The effectiveness of video technology as an adjunct to teach and evaluate epidural anesthesia performance skills
Background: Although video review has been used in teaching, it has not been reported for use as an adjunct to teaching anesthesiology residents. The purpose of the prospective, randomized, blinded study was to determine whether teaching with video review improves epidural anesthesia skills of anesthesiology residents. Methods: Twenty-two second-year (CA-2) anesthesiology residents beginning their first obstetric anesthesia rotation were assigned to video or nonvideo groups. All residents were filmed daily as they placed epidural analgesia. Residents assigned to the video group reviewed their tapes twice a week with an attending anesthesiologist, whereas residents assigned to the nonvideo group never saw their films. Four experienced attending anesthesiologists independently judged videotapes taken on days 1, 15, and 30 and scored the residents for "overall" skill (range of summed overall grades, 0-40), as well as on 13 predetermined criteria. Results: As determined by kappa coefficients, interrater reliability was high among the judges (k = 0.7-0.8). Residents in the video group improved to a greater degree than residents in the nonvideo group. On day 1, the median overall grades for the video and nonvideo groups were 21 and 12, respectively. By day 15, the corresponding grades had increased to 32 and 24, respectively (P < 0.01). However, overall median grades continued to improve between days 15 and 30 in the video group only (P < 0.01). Conclusions: Review of resident videotapes resulted in greater improvement in overall and predetermined performance criteria. In addition, video review was helpful in identifying skills that were inadequately learned, thus allowing for specific teaching in those areas.