Scientific Article| Volume 48, ISSUE 2, P199.e1-199.e12, February 2023

Download started.


An Assessment of Upper-Extremity Surgical Technique Videos and Their Relationship With Procedural Learning Theory

  • Daniel A. London
    Corresponding author: Daniel A. London, MD, MS, Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Ave, Columbia, MO 65201.
    Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY

    Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
    Search for articles by this author
  • Ryley K. Zastrow
    Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY

    Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
    Search for articles by this author
  • Paul J. Cagle
    Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY
    Search for articles by this author
Published:December 15, 2021DOI:


      Our purpose was to ascertain how well award-winning and highly viewed upper-extremity surgical videos meet the needs of users and adhere to procedural learning theory. We hypothesized that upper-extremity videos hosted on academic society websites meet user needs better than upper-extremity videos hosted on a commercial website.


      Twenty-five upper-extremity videos were evaluated by 3 reviewers. A standardized scoring sheet was used to assess each video’s content, production quality, and adequacy. Video lengths were compared. The inclusion frequencies of specific content categories, the adequacy of content, and meeting certain production standards, all of which assess consistency with procedural learning theory, were reported, stratified by video host. Associations between the video host and video content, production quality, and adequacy were assessed.


      The median lengths of academically hosted and commercially hosted videos were similar. Regardless of the video host, no video contained information in all content categories. Sixty percent of the scored categories were present in less than 75% of evaluated videos. Academically hosted videos contained scored content more frequently than commercially hosted videos in 68.4% of categories. There were significant associations between academic hosts and inclusion of a case presentation, surgical indications, outcomes literature, a preoperative examination, follow-up visit intervals, and alternative surgical techniques. Overall, academically hosted videos had a higher percentage of adequate content categories compared with commercially hosted videos.


      Videos on academic websites more consistently meet users’ content needs and production expectations, as informed by procedural learning theory, while having higher rates of adequate content compared with videos on commercial websites.

      Clinical relevance

      While academically hosted videos appear to more consistently adhere to the tenets of procedural learning theory, opportunity exists for video creators to more consistently apply procedural learning theory, allowing for the creation of even more educationally beneficial online surgical videos.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mota P.
        • Carvalho N.
        • Carvalho-Dias E.
        • João Costa M.
        • Correia-Pinto J.
        • Lima E.
        Video-based surgical learning: improving trainee education and preparation for surgery.
        J Surg Educ. 2018; 75: 828-835
        • Rapp A.K.
        • Healy M.G.
        • Charlton M.E.
        • Keith J.N.
        • Rosenbaum M.E.
        • Kapadia M.R.
        YouTube is the most frequently used educational video source for surgical preparation.
        J Surg Educ. 2016; 73: 1072-1076
        • London D.A.
        • Zastrow R.K.
        • Gluck M.J.
        • Cagle P.J.
        Experience level influences users' interactions with and expectations for online surgical videos: a mixed-methods study.
        J Hand Surg Am. 2021; 46: 560-574
        • Addar A.
        • Marwan Y.
        • Algarni N.
        • Berry G.
        Assessment of “YouTube” content for distal radius fracture immobilization.
        J Surg Educ. 2017; 74: 799-804
        • Farag M.
        • Bolton D.
        • Lawrentschuk N.
        Use of YouTube as a resource for surgical education–clarity or confusion.
        Eur Urol Focus. 2020; 6: 445-449
        • Farr C.
        Doctors are turning to YouTube to learn how to do surgical procedures, but there’s no quality control.
        (Accessed April 4, 2020)
        • Jacobson M.J.
        Problem solving, cognition, and complex systems: differences between experts and novices.
        Complexity. 2001; 6: 41-49
        • Sewell J.L.
        • Boscardin C.K.
        • Young J.Q.
        • ten Cate O.
        • O'Sullivan P.S.
        Learner, patient, and supervisor features are associated with different types of cognitive load during procedural skills training: implications for teaching and instructional design.
        Acad Med. 2017; 92: 1622-1631
        • Mas F.G.
        • Plass J.
        • Kane W.M.
        • Papenfuss R.L.
        Health education and multimedia learning: connecting theory and practice (part 2).
        Health Promot Pract. 2003; 4: 464-469
        • Grunwald T.
        • Corsbie-Massay C.
        Guidelines for cognitively efficient multimedia learning tools: educational strategies, cognitive load, and interface design.
        Acad Med. 2006; 81: 213-223
        • Cheung J.J.H.
        • Kulasegaram K.M.
        • Woods N.N.
        • Moulton C.A.
        • Ringsted C.V.
        • Brydges R.
        Knowing how and knowing why: testing the effect of instruction designed for cognitive integration on procedural skills transfer.
        Adv Health Sci Educ Theory Pract. 2018; 23: 61-74
        • Cheung J.J.H.
        • Kulasegaram K.M.
        • Woods N.N.
        • Brydges R.
        Why content and cognition matter: integrating conceptual knowledge to support simulation-based procedural skills transfer.
        J Gen Intern Med. 2019; 34: 969-977
        • Feng G.C.
        Mistakes and how to avoid mistakes in using intercoder reliability indices.
        Methodology. 2015; 11: 13-22
        • Sawyer T.
        • White M.
        • Zaveri P.
        • et al.
        Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine.
        Acad Med. 2015; 90: 1025-1033
        • Saun T.J.
        • Odorizzi S.
        • Yeung C.
        • Johnson M.
        • Bandiera G.
        • Dev S.P.
        A peer-reviewed instructional video is as effective as a standard recorded didactic lecture in medical trainees performing chest tube insertion: a randomized control trial.
        J Surg Educ. 2017; 74: 437-442
        • Zhang D.S.
        • Zhou L.N.
        • Briggs R.O.
        • Nunamaker J.F.
        Instructional video in e-learning: assessing the impact of interactive video on learning effectiveness.
        Inf Manag. 2006; 43: 15-27
        • Peyton J.W.R.
        Teaching and Learning in Medical Practice.
        Manticore Publishing House Europe Limited, 1998
        • Sweller J.
        Cognitive load during problem solving: effects on learning.
        Cogn Sci. 1988; 12: 257-285
        • Sweller J.
        Cognitive load theory, learning difficulty, and instructional design.
        Learn Instruction. 1994; 4: 295-312
        • Dubrowski A.
        • Xeroulis G.
        Computer-based video instructions for acquisition of technical skills.
        J Vis Commun Med. 2005; 28: 150-155
        • Leppink J.
        • van den Heuvel A.
        The evolution of cognitive load theory and its application to medical education.
        Perspect Med Educ. 2015; 4: 119-127
        • Chick R.C.
        • Clifton G.T.
        • Peace K.M.
        • et al.
        Using technology to maintain the education of residents during the COVID-19 pandemic.
        J Surg Educ. 2020; 77: 729-732
        • Herron M.
        Optimising surgeons' education to optimise patients' outcomes.
        J Trauma Orthop. 2018; 6: 82-84
        • Kardas M.
        • O’Brien E.
        Easier seen than done: merely watching others perform can foster an illusion of skill acquisition.
        Psychol Sci. 2018; 29: 521-536