Invited Editorial LAP-VEGaS Practice Guidelines for Video-based Education in Surgery: Content is Just the Beginning.

T he use of video as an instructional method has expanded rapidly over the last few decades. Advances in the technology required to capture, edit, and distribute video have enabled widespread use. The andragogical advantages of using video are many, including the ability to scale instruction to large and small audiences, providing student-controlled and self-paced learning, facilitating asynchronous learning for professionals with hectic schedules, and the ability to orient the content in realistic and contextually important environments important to adult learners. In surgery, the capturing of procedural video has been greatly facilitated by the rapid rise of endoscopic approaches in the last 30 years. As the screen is the interface used by both the surgeon and the learner, watching recordings of endoscopic procedures hold great potential as an effective and engaging teaching tool. Many surgical societies offer video-based education products, and a quick Google search returns more than 10 million laparoscopic surgery videos available online. In this edition of Annals of Surgery, a group of authors from Europe, Asia, and Australia report a consensus statement as a step toward establishing laparoscopic surgery video education guidelines (LAPVEGaS). The group utilized a Delphi methodology to generate consensus around 37 statements relating to the quality and utility of laparoscopic surgical videos. This consensus statement continues work done previously to assess the training value of colorectal surgery videos available online. In this initial work, nearly 200 videos were identified from more than 30 different websites. Recordings were assessed for educational content and safety of the demonstrated procedural steps using the laparoscopic competency assessment tool (LCAT) for colorectal surgery. Not surprisingly, they found great variability with respect to educational content as well as a downward trend over time in the safety of the techniques demonstrated as measured by LCAT. This LAP-VEGaS consensus statement serves as a first step toward building a meaningful conceptual framework for the creation of educational videos for laparoscopic surgery. Of the 37 statements that reached consensus, 15 address issues with the quality of the video, the credentials of the presenters, and the rigor of the peer review process. Twelve of the statements involve details of required content, which is fairly prescriptive and exhaustive and includes requirements not universally applicable to all laparoscopic surgery such as demonstrating the site for specimen extraction and inclusion of details on histopathology and lymph node harvest. Six statements incorporate miscellaneous commentary on issues such as the need for consent, required incorporation of video review into curricula, and the value of sharing video at conferences. Disappointingly, only 4 statements address issues of optimizing the video to facilitate learning. A great deal of knowledge exists in the education literature relating to the optimization of video and other e-Learning tools. There is general consensus around 3 key elements that must be addressed to create effective educational video: managing cognitive load, maximizing learner engagement, and promoting active learning. The most important of these 3 areas for surgeon educators to understand is the management of cognitive load. Cognitive Load Theory suggests that learning is accomplished by capturing information from sensory memory, moving it into limited capacity working memory, and then encoding and storing it in high-capacity long-term memory. Learning is dependent upon how well the limited capacity of working memory is managed. Three factors relating to the information to be learned and the quality of instruction determine how much learning takes place. These factors are the intrinsic cognitive load of the material presented, the extraneous load associated with the instructional design, and the germane load generated from processing the information to be learned. Intrinsic load is a factor of the complexity of the material being presented relative to the expertise of the learner. The amount of working memory it consumes is dependent upon how much of