In the realm of surgery, technological advancements are evolving rapidly. Patient outcomes depend on proficiency in surgical practice, requiring comprehensive and diverse skills from resident trainees. Currently, this proficiency is often lacking due to gaps in training.

Surgery training programs begin immediately after medical school and generally span five to seven years. Across all subspecialties, these programs face the constant challenge of balancing trainee education with patient safety and operating room efficiency. In addition, mentorship from surgeons is limited by the administrative and clinical burdens they face.

In a study published in the Journal of Vascular Surgery Cases, Innovations and Techniques, Dr. Maham Rahimi, Associate Professor of Cardiovascular Surgery at Houston Methodist, demonstrated that video-based microlearning is a feasible and valid method for enhancing vascular surgery training. Trainees were offered video-based microlearning in bite-sized modules on end-to-side anastomosis techniques, and senior surgeons evaluated resident performance.

“Our study aimed to highlight the feasibility of video-based microlearning as a valuable adjunct to traditional vascular surgery residency training. As surgical training continues to evolve, such innovative learning approaches promise to optimize surgical education and ultimately improve patient outcomes in vascular surgery.”

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Maham Rahimi, MD, PhD, RPVI

What is end-to-side anastomosis?

The end-to-side anastomosis technique is used to create a surgical connection between the open end of a blood vessel or graft and the side wall of a larger blood vessel. Bypass surgeries, organ transplants and microvascular reconstructions commonly use end-to-side anastomosis. In each of these cases, precautions must be taken to ensure proper suturing methods are employed to ensure correct blood flow dynamics.

Combining surgical simulation with video-based microlearning

The Integrated Vascular Surgery Residency Program at Houston Methodist is a robust 5-year program that trains vascular surgeons to provide comprehensive, personalized surgical care. Resident surgeons are also eligible for the primary certificate in vascular surgery, offered by the American Board of Surgery. Mastery of vascular surgery requires extensive hands-on simulation, manual dexterity, anatomical knowledge, cognitive understanding and the ability to perform complex techniques under significant situational pressure.

The Houston Methodist Integrated Vascular Surgery Residency program combines surgical simulation with video-based microlearning to minimize patient risk and maximize skill acquisition in a non-operative, risk-free environment.

Pushing the envelope with video-based microlearning

Structural video-based microlearning significantly improved technical proficiency in vascular anastomosis, with high inter-rated reliability and immediate skill translation.

The educational curriculum consisted of 10 video-based modules, each approximately ranging from 30 seconds to 1.5 minutes long, demonstrating specific technical steps involved in end-to-side vascular anastomosis. Trainees were able to access and review the modules repeatedly according to their individual learning needs. They practiced the techniques at home using readily available surgical simulation materials, including Penrose drains.

The trainees' performance was evaluated by three senior surgeons before and after the training. Other components of the training included didactic sessions by faculty members and on-the-job training in the operating room.

"The traditional apprenticeship model is inefficient and variable. Video-based learning has emerged as an effective educational adjunct, addressing gaps in traditional methods through its reproducibility and ease of adaptation," said Dr. Rahimi.

The purpose of this teaching model was to improve three critical parameters: operating room performance, operating room autonomy and patient outcomes.

The study workflow included the following components:

• First attempt

• Microlearning

• Second attempt

• Evaluation

• Feedback

• Survey

Scalable education system and next steps

Modern surgical training is shifting to a competency-based model. The use of video-based microlearning outside the operating room, combined with feedback from trainees, can lead to significant improvements in surgical skills — not only in vascular surgery but across various specialties. Neurosurgery, thoracic surgery, orthopedic surgery and other surgical departments can adopt this approach by creating bite-sized videos (about 1 minute long) to boost technical skill acquisition before trainees operate on patients. The scalability of these methods across residency programs and their long-term impact on patient outcomes should be investigated in the future.