# The Next Upgrade for Surgical Procedure-Based Assessments: Clinical Video Footage

## TL;DR

This study explores how using clinical video footage can improve surgical trainee assessments and reflection, while also highlighting legal and practical challenges.

## Contribution

The study introduces the potential of intraoperative video for enhancing procedure-based assessments and reflective practice among orthopaedic trainees.

## Key findings

- Most trainees believe video recordings would help with reflective practice and PBA completion.
- Over half of trainees did not complete PBAs with their consultant, suggesting current methods are flawed.
- The study identifies medicolegal and ethical concerns that need addressing before routine video use.

## Abstract

Introduction

Video recording to teach and assess both technical and non-technical skills is well-established within medical education. Trainees’ clinical and practical competencies are evaluated using procedure-based assessments (PBAs). However, there is limited research describing how these PBAs truly reflect trainee performance.

Objectives

We sought to quantify timing and consultant involvement in PBA completion among orthopaedic trainees, explore trainees’ views on intraoperative video for reflection and PBA completion, and summarise key medico-legal and ethical considerations for routine intraoperative recording in the UK.

Method

We surveyed orthopaedic trainees in the East of England Deanery, United Kingdom. This is a pilot study to highlight the limitations of current systems of PBAs and to explore the potential utility of videos in PBAs. The survey was developed as a pilot by the authors of the study with the consultation of the senior author and pretested amongst the trainees of one hospital before the actual survey was distributed. A six-item questionnaire was then sent out to all trainees of the deanery in online and paper form during face-to-face deanery teaching and to email addresses recorded with the deanery. The responses were recorded and collated directly in the case of paper forms and via a reliable survey platform for the online responses.

Results

The survey response rate was 75% (55/73). Thirty-three trainees (60%) felt that current PBAs do not allow them to highlight their strengths and weaknesses, 48 (87%) felt that retrospective access to a video recording would aid reflective practice, and 39 (71%) felt it would assist with PBA completion. Twenty-seven trainees (49%) reported not completing their PBAs with their consultant.

Conclusion

This paper highlights potential limitations in existing forms of trainee assessment and feedback. We suggest using trainees’ clinical footage to evaluate skills and performance and enhance feedback in PBAs, which has resonated well with trainees, the intended beneficiary. We discuss in detail the medicolegal implications of cameras in operative training, with possible limitations to their adoption in current practice. While video has potential educational value, further research is required to evaluate practical, legal, and educational impacts before widespread implementation.