title: Surgical Coaching from Head-Mounted Video in the Training of Fluoroscopically Guided Articular Fracture Surgery.
abstract: BACKGROUND
  The evolving surgical skills education paradigm in orthopaedics has generated a strong demand for validated educational tools and methodologies. This study aimed to confirm that a one-on-one faculty coaching review of the head-mounted video recording of a resident's surgical performance on a validated articular fracture simulation trainer would substantially improve subsequent performance.
  
  
  METHODS
  Fifteen first-year or second-year orthopaedic surgery residents reduced and fixed a standardized intra-articular tibial plafond fracture model under fluoroscopic guidance. Their performances were recorded by a head-mounted video camera. Prior to repeating the procedure six weeks later, eight subjects (the intervention group) reviewed the video of their performance with an orthopaedic traumatologist, and seven subjects (the control group) did not. Cohort performance was compared with respect to task duration, number of fluoroscopic images, and scores on the Objective Structured Assessment of Technical Skills (OSATS) as evaluated by fellowship-trained orthopaedic traumatologists blinded to the residents' year in training and prior surgical experience.
  
  
  RESULTS
  The initial performance OSATS scores were not significantly different (p ≥ 0.05) between the control and intervention groups. Assessments of their repeat performance showed a significant net interval improvement (p < 0.05) in OSATS scores in the intervention group (mean [and standard deviation], 21 ± 8 points) compared with the control group (6 ± 3 points). The mean fluoroscopy utilization had a significant net decrease (p < 0.05) in the intervention group (-5.4 ± 11.7 points) compared with the control group (5.3 ± 7.0 points). Task duration in the repeat performance was similar between both groups.
  
  
  CONCLUSIONS
  Personalized video-based feedback improved performance on a standardized articular fracture trainer for first-year and second-year residents. The described technique may further enhance resident surgical skills education.
authors.affiliation: Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for M.D. Karam: matthew-karam@uiowa.edu. E-mail address for J.L. Marsh: j-marsh@uiowa.edu.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Karam
authors.affiliation: Department of Mechanical and Industrial Engineering, The University of Iowa, 3131 Seamans Center for the Engineering Arts and Sciences, Iowa City, IA 52242. E-mail address: geb-thomas@uiowa.edu.
authors.forename: Geb W
authors.initials: GW
authors.lastname: Thomas
authors.affiliation: Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for M.D. Karam: matthew-karam@uiowa.edu. E-mail address for J.L. Marsh: j-marsh@uiowa.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Koehler
authors.affiliation: Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for M.D. Karam: matthew-karam@uiowa.edu. E-mail address for J.L. Marsh: j-marsh@uiowa.edu.
authors.forename: Brian O
authors.initials: BO
authors.lastname: Westerlind
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 640 Jackson Street, St. Paul, MN 55101. E-mail address for P.M. Lafferty: PLaffMD@gmail.com. E-mail address for A.E. Van Heest: vanhe003@umn.edu.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Lafferty
authors.affiliation: Pacific Research Laboratories, 10221 Southwest 188th Street, PO Box 409, Vashon Island, WA 98070.
authors.forename: Gary Thomas
authors.initials: GT
authors.lastname: Ohrt
authors.affiliation: Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for M.D. Karam: matthew-karam@uiowa.edu. E-mail address for J.L. Marsh: j-marsh@uiowa.edu.
authors.forename: J Lawrence
authors.initials: JL
authors.lastname: Marsh
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 640 Jackson Street, St. Paul, MN 55101. E-mail address for P.M. Lafferty: PLaffMD@gmail.com. E-mail address for A.E. Van Heest: vanhe003@umn.edu.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Van Heest
authors.affiliation: Department of Orthopaedics and Rehabilitation, The University of Iowa, 2181 Westlawn Building, Iowa City, IA 52242. E-mail address: don-anderson@uiowa.edu.
authors.forename: Donald D
authors.initials: DD
authors.lastname: Anderson
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D005471:Fluoroscopy; D006801:Humans; D007596:Joints / Q000293:injuries* / Q000601:surgery*; D009985:Orthopedics / Q000193:education*; D025321:Surgery, Computer-Assisted / Q000193:education*; D011795:Surveys and Questionnaires; D013978:Tibial Fractures / Q000601:surgery*; D014741:Video Recording / Q000295:instrumentation*