Introduction

The apprenticeship model of surgical training, in which residents learn primarily in the operating room with limited structured feedback, has been shown to be inferior to proficiency-based approaches. Video-based review and coaching is a promising strategy for improving performance; however, prior studies have largely focused on laparoscopic procedures and examined either faculty-guided or self-guided approaches in isolation. Few have directly compared these modalities or extended them to open surgery, where structured video feedback is less common. This study evaluates the effectiveness of coached versus self-guided video review in improving technical skills among surgical residents and fellows.

Methods

This study was reviewed and deemed exempt by the Institutional Review Board at the University of Michigan (HUM00275105). We conducted a prospective cohort study of residents and fellows on the University of Michigan Transplant Surgery Service. Each participant completed approximately five cases with coached and self-guided review. Coaching sessions involved joint video review with a faculty surgeon, focused on domains of the Objective Structured Assessment of Technical Skills (OSATS). Outcomes included pre- and post-rotation OSATS ratings by supervising attendings and resident self-assessment surveys. Audiovisual recordings were obtained for all cases to facilitate review.

Results

Preliminary findings suggest that video-based review with faculty coaching enhances technical skill acquisition and feedback integration. Residents reported that coaching provided targeted, individualized feedback that reinforced intraoperative teaching in a lower-stress environment. One participant reflected: “The intraoperative video assessment was extremely helpful for my technical skill development by providing targeted feedback on individual steps where I had room for improvement… it builds upon real-time feedback in an important way.” Quantitative analyses of OSATS scores and self-assessments are in progress.

Conclusion

Early qualitative results suggest that coached video review offers distinct benefits beyond intraoperative teaching, as it reinforces learning in a lower-pressure environment and enables targeted skill refinement. This study is among the first to compare coached and self-guided review and extend video-based coaching to open procedures, addressing an important gap in surgical education. Integrating structured video review into residency training has the potential to accelerate technical skill development, complement proficiency-based models, and modernize surgical education beyond the apprenticeship approach.