Abstract
An online video-based learning program in nerve surgery was developed in this
thesis as an educational framework to (1) translate expertise globally into clinical
practice, (2) implement the constant improvements and innovation in surgery which
essentially comes to a halt after surgical training, and (3) address the training disparities
and need for improved outcomes.
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Innovation is a vital process for the advancement
of surgery and contributes to improved life expectancy and enhanced quality
of life. However, this passive process from ideation to implementation can take
many decades, an estimated 17 years for just 14% of medical research to translate
from benchtop to bedside and influence patient care. The expert-performance approach
proposes to identify superior performance, study performance, and create
training methods to facilitate cognitive representations associated with expertise.
Video is a rich medium to capture expertise and promote visual learning from modeled
examples especially in nerve surgery, a specialty with an illustrious history of
innovation and defined management paradigms. When combined with expert-performance,
video-based learning provides an opportunity to accelerate surgical innovation
through the active process of dissemination and implementation. In this
thesis, an online video-based learning program in nerve surgery was developed as
an educational framework to translate expertise globally into clinical practice by
using YouTube for audience outreach and a surgeon-focused platform to maximize
educational value. The program recruited 1,500+ surgeons (54% in-practice, 46%
trainees) and received 4M+ views (69% outside the U.S.) from across the world. Of
the registered users, 43% were active learners at least once a month. To validate
this model, learning analytics were introduced to establish surgeon engagement
as a benchmark for quality in surgical videos and dynamic lectures teaching clinical
reasoning. To examine the role of surgical videos in learning technical skills,
novice residents improved performance by having fewer operative errors and improved
confidence when learning from videos in a simulated cadaveric study. To
teach clinical reasoning to our membership and accompany the surgical videos, a
video-based module was designed using the cognitive theory of multimedia learning
(CTML) and demonstrated knowledge acquisition and retention in surgeons, indicting
potential long-term practice change and adoption of novel evidence-based
procedures. Ethical development of innovative procedures is paramount and mandates
robust evaluation for safety, efficacy, and effectiveness. In designing training
methods to translate expertise and reduce learning curves, an ethical dilemma was
encountered regarding the use of an atlas, derived from victims of the Holocaust,
in surgery and education. To address this issue, the use of Pernkopf’s atlas was assessed
in surgical practice to develop a four-point proposal for its ethical handling
to include disclosure, bioethical and religious considerations, and remembrance.
Based on the authority of the Vienna Protocol, ethical and religious guidelines were
created using a four-option framework to permit its use in surgery and education
when physicians acknowledge and disclose its immoral origins, in a manner that
honors the victims. These combined results indicate video-based learning as an
effective approach for the dissemination and implementation of surgical innovation
when guided by expert-performance and CTML, and thereby creates a learning environment to develop guidelines that address ethical issues encountered at the
intersection of surgery, anatomy, and education. This educational framework warrants
identifying expertise in surgery to expand training opportunities that transcend
geographic, economic, racial, gender, and language barriers and address
disparities in healthcare across the world.
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