dure captured on video. Each orthopaedic resident surgeon (n=7) subsequently performed a surgical intervention on a patient with an ankle or hip fracture with a hi-de�nition portable video camera posi-tioned on their forehead. The video obtained was processed and up-loaded to a secure Internet server. Orthopaedic residents and surgeons utilized an internally designed web and mobile Internet website (Fig. 1) to view surgical video (Fig. 2) and provide coaching via free text input and a 9-point rating scale (Fig. 3). The website was built using the Hyper-text Preprocessor (PHP), Apache, and MySQL programming languages. Subjective experiences of orthopaedic residents who used the technol-ogy platform were acquired though a post-experience questionnaire.

Results

Discussion

Entrance Pivot: Knee Flexion (n=140)

0

10

20

30

40

50

60

A/P NO ACLA/P ACL

I/E NO ACL I/E ACL

3

12

7

25

34

30

1

9

4

24

34

30

Figure 8 These data (min, quartiles, max) represent the knee joint �exion angles at the maximum anterior translation and maximum internal rotation of the entrance pivot.

0

3

6

9

12

15

A/P NO ACL A/P ACL I/E NO ACL I/E ACL0.3

1.5

0.80.3

1.7

0.80.3

1.7

0.50.3

1.8

0.8

Exit Pivot: Inter-Rater Error

Figure 11 These data (min, quartiles, max) represent the marginal di�erences between four raters in maximum anterior translation and maximum internal rotation during the exit pivot.

0

3

6

9

12

15Entrance Pivot: Inter-Rater Error

A/P NO ACL

A/P ACL

I/E NO ACL I/E ACL0.3

1.5

0.5 0.5

1.51.0

0.5

1.8

1.0

0.5

2.3

1.0

Figure 10 These data (min, quartiles, max) represent the marginal di�erences between four raters in maximum anterior translation and maximum internal rotation during the entrance pivot.

Figure 13 These data represent the marginal di�erences between each of two trials for each rater on each knee specimen relative to the exit pivot. Each rater is identi�ed by numbers 1-4.

No ACL A/P

ACL A/PNo ACL I/EACL I/E

Exit Pivot: Intra-Rater Error

0.0

0.5

1.0

1.5

2.0

2.5

1

2 3

4

Figure 12 These data represent the marginal di�erences between each of two trials for each rater on each knee specimen relative to the entrance pivot. Each rater is identi�ed by numbers 1-4.

No ACL A/P

ACL A/PNo ACL I/E

ACL I/E

Entrance Pivot: Intra-Rater Error

0.2

1.0

0.8

0.6

0.4

12

3 4

Figure 1 Anteriorly directed tibial force coupled with an internal rotary tibial force during knee joint range of motion comprise the LPPST.

IP pending

0

5

10

15

20

25

30

A/P NO ACL

I/E NO ACL

A/P ACL

I/E ACL

4

8

6

0

21

9

15

12

8

1311

Entrance Pivot: Maximum A/P and I/E (n=140)

Figure 6 These data (min, quartiles, max) represent the maximum anterior tibial translation and maximum internal tibial rotation during the entrance pivot.

0

5

10

15

20

25

30

A/P NO ACL

A/P ACL

I/E ACL

Exit Pivot: Maximum A/P and I/E (n=120)

I/E NO ACL

4

9

6

0

21

9

15

12

9

13

11

Figure 7 These data (min, quartiles, max) represent the maximum anterior tibial translation and maximum internal tibial rotation during the exit pivot.

The majority of adverse surgical events are attributable to surgeon tech-nical error. Previous authors have found video coaching in the setting of orthopaedic training to be an e�ective tool. New, low-cost tools allow video data to be easily acquired, stored, and presented for viewing and analysis. The purpose of this study is to describe our initial experience with video capture in the operating room and our development of a novel digital interface that allows orthopaedic surgeons and residents to give and receive coaching on surgical video. We present subjective experiences with our technology platform through resident responses to a post-experience questionnaire.

Orthopaedic residents who used this technology platform thought that viewing video of themselves performing surgery and receiving coach-ing from other surgeons through a digital interface was useful. Further work is required to alleviate human factors issues in the video acquisi-tion process and to understand the most e�cient work�ow from video data acquisition to presentation of surgical video that is suitable for viewing and evaluation in the setting of orthopaedic education.

Fig. 1

Fig. 3

Fig. 2

ResultsOf 7 residents who took part in the study, 83% rated the video camera positioned on their head as mildly uncomfortable or uncomfortable a majority of the time. 86% of residents thought watching themselves perform surgery was a useful tool to improve surgical skills. 83% of resi-dents thought receiving coaching on their surgical video from a trained orthopaedic surgeon utilizing our Internet website would aid their or-thopaedic education; 50% of residents thought receiving coaching from other residents would be useful (50% thought possibly useful). Resi-dents commented that the ability to redirect the camera’s aim intraop-eratively would be helpful and that incorporation of �uoroscopy images would improve the educational value of their videos.