IMPLEMENTATION OF INNOVATION AND ETHICS USING VIDEO-BASED LEARNING IN NERVE SURGERY

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. 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.