title: Common Femoral Artery Access on YouTube: What Practices are Being Shown and Who is Delivering the Message?
abstract: OBJECTIVE
  Novice learners are increasingly turning to YouTube as a learning resource for surgical procedures. One example of such a procedure is common femoral artery puncture and sheath placement. Practitioners in several specialties perform this procedure to access the arterial system for angiography and intervention. We set forth to compare the techniques demonstrated on YouTube by the various specialists, as well as compare each specialty׳s prevalence on this website.
  
  
  METHODS
  YouTube (www.youtube.com) was accessed in December 2015 at multiple time points with a cleared-cache web browser for the keyword search categories: "femoral artery access," "femoral access," and "angiography access." The top 500 videos from each of these keyword searches were analyzed. Videos were categorized by practitioner specialty, technique, duration of video, age of video, and total views. Videos with clear demonstration of femoral artery access were included in the analysis. All industry videos were excluded from the analysis. Categorical variables were compared using Fisher׳s exact test, and continuous variables were compared with the Student׳s t-test.
  
  
  RESULTS
  A total of 2460, 4680 and 1800 videos were found for each keyword search, respectively. Of these, 33 videos clearly demonstrated femoral artery access technique. Vascular specialists, compared to interventional cardiology and radiology, had fewer videos (n = 4 vs. 14) and older videos (3.5 ± 2.1y vs. 2.25 ± 0.5y, p < 0.05). The vascular specialists demonstrated ultrasound-guided access, while interventional cardiology predominantly demonstrated landmark-guided access (p < 0.05).
  
  
  CONCLUSIONS
  Although YouTube and other online resources are being used by novice learners, vascular specialists are underrepresented for femoral artery access, a foundational vascular procedure. Other practitioners demonstrate videos with landmark-guided access and rarely demonstrate ultrasound use. As recognized vascular experts, vascular surgeons should improve their visibility in online learning resources.
authors.affiliation: Division of Vascular Surgery, VCU School of Medicine, Richmond, Virginia. Electronic address: pitchergs@vcu.edu.
authors.forename: Grayson S
authors.initials: GS
authors.lastname: Pitcher
authors.affiliation: Division of Vascular Surgery, VCU School of Medicine, Richmond, Virginia.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Newton
authors.affiliation: Division of Vascular Surgery, VCU School of Medicine, Richmond, Virginia; Division of Vascular Surgery, VCU Health System, Richmond, Virginia.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Amendola
mesh_terms: D006348:Cardiac Surgical Procedures / Q000193:education; D003430:Cross-Sectional Studies; D020375:Education, Distance / Q000379:methods*; D004521:Educational Measurement; D005263:Femoral Artery; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D009493:Neurosurgery / Q000193:education; D013337:Students, Medical / Q000706:statistics & numerical data; D062666:Vascular Access Devices; D014656:Vascular Surgical Procedures / Q000193:education; D014741:Video Recording
keywords: Medical Knowledge; Practice-Based Learning and Improvement; YouTube; femoral artery access; medical students; residents; vascular surgery