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Original Investigation
April 2017

Complementing Operating Room Teaching With Video-Based Coaching

Author Affiliations
  • 1Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 3currently with the Department of Surgery, Connecticut Children’s Medical Center, Hartford
  • 4Goodman Surgical Education Center, Department of Surgery, Stanford University, Palo Alto, California
  • 5STRATUS (Simulation, Training, Research and Technology Utilization System) Center for Medical Simulation, Brigham and Women’s Hospital, Boston, Massachusetts
  • 6Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 7Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 8currently with the Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia
  • 9Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
  • 10Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
JAMA Surg. 2017;152(4):318-325. doi:10.1001/jamasurg.2016.4619
Key Points

Question  Is post hoc video-based coaching an effective modality for teaching residents to operate?

Findings  This mixed methods analysis compared teaching in a video-based coaching session with teaching during the corresponding operating room case. During video-based coaching, instruction was more individualized to the resident, and higher-level concepts, such as decision making, were discussed.

Meaning  In this era of reduced resident operative time and autonomy, intraoperative education may be supplemented by video-based coaching.


Importance  Surgical expertise demands technical and nontechnical skills. Traditionally, surgical trainees acquired these skills in the operating room; however, operative time for residents has decreased with duty hour restrictions. As in other professions, video analysis may help maximize the learning experience.

Objective  To develop and evaluate a postoperative video-based coaching intervention for residents.

Design, Setting, and Participants  In this mixed methods analysis, 10 senior (postgraduate year 4 and 5) residents were videorecorded operating with an attending surgeon at an academic tertiary care hospital. Each video formed the basis of a 1-hour one-on-one coaching session conducted by the operative attending; although a coaching framework was provided, participants determined the specific content collaboratively. Teaching points were identified in the operating room and the video-based coaching sessions; iterative inductive coding, followed by thematic analysis, was performed.

Main Outcomes and Measures  Teaching points made in the operating room were compared with those in the video-based coaching sessions with respect to initiator, content, and teaching technique, adjusting for time.

Results  Among 10 cases, surgeons made more teaching points per unit time (63.0 vs 102.7 per hour) while coaching. Teaching in the video-based coaching sessions was more resident centered; attendings were more inquisitive about residents’ learning needs (3.30 vs 0.28, P = .04), and residents took more initiative to direct their education (27% [198 of 729 teaching points] vs 17% [331 of 1977 teaching points], P < .001). Surgeons also more frequently validated residents’ experiences (8.40 vs 1.81, P < .01), and they tended to ask more questions to promote critical thinking (9.30 vs 3.32, P = .07) and set more learning goals (2.90 vs 0.28, P = .11). More complex topics, including intraoperative decision making (mean, 9.70 vs 2.77 instances per hour, P = .03) and failure to progress (mean, 1.20 vs 0.13 instances per hour, P = .04) were addressed, and they were more thoroughly developed and explored. Excerpts of dialogue are presented to illustrate these findings.

Conclusions and Relevance  Video-based coaching is a novel and feasible modality for supplementing intraoperative learning. Objective evaluation demonstrates that video-based coaching may be particularly useful for teaching higher-level concepts, such as decision making, and for individualizing instruction and feedback to each resident.