Letter in response to Singh et al: A Randomized Controlled Study to Evaluate the Role of Video-based Coaching in Training Laparoscopic Skills

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To the Editor: We congratulate Singh et al1 on their valuable study evaluating video-based coaching to aid training. Indeed, with a shift to fewer working hours2,3 for surgical trainees such technology is going to be vital to enable them to learn and consolidate skills. We commend the authors on the study design and acknowledge that a randomized control trial in medical education in not only hard to implement but utilizing a control group, albeit with a small sample size, is often exceedingly challenging.
Some members of our research collaborative have recently carried out a study evaluating the use of video technology to learn simple suturing4 and have determined that video technology may facilitate greater learning. Further, our study demonstrated parity in improvement between having an expert review of performances with a trainee and the trainee reviewing their own performance in accompaniment with an expert video.4
In the present study, it is unsurprising that the intervention group, which received intensive coaching based on their performance, improved significantly over the control group who did not receive the opportunity to review their own performance. It would have been interesting to determine what level of improvement subjects would have made had they been able to review their own performance between attempts and self-assess coupled with a standardized expert video. The ability to self-assess is a vital skill in medical training5 and subjects familiar with a procedure should be able to evaluate their own performance and determine areas for improvement. It is disappointing to hear that the decision not to allow control subjects to review their own performance was based on current clinical practice at their institution, given that modern technology makes recording of laparoscopic procedures extremely feasible and something that should be encouraged, particularly in those learning new skills. Incorporating individual video review of the case into the study may have added weight to the need to do this regularly.
A final consideration is that of retention of surgical skills. Those in the intervention group were fortunate to receive intensive coaching over a short period of time, enabling considerable improvement. The question remains as to whether they are able to maintain this skill level in the longer term without an expert tutor or further reinforcement of the skill. It may well be that the excellent improvement demonstrated is short-lived and simply a transient response to the intensive coaching. The long-term improvement is the more educationally valuable measure and it is the impact on this that needs to be established.
We agree that video technology has an important future for learning and refining clinical and surgical skills. The important component, however, is not in the technology per se but lies in the means, by which feedback could be provided to the learner. Logistically, coaching seems not to be implementable on a large scale for those undergoing simulated training, with the requirements for one-on-one setting of goals and realization of these goals and assessment taking up considerable time for both the educator and the learner. We envisage integrating self-assessment early into medical curricula to enable students to learn this vital skill and ensure their continuous professional development. This coupled with simple measures to use existing technology enable medical students to view their own performances when learning new skills, and putting into practice self-assessment measures, should provide a more cost-effective and feasible method of enabling useful feedback for maximal learning with lasting effects.

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