Usefulness of smart glasses and point of view for suturing skills training in medical students: pilot study

Introduction

Smart glasses are a wearable computer device equipped with a compact video camera, which offers live streaming and video recording from the wearer’s point of view (POV). In the last decade, smart glasses in surgical education have been widely adopted, including live streaming to allow a surgeon to remotely mentor another surgeon to improve their performance.¹ In clinical training, recent research suggests that reviewing the recorded video from the trainees’ POV improves their self-reflection and augments the trainer’s feedback.²

We are interested in the potential of using smart glasses and POV for surgical skills training in medical students. No previous publication has been identified.

We conducted a pilot study to investigate the perceived usefulness of smart glasses and POV for suturing skills training in medical students.

Method

Twenty-four preclinical medical students participated in a suturing skills training workshop. The workshop was held in three phases:

• Phase I: the suturing skill was demonstrated by the tutor, who was wearing smart glasses (Vuzix M-300, Vuzix Corporation, New York, USA). The students were invited to either view the demonstration directly in front of the demonstrator or watch the live-streaming demonstration with the overhead projector.

• Phase II: the students carried out suturing in pairs, and each pair was provided with a set of smart glasses and a smart phone (Google Pixel 1, Google LLC, California, USA). Students wore the smart glasses to video-record their performance. Their performance was also live-streamed to a smart phone screen.

• Phase III: the students were requested to reflect on their performance in 3 min. Following the reflection session, students were divided into four groups of six students and were instructed to provide feedback to each other in 7 min. The kit was available for students to view their own performance or to show their performance to their peers. No additional instructions or training on how to conduct the reflection or feedback sessions were given to the students.

All participants were provided with a semistructured questionnaire. At the top of the questionnaire, it was made clear that all responses would be treated anonymously and that evaluation data would be used for publication. Consent was implied by the completion and submission of the questionnaire.

The questionnaire contained quantitative questions with an 11-point Likert scale (0–10). The questions with free-text responses focused on the current and future opportunities and barriers to wider implementation. These free-text responses were analysed using thematic framework analysis by two coauthors (TS and JB), and any differences were resolved by discussion.³

Results

All 24 students completed the questionnaires.

The usefulness of smart glasses was scored on an 11-point Likert scale (0: least useful, 10: most useful) for each phase of the suturing skills workshop. Live streaming using the smart glasses was not considered useful during the demonstration (mean 6.4, SD 1.6) or the performance (mean 5.5, SD 1.2). However, reviewing the recorded videos of their performance was considered very useful for self-reflection (mean 9.2, SD 1.1) and peer feedback (mean 8.3, SD 1.2).

Four themes were identified from the free-text comments: (1) usefulness for learning during the event, (2) usefulness for learning after the event, (3) limitations and (4) future uses. Subthemes were also developed. See table 1.

Table 1.

Thematic frame analysis

Subtheme	Comments	Illustrative quotations
Theme 1: usefulness for learning during the event
Watching demonstration	Watching the demonstrator directly was preferable to watching the live streaming, with minimal benefit from live streaming of the demonstrator’s POV.	‘Was looking at demonstrator for understanding the process so with the glasses or without, no difference’. (Participant 2)
Performing	Wearing smart glasses did not affect their performance as the students ignored their presence when focusing on the task.	‘No difference in carrying out the task. Didn't hinder my view, easy to adjust to’. (Participant 5)
Assisting	Live streaming of surgeon’s POV on screen helped the assistant.	‘I could see what the surgeon was doing and when I needed to assist‘. (Participant 4)
Theme 2: usefulness for learning after the event
Self-reflection	The students’ analysis with the POV videos spotted errors and poor technique. Reviewing the recorded video helped the students appreciate the tutor’s’ advice, which was given during their performance.	‘Can critically analyse performance and spot poor technique error’. (Participant 1) ‘… I feel that this would be perfect for self-reflection because a big problem of recall is accounted for by recording a video of the procedure’. (participant 21) ‘Can't really reflect on a procedure by looking at my suture - video helps to break down the steps involved in the task and see what I did from a 3rd person's point of view’. (Participant 2) ‘Allows reviewing of the process, rather than just viewing the final product’. (Participant 20)
Group reflection	Watching the peer’s video provided more information about their skills than assessing the quality of knots. The feedback was clear and precise when watching the video together. Sharing good performance among the group helped the students reflect on their technique.	‘Allows more clear evaluation of each peers performance rather than just the final product’. (Participant 20) ’You can see the performance of those who have done well, how they did so, such that we can improve our own work’. (Participant 13)
Theme 3: limitations
Intrusive	The product was initially considered bulky, but the students got used to it once they started the workshop.	‘A bit uncomfortable to wear’ (Participant 11) ‘t is in your peripheral vision but you soon forget about it’. (Participant 1)
Smart glass resolution	The resolution and frame per second could be a limiting factor for more detailed procedures.	‘Lack of resolution and frame per second’. (Participant 3)
Availability	The suppliers are limited for some smart glass products and the prices remain high.	‘I question the availability and cost of Google glasses’. (Participant 8)
Time restraint	Ample time must be allocated for the optimal effect of reflection and feedback with the recorded video.	‘I thought there wasn't enough time to review the recorded video’. (Participant 19)
Anxiety of being recorded	Video recording may induce the operators’ anxiety.	‘May make surgeons feel anxious about being recorded’. (Participant 15)
Theme 4: future uses
Undergraduate education	The surgeon’s POV may be live-streamed for the students’ learning in the operation theatre. Reviewing the recorded videos may help the students for their exam preparation.	‘Teaching in theatre - as a student I cannot see what the surgeon is doing - if these glasses were worn, I could watch on screen’. (Participant 7) ‘Good for skills being learnt in early stages, so you can look back. Could be helpful in OSCE prep where we only get taught skills once’. (Participant 13)
Postgraduate education	The benefits of POV may be transferrable to postgraduate surgical training, such as laparoscopy and endoscopy training.	‘… surgeons can reflect better on their work with the use of this and it is helpful for people learning to see what the instructor is doing’. (Participant 6) “
Legal purposes	The recorded video may provide evidence for legal disputes.	‘Surgical training, legal dispute, teaching’ (Participant 1)

OSCE, Objective Structured Clinical Examination; POV, point of view.

Discussion

Live streaming of the demonstration and the performance was not considered to be useful in the workshop. However, when students are assisting or observing an actual operation, they may experience a limited view of the operation site. In these circumstances, live streaming from the surgeon’s POV may be beneficial for their learning.

Students considered POV video recording as very useful for surgical skills training, allowing students to review their performance repeatedly and also give them the opportunity to seek a second opinion from other tutors or peers. The students believed that this would provide them with additional benefits for their learning. However, the students highlighted the importance of securing sufficient time to review the recorded videos for their reflection and feedback.

The students suggested that the technical specifications of the smart glasses may limit their use in clinical education. For this suturing workshop, the image quality and the battery life were satisfactory for the purpose. We are optimistic that the smart glass technology is still in the early stages of product development and the technology and usability will advance rapidly.

Understandably, wearing smart glasses induced some anxiety in the students. A study supported our belief that the regular use of the device will familiarise the students with the new technology and minimises the anxiety.⁴

From the ethical and legal point of view, the smart glasses protocol must be compliant to the prevailing laws and guidelines. The protocol should include the ownership, storage and editing process of the recorded videos and the confidentiality protection. These points should be explicitly explained in the consenting process. We agree with the students’ view that the recorded videos would serve as useful evidence in case of legal disputes.

Conclusions

This pilot study has demonstrated the usefulness of smart glasses and the unique POV perspective for suturing skills, and potentially other surgical skills, training in medical students by enhancing self-reflection and feedback. Although there are current limitations and pitfalls, we are optimistic that smart glasses can improve the learner’s acquisition of a variety of surgical skills. We recommend further prospective controlled studies that use an objective scoring system to demonstrate an impact on performance. The future application of smart glasses and POV could have a distinctive role in undergraduate and also postgraduate medical education. The POV approach has the potential to optimise the training experience during simulation training and in clinical practice, making the most of limited clinical learning opportunities, such as in the current COVID-19 pandemic.⁵