title: Watch what happens: using a web-based multimedia platform to enhance intraoperative learning and development of clinical reasoning.
abstract: BACKGROUND
  We aim to determine whether observed operations or internet-based video review predict improved performance in the surgery clerkship.
  
  
  METHODS
  A retrospective review of students' usage of surgical videos, observed operations, evaluations, and examination scores were used to construct an exploratory principal component analysis. Multivariate regression was used to determine factors predictive of clerkship performance.
  
  
  RESULTS
  Case log data for 231 students revealed a median of 25 observed cases. Students accessed the web-based video platform a median of 15 times. Principal component analysis yielded 4 factors contributing 74% of the variability with a Kaiser-Meyer-Olkin coefficient of .83. Multivariate regression predicted shelf score (P < .0001), internal clinical skills examination score (P < .0001), subjective evaluations (P < .001), and video website utilization (P < .001) but not observed cases to be significantly associated with overall performance.
  
  
  CONCLUSIONS
  Utilization of a web-based operative video platform during a surgical clerkship is an independently associated with improved clinical reasoning, fund of knowledge, and overall evaluation. Thus, this modality can serve as a useful adjunct to live observation.
authors.affiliation: Department of Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, MHB-7GS 313, New York, NY 10032, USA. Electronic address: rhm2125@cumc.columbia.edu.
authors.forename: Abbey L
authors.initials: AL
authors.lastname: Fingeret
authors.affiliation: Department of Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, MHB-7GS 313, New York, NY 10032, USA.
authors.forename: Rebecca H
authors.initials: RH
authors.lastname: Martinez
authors.affiliation: Department of Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, MHB-7GS 313, New York, NY 10032, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Hsieh
authors.affiliation: Department of Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, MHB-7GS 313, New York, NY 10032, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Downey
authors.affiliation: Department of Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, MHB-7GS 313, New York, NY 10032, USA.
authors.forename: Roman
authors.initials: R
authors.lastname: Nowygrod
mesh_terms: D000328:Adult; D000368:Aged; D002982:Clinical Clerkship; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D019212:Multimedia; D025341:Principal Component Analysis; D012189:Retrospective Studies; D014741:Video Recording
keywords: Case log; Clinical reasoning; Cognitive pretraining; Education; Video