The 21st century has ushered in a new era of learning, one in which technological platforms are heavily relied upon for the dissemination and acquisition of information. One of these platforms is YouTube. It is difficult to overestimate the impact of YouTube on the world we live in today. It has revolutionized the sharing of information between creators and consumers, by expanding communication beyond the written word and still images and removing barriers to the distribution and access of content.
The first ever YouTube video was uploaded on April 23, 2005 by YouTube co-founder Jawed Karim. Entitled “Me at the zoo”, it was 18 seconds long and described himself “in front of the elephants with a long trunk”. From this unlikely beginning, YouTube has grown into the largest video-sharing platform on the internet, with more than 2 billion-logged monthly users. At the same time it has also turned from a source of entertainment into a resource for learning about virtually any subject under the sun. All of us have turned to YouTube at some point to find a video on “how to do something”, particularly with respect to tasks that benefit from live demonstration or topics that involve a lot of visual information.
Regional anesthesia is a subject that is ideally suited to video-based education, given that it involves a complex motor task with a large visual component, especially with regard to ultrasound guided techniques. Ultrasound guided regional anesthesia is a highly dynamic process with multiple complex streams of visual and tactile information that must be processed, including the ultrasound scan, and manipulation of probe and needle relative to the patient. This requires the integration of a working knowledge of sonoanatomy, hand-eye coordination and manual dexterity. These skills are difficult to convey with the written word and still images and is one reason for the popularity of hands-on workshops at conferences, in which the process of pre-procedural scanning and the relevant sonoanatomy can be demonstrated. This same information can be conveyed in a YouTube video, and although the learner is unable to request clarification and obtain feedback in real-time, this is compensated by other advantages of this format. The creator-educator can communicate other information required for understanding, such as the clinical anatomy underpinning the block technique1, the indications and contraindications, and the complications. The technical execution of the block can also be demonstrated with videos from actual clinical practice, bridging the gap between the pre-procedural scanning (which can be learnt at in-person workshops) and needling and local anesthetic injection (which cannot). The learner is also able to review the material as often as required, and at their convenience. The 24/7 availability of YouTube content and its accessibility on a variety of devices, ranging from laptops to tablets or smartphones, makes it an invaluable resource for “just in time” learning. Short procedure-focused videos can be used as a ‘refresher” prior to performing a block. Teachers can also direct trainees to use this material as a post-procedure review to reinforce learning after having completed a supervised block, which is both resource and time-efficient during a busy clinical day.
It is important to recognize that many of the advantages of YouTube can also be limitations when it comes to education in regional anesthesia. The lack of significant barriers to the creation and distribution of information facilitates rapid and early dissemination of new knowledge and techniques. However, this creates problems related to both quantity and quality. The learner has a vast repository of uncurated content at their fingertips and the issue becomes: where to begin and who to trust? The absence of a minimum bar for quality, mandatory requirements to substantiate video content with evidence, and the need for peer-review or any other form of fact-checking, raises the very real risk that the information presented may be unreliable, inaccurate, or unsupported10. The ease of content consumption, together with the tendency for YouTube creators to make short videos in recognition of the limited attention span of viewers also risks encouraging shallow learning, which may not sufficiently equip physicians to handle the complexity of actual management of real patients. Deep learning of important concepts and facts, and retention of this knowledge is best acquired with a slower process of reading, thinking, application to a real or simulated problem, and repeating this process. Poorly produced videos with suboptimal ultrasound images and inadequate text or narrated descriptions, while not containing gross misinformation, may further mislead novice practitioners 5. Furthermore, when searching for videos on a specific topic, it must be remembered that the results generated by YouTube’s search engine are ordered not by quality, but by engagement metrics that are determined by YouTube’s own proprietary algorithm7. The onus is therefore currently very much on the learner to determine where to focus their time and attention, and to make a judgment as to whether the content is trustworthy.
There are a number of ways that these limitations could be addressed. Several studies evaluating the quality and education value of regional anesthesia content have found that the most valuable videos were produced and uploaded by academic institutions, specialty societies, or well-recognized experts through their respective websites and YouTube channels. Using questionnaire-based scoring systems4,5,9, these videos were found to possess evidence-based key elements and systematic approaches necessary for successful execution of a particular technique for the benefit of patients11. This can should be further developed into a standardized rating system or specialty-specific guidelines for educational videos, to assist learners in judging the quality of the viewed material. Academic institutions and subspeciality societies can also take on a more direct role by acknowledging the importance and validity of online videos in medical education, dedicating resources to content creation, and recognizing the individuals who contribute to producing high-quality content. There may also be a place for a virtual library or hub of curated online video content, vetted and overseen by a reputable organization or appropriately-qualified individuals.
A final point is that the impact of a video extends beyond just its content, and is very much dependent on the way in which the message is delivered. Budding creators should therefore invest time and effort in the study of media arts and presentation in general, as effective audiovisual design and communication is common across all subjects.
YouTube has not and will not replace other methods of regional anesthesia education, as for all its advantages, the learning experience remains a virtual one. There will still be a place for in-person workshops incorporating scanning on live human models, or needling practice on phantoms or cadavers, as well as structured clinical exposure within residency programs. It is nevertheless a valuable complement to textbooks and published articles in facilitating the study and acquisition of factual knowledge that must (or should) precede the hands-on learning experience. YouTube and other online digital video-sharing platforms are here to stay, and we must leverage their unique advantages to improve both the quality and reach of regional anesthesia education.
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