YouTube as a resource for surgical education with a focus on plastic surgery – a systematic review

Figures & data

Figure 1. Search flowchart according to PRISMA guidelines.

Table 1. Summary of studies on the educational value of YouTube videos about surgical procedures.

Study	Year/ level of evidence	Quality evaluation of YouTube videos about:	No. of evaluated videos	Findings	Quality assessment tool	Recommendation
Is YouTube a potential training source for total extraperitoneal laparoscopic inguinal hernia repair (TEP) [28]?	2019/ 4	TEP	55	View counts of poor quality videos can be as high as for good quality videos	Scoring system developed by authors	Increase educational quality videos. Do not use not peer reviewed videos as an educational tool.
Educational value of surgical videos on transabdominal pre-peritoneal hernia repair (TAPP) on YouTube [29]	2020/ 4	TAPP	20	Most viewed videos 2019 do not conform to LAP-VEGaS and International Endohernia guidelines. Utility as surgical learning tools is questionable	LAP-VEGaS guidelines International Endohernia Society guideline	Surgical societies should support the creation and publication of good educational videos
Evaluation of surgical educational videos available for third year medical students [30]	2020/ 4	Laparoscopic cholecystectomy and laparoscopic appendectomy.	40	No video met all eight criteria from the ideal third year medical student educational video checklist	Checklist of eight criteria that were regarded as essential for an ideal surgical video	The created video checklist can be used as a guide for creating quality surgical educational videos in the future.
Educational assessment of the major lower limb amputations videos on YouTube [31]	2020/ 4	Lower extremity amputation (LEA)	13	Most videos were found to be of low-to-moderate quality	Assessment tool for limb amputations consisting of 11 items	High educational quality videos are needed to assist surgeons when planning and conducting LEAs.
Does YouTube include high-quality resources for training on laparoscopic and robotic radical prostatectomy [32]?	2019/ 4	laparoscopic and robotic radical prostatectomy (RP).	226	High-quality videos are available but there is no objective parameter to predict the educational quality of the videos.	Prostatectomy Assessment and Competency Evaluation (PACE) score	Development of structured and validated training programs is one of the main topics to be taken into consideration by the urologic community.
Assessing the educational quality of ‘YouTube’ videos for facelifts [16]	2019/ 4	Face lift	13	Majority of videos showed significant shortcomings in their preoperative, intraoperative, and post-operative content.	Thirteen intraoperative, pre/postoperative, and video quality characteristics scored on a binary scale by three surgeons	Surgical trainees should implement discretion when choosing YouTube videos to complement their learning.
Transanal total mesorectal excision (TaTME): are we doing it for the right indication? An assessment of the external validity of published online video resources [33]
Educational Quality of YouTube Videos on Knee Arthrocentesis [34]	2013/ 4	Knee arthrocentesis	13	Few videos appeared to be suitable for application in a Web-based format for medical students, fellows, and residents	Assessment of procedural technique and educational value with a 5-point global score, from poor to excellent educational quality.	Improvement of future video-based instructional materials on YouTube would be necessary before regular use for teaching could be recommended.
YouTube as a Potential Training Resource for Laparoscopic Fundoplication [35]	2016/ 4	Laparoscopic fundoplication	71	Varying degrees of quality. A process for filtering videos with high surgical and educational quality is feasible	Objective component rating scale, educational quality rating score, total video quality score	Alternative video platforms aimed at medical professionals should be considered for educational purposes
Viewer discretion advised: is YouTube a friend or foe in surgical education [15]?	2017/ 4	Laparoscopic cholecystectomy	10	Top ranked videos show suboptimal technique with half of videos demonstrating concerning maneuvers and only one in ten having an adequate critical view of safety.	GOALS score. CVS ‘doublet view’ score Additional screening for safety concerns not listed by the previous tools.	Critical analysis skills should be integral part of medical curriculum. Academic institutions and societies should promote and disseminate high-quality surgical videos.
Reliability and Educational Value of Laparoscopic Sleeve Gastrectomy Surgery Videos on YouTube [36]	2019/ 4	Laparoscopic sleeve gastrectomy (LSG)	90	43% of videos considered reliable. No relationship between reliability and views, likes, dislikes, resolution was found.	Evaluation of necessary surgical steps based on Delphi Consensus	Trainees are advised to search for peer reviewed contents that are dedicated to education.
Concerns of quality, utility, and reliability of laparoscopic gastrectomy for gastric cancer in public video sharing platform [37]	2019/ 4	LG for gastric cancer	102	Useful and appropriate educational tool. Video quality varied, and the level of information incompleteness was fairly high due to insufficient reviews	Video power index (VPI). Journal of American Medical Association (JAMA) benchmark criteria. The educational value and completeness were evaluated with a checklist developed by the researchers.	Surgeon trainers and surgical educators need to critically analyze the quality of video content and exercise responsibility in directing trainee surgeons. In the current era, it is best for trainees to search for peer-reviewed content.

Table 2. Summary of studies on the educational value of YouTube videos about plastic surgery.

Study	Year/level of evidence	Focus group	No. of evaluated videos	Findings	Quality assessment tool	Recommendation
Patient information on breast reconstruction in the era of the world wide web. A snapshot analysis of information available on youtube.com [38]	2013/ 4	Patients	100	Videos do not provide comprehensive information	Three main information categories with subcategories were evaluated,	There is a need for validated, quality health information. There is certainly no substitute for a face to face discussion between healthcare providers and patients
YouTube for Cosmetic Plastic Surgery: An Effective Patient Resource [26]?	2019/ 4	Patients	173	Videos including US board-certified plastic surgeons were of significantly higher quality	DISCERN criteria	Plastic surgeons should be aware of YouTube as a resource and counsel patients about it. They should strive to upload high quality videos to provide more appropriate resources.
Can You Trust What You Watch? An Assessment of the Quality of Information in Aesthetic Surgery Videos on YouTube [20]	2019/ 4	Patients	523	The information contained in aesthetic surgery videos on YouTube is low quality.	Modified version of the Ensuring Quality Information for Patients criteria	Patients should be aware that the information has the potential to be inaccurate. Plastic surgeons should be encouraged to develop high-quality videos to educate patients.
Assessing the educational quality of ‘YouTube’ videos for facelifts [16]	2019/ 4	Trainees	See Table 1	See Table 1	See Table 1	See Table 1
YouTube and the Expanding Role of Videos in Dermatologic Surgery Education [24]	2012/ 4	Trainees	/	The number of videos will continue to grow. It is difficult to verify sources and the credentials of the video posters.	Descriptive	Clinicians and consumers should be aware of the source and intent of the video content before accepting the content.
Plastic Surgery on YouTube [25]	2020	Both	280	YouTube is an underutilized social media platform by plastic surgeons Educational videos are low in number and quality.	Descriptive	Plastic surgeons and institutions should utilize YouTube’s expanding popularity and powerful reach for spreading awareness about plastic surgery-related safe practices and evidence-based data.

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Arslan B, Gönültaş S, Gökmen E, et al. Does YouTube include high-quality resources for training on laparoscopic and robotic radical prostatectomy? World J Urol. 2020;38(5):1195–1199.

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Toolabi K, Parsaei R, Elyasinia F, et al. Reliability and educational value of laparoscopic sleeve gastrectomy surgery videos on YouTube. Obes Surg. 2019;29(9):2806–2813.

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