Video Observed Surgical Skills vs Directly Observed Surgical Skills Among Postgraduate Residents of Pediatric Surgery: A Comparative Study

Learning to perform delicate surgery on children is a demanding journey that requires years of training under the watchful eyes of experienced mentors. In this specialized field, the ability to judge a trainee's skill is just as critical as the skill itself. Traditionally, this judgment happens in real time, with a senior surgeon standing beside the operating table, watching every movement and offering immediate feedback. This direct observation has long been the gold standard for ensuring that future surgeons are ready to operate safely. However, relying on a teacher's physical presence in every single procedure creates a significant logistical challenge, especially in busy hospitals or places where expert staff are scarce. The question arises whether recording these operations on video and having experts review the footage later can provide an equally accurate picture of a surgeon's abilities, or if the live experience offers something the camera simply cannot capture.

Researchers at the Pediatric Surgery Department of King Edward Medical University set out to answer this question by putting two methods of assessment side by side. They gathered twenty senior residents, who were in their final year of training, and watched them perform ninety-six different elective operations. For each procedure, the team employed a dual approach to evaluation. First, two faculty members stood in the operating room to observe the surgery directly, noting every detail of the resident's performance. At the same time, the entire operation was recorded on video. Later, two different faculty members, who had not been present in the room, watched these recordings and scored the residents using the exact same checklist. This checklist, known as the OSATS, breaks down surgical skill into seven specific areas, such as how well the surgeon respects the tissue, how they use their assistants, and their overall efficiency.

When the researchers compared the scores, a clear pattern emerged regarding the overall impression of the surgeons. The faculty members who watched the surgeries live gave higher average scores than those who watched the videos later. The live observers awarded an average score of nearly twenty-five points, while the video reviewers averaged just under twenty-one points. This gap of about four points suggests that watching a procedure unfold in person feels more positive or perhaps allows for a more forgiving assessment than reviewing a recording. However, the story changes when looking at the specific skills themselves. When the researchers examined each of the seven individual categories of surgical ability, the scores from the video watchers were remarkably close to those from the live watchers. The differences in these specific areas were so small—ranging from a fraction of a point to less than a third of a point—that they fell well within a margin considered equivalent. In other words, while the overall mood of the assessment differed, the detailed breakdown of skills was consistent across both methods.

The study concludes that reviewing video recordings is a valid way to assess the specific technical domains of pediatric surgery, offering a practical alternative to having a teacher present in the operating room for every single case. This finding is particularly valuable for training programs with limited resources, as it removes the need for a faculty member to be physically present for every assessment, potentially making it easier to train more surgeons. Yet, the researchers offer a necessary word of caution. Because the video reviewers consistently gave lower overall scores, using this method for high-stakes decisions, such as determining if a resident is ready to practice independently, should be done carefully. The video method works well for helping residents improve their specific techniques, but until further testing confirms its reliability for final pass-or-fail judgments, it should not replace the traditional live assessment for those critical moments.