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Assessment of Resident Microsurgical Skill Using an Online Video System

Taylor, Nate Wetter M.D.; Webb, Kelli M.D.; Neumeister, Michael W. M.D.; Bueno, Reuben A. Jr M.D.

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Plastic and Reconstructive Surgery: January 2014 - Volume 133 - Issue 1 - p 78e-79e
doi: 10.1097/01.prs.0000436803.50541.6b
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Assessment and documentation of surgical skill are becoming increasingly more important in competency-based residency training as accreditation of training programs moves toward a milestones curriculum.1,2 Simulation in the skills laboratory allows development of skill and achievement of milestones in a setting less demanding than in the operating room, with less consequence from technical error and potential harm to patients.3,4 Faculty will need to serve as evaluators in assessing trainee skill and achievement of surgical milestones and providing meaningful feedback as residents gain progressive responsibility in surgical procedures. Video recording of resident performance in a surgical skills laboratory allows faculty to evaluate resident surgical performance at any time without having to be present.5 Uploading the recordings to a host site allows online access from any location. A system that allows simultaneous viewing of the recorded performance and completion of an evaluation form would increase convenience and efficiency for faculty evaluators. This article describes the development of a Web-based video system for assessment of microsurgical skill during residency training (Fig. 1).

Fig. 1
Fig. 1:
Video recording of resident operative performance (on left) and evaluation instrument (on right), which can be viewed on the same screen, allowing for more efficient use by evaluator. In the left lower corner, there are links for jumping to critical points in the video-recorded performance.

Video recordings were made of residents performing a rat artery anastomosis and stored on the institution’s server. Custom Web programming using Hypertext Markup Language, (World Wide Web Consortium), PHP: Hypertext Preprocessor (The PHP Group), JavaScript (Mozilla Foundation) was used to combine the video and the assessment tool onto a single Web page. Faculty evaluators were sent a link by email to view the recorded performance and complete the Micorsurgical Skills Assessment Tool (Fig. 2).

Fig. 2
Fig. 2:
Configuration page, for setting up prepopulated video and evaluator information and critical point locations. The video (with critical point links) can be previewed during configuration. When the recording is finished, a customized link can be sent to the evaluator via email.

In order to meet the demands of duty hour restrictions and patient safety, acquisition of surgical skills outside the operating room through simulation in a skills laboratory will play an increasingly large role in residency training.3 Simulation during surgical resident training has the benefit of developing and improving skill without putting patient safety at risk.3,4 Video recording of resident performance in a specific technical skill provides accurate assessment and meaningful feedback to both the trainee and the evaluator.5

While faculty may support the use of video recordings to assess proficiency in a specific skill, the potential inconvenience of accessing those recordings and lack of time efficiency in evaluating and documenting the performance may be barriers to timely completion of evaluations by faculty. The video assessment system described allows the following: (1) online access, so video recordings can be viewed by faculty at any time and from any location, at the faculty’s convenience; (2) ability to skip to critical points in the recorded performance; (3) simultaneous viewing of performance and completion of the evaluation form from the same screen; and (4) low cost, with use of an institutional server for video storage and a free response service. The potential uses of this type of system in residency training include verifying proficiency for specific technical skills in a simulated meaningful feedback of performance for both learner and teacher, and documenting achievement of a technical milestone during training.


The authors have no financial interest to declare in relation to the content of this article.


This work was supported by Plastic Surgery Foundation grant award 200948.

Nate Wetter Taylor, M.D.

Kelli Webb, M.D.

Michael W. Neumeister, M.D.

Reuben A. Bueno, Jr., M.D.

Institute for Plastic and Reconstructive Surgery

Southern Illinois University School of Medicine

Springfield, Ill.


1. Bancroft GN, Basu CB, Leong M, et al. Outcome-based residency education: Teaching and evaluating the core competencies in plastic surgery. Plast Reconstr Surg. 2008;121:441e–448e
2. Nasca TJ, Philibert I, Bringham T, et al. The next GME accreditation system: Rationale and benefits. N Engl J Med. 2012;366:1051–1056
3. Reznick RK, MacRae H. Teaching surgical skills: Changes in the wind. N Engl J Med. 2006;355:2664–2669
4. Tavakol M, Mohagheghi MA, Dennick R. Assessing the skills of surgical residents using simulation. J Surg Educ. 2008;65:77–83
5. Laeeq K, Infusino S, Lin SY, et al. Video-based assessment of operative competency in endoscopic sinus surgery. Am J Rhinol Allergy. 2010;24:234–237


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