American Society for Peripheral Nerve

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Effectiveness of Video-Based Learning in Teaching Clinical Reasoning for Cubital Tunnel Surgeries
William M Padovano, MPHS1, Andrew Yee, BS2, J. Megan M. Patterson, MD3, Mitchell A Pet, MD1, J. Henk Coert, MD, PhD4 and Susan E Mackinnon, MD1, (1)Washington University School of Medicine, Saint Louis, MO, (2)Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, (3)Department of Orthopaedics, University of North Carolina, Chapel Hill, NC, (4)University Medical Center Utrecht, Utrecht, Netherlands

Background: In a landmark 2010 report, the National Academy of Medicine identified major deficits in the continuing medical education (CME) system in the United States. It called for a transition away from CME and toward a system of continuing professional development (CPD), which facilitates sustainable practice change by disseminating expert clinical judgement. The report further highlighted online multimedia (e-learning) as a promising strategy for CPD. However, the feasibility, acceptability, and long-term impact of video-based learning in promoting clinical judgement remain poorly understood.

Methods: An online educational module was developed to teach electrodiagnostic indications for cubital tunnel surgery. It consisted of (1) a baseline knowledge assessment, (2) choice of two self-paced video presentations (7 minutes and 28 minutes), and (3) a post-video knowledge assessment. To evaluate knowledge retention, participants completed an additional knowledge assessment 3 months later. Surveys assessed baseline practices, practice change, perceived educational value of the module, and barriers to implementation. Surgeons were recruited via email from Learn Surgery and DocMatter and received 0.75 AMA PRA Category 1 Credit. Changes in knowledge assessments were evaluated by Wilcoxon signed-rank test.

Results: A total of 281 surgeons participated in the educational module (75% practicing physicians, 7% fellows, 18% residents). Among practicing surgeons, 93% offered surgery for cubital tunnel syndrome, and 32% specifically offered anterior interosseous to ulnar motor supercharge end-to-side (SETS) nerve transfer. Median score on the baseline knowledge assessment was 50%. A majority of participants spent at least 30 minutes watching one or both presentations. Knowledge assessment scores improved by 30 percentage points (p<0.0001) immediately following the presentation(s). Knowledge improvements persisted at 3 months after watching the presentation(s), and 74% of surgeons reported that the module changed how they managed cubital tunnel syndrome. Among practicing surgeons who did not offer SETS nerve transfer, 70% indicated that they would consider adding this procedure to their practice after completing the module.

Conclusions: Video-based learning is an effective strategy for promoting continuing professional development in surgeons. The educational module was well-received, led to substantial improvements in knowledge among both practicing surgeons and trainees, and supported long-term practice change.

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