Active Annotation Versus Passive Review of Operative Videos for Training in Endoscopic Pituitary Surgery: A Preclinical Randomized Controlled Study

BACKGROUND AND OBJECTIVES: Resident duty-hour restrictions necessitate innovations in surgical training, as long learning curves may result in residents completing training without sufficient experience to perform surgeries safely. Annotation of operative videos, involving labeling surgical steps, instruments, or anatomy, might offer a risk-free environment to improve surgical learning and reflective practice. This study evaluated the effect of video annotation on surgical education. METHODS: A double-blinded, parallel, randomized controlled trial was conducted, with novice neurosurgical doctors allocated using centralized computer-generated randomization. Participants annotated operative videos, restricted to instruments and steps, as the platform did not support anatomy annotation, or performed passive video review. All completed an implementation questionnaire. At baseline and after the intervention, both groups completed a simulated pituitary adenoma resection on a high-fidelity simulator. Performance was compared using knowledge quizzes, modified Objective Structured Assessment of Technical Skills, and confidence surveys. RESULTS: Participant median age was 28 years [IQR: 26-29] and 79% were male, with 7 in each group. The implementation survey demonstrated greater feasibility (4.35, 95% CI: 1.44-13.13, P = .009), acceptability (6.04, 95% CI: 1.99-18.33, P = .001), and appropriateness (4.01, 95% CI: 1.40-11.52, P = .010) in the annotation group. Procedural and instrument knowledge score changes were significantly improved in the annotation compared with review group (step: 1.14, 95% CI: 0.36-1.93, P = .008; instrument: 1.14, 95% CI: 0.06-1.90, P = .040). The annotation group significantly improved simulated surgical skills from baseline, with mean modified Objective Structured Assessment of Technical Skills global rating scale increasing to 5.14 (95% CI: 2.36-7.93, P = .004) vs 2.57 (95% CI: −1.30 to 6.44, P = .16) with video review. Confidence improved similarly in both groups. CONCLUSION: Active video annotation is feasible and acceptable for enhancing surgical education. It led to improvement in knowledge compared with passive video review and improved simulated surgical skills and confidence from baseline, suggesting suitability for integration into training programs. The impact, however, on operating room performance or patient outcomes remains unknown and warrants further study.