The Cutting Edge How Surgical Video is Changing Medical Training

In 1899, the first film of surgery was made in Argentina. The one-minute video, which showed a physician removing a lung cyst, was a precursor to one of today's most powerful teaching tools: surgical video simulation. Now, medical schools and residency programs around the world use video daily to train residents on the latest techniques.

“At The University of Tennessee Medical Center surgical simulation, including review of videos of surgeries you’ve performed, is an integral part of resident training,” said Nikki Zite, MD, MPH, FACOG, professor and Residency Program director in Obstetrics & Gynecology.

Residents watch videos of surgeons from the medical center and around the world. Through these videos, residents gain knowledge by observing techniques, some of which they may not otherwise have the chance to see.

Putting “Game Film” to Work for Residents

As early as 2008, Wes White, MD, and his colleagues at other top medical institutions began recording full-length surgeries and editing them into educational videos. They presented the videos at national and international meetings, studying film to learn the techniques of world-class surgeons.

While at one of those meetings, White — who is the associate program director of the Urology Residency program and chief of Laparoscopic and Robotic Surgery – realized that he learned as much, if not more, watching his own surgeries. In effect, the film acted as a coach, giving him a fresh perspective on procedures he was already expert in.

He likened it to a high-performing athlete watching game video. He realized that watching their own videos could be equally helpful to residents, allowing them to make minute changes to their technique and improve the way they think on their feet.

White, an associate professor of Urology, uses video recordings of surgeries to coach his residents. He likens it to the game film athletes watch during training.

“There are things you can continue to do better,” said White. “They tend to be minor things, like how you hold your hand or whether the light is positioned correctly.”

For residents who are still in the early phase of their career, video coaching can accelerate the learning curve. “Watching your own film is almost like doing mental repetitions,” said White. “If residents can watch these films repeatedly, they can prepare themselves for almost anything.”

Through this mental repetition, they learn the judgment that must be used at every step in the surgery. “It makes them more likely to make better decisions, which makes a better patient outcome even more likely than it already was,” said White.

The use of self-surgical review isn’t limited to the training program in the medical center’s Urology department. Recently, Obstetrics & Gynecology began reviewing videos of their surgeries, as well.

“Adding the review of your own surgical cases enhances education,” said Nikki Zite, MD, professor and residency director in Obstetrics & Gynecology. “It can also decrease the time it takes to master skills, and ultimately improve patient safety.”

A Modern Twist on a Traditional Model

Education is an important part of The University of Tennessee Medical Center’s mission, and the faculty stay on the cutting edge to maintain their role as thought leaders. As a result, they continually review new ways of training, even looking beyond the medical field for innovation.

In White’s case, that was the sports field. “I wanted to learn more about coaching high-performers using video,” he said. His goal was to use the film in the most effective way possible, but as a surgeon, this was new territory for him.

So he turned to an expert, former University of Tennessee Volunteers football coach, Phil Fulmer, asking him if he would share some of his expertise on using game film as a coaching tool. The session proved invaluable, expanding White’s coaching skills beyond video simulation. “It became a conversation about driving peak performance,” said White.

And White and his colleagues — like their residents — want to improve with each successive case. This type of forward motion doesn’t just score a touchdown on the field. It makes The University of Tennessee Medical Center a leader in medical care for East Tennessee.

“I’ve found that by doing this, I’m getting better, too,” White said. “Even after we’ve done thousands of surgeries, we strive to continue improving and growing.”


Photography by Dean Baker