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The Internet is a growing resource of instructional medical procedural videos. Unrestricted by time or place, viewers can access knee arthrocentesis videos as unregistered users on non peer-reviewed public websites e.g. YouTube. To our knowledge, there is no instructional arthrocentesis video evaluation instrument. The purpose of this project is to review arthrocentesis videos currently on the Internet and evaluate them for content, technical, and instructional quality.
Method:
YouTube, the public video sharing website, was searched on June 15, 2009, using the terms "knee arthrocentesis" or "knee aspiration". Data for determination of video length, viewership rate, and author credential were collected.
Videos were independently evaluated by one medical resident and one Rheumatology faculty:
a) for content using a 16 item checklist based on the New England Journal of Medicine1 (NEJM) website knee arthrocentesis video (indications, contraindications, equipment needed, obtaining consent, limb positioning, identification of anatomy, skin cleansing, draping, anesthetics, needle direction/insertion, removal of fluid, instruction on "milking" the knee effusion, needle removal/safety, post-procedure care, fluid handling, complications)
b) for instructional quality by assigning the highest level achieved on Bloom’s taxonomy/cognitive domain (from lower to higher levels of behavior: knowledge, comprehension, application, analysis, evaluation, creation)
c) for technical visual and audio quality.
Results:
The NEJM video was longest at 6:23, and was assigned the highest learning behavior category level of “analysis”.
Seven YouTube videos (Table) were evaluated after excluding 2: one copied from NEJM, a second without audio. Compared to the video on NEJM, the 7 videos on YouTube vary in length (0:31–4:51), viewership (1–33.6 views/day), author credential (commercial, physician, university residency), number of content items addressed (3–11), and highest level of cognitive learning behavior achieved. One commercial video, 1:32 in duration addressing 5/16 content items, reached the same level (analysis) of cognitive learning behavior as the 6:23, 16 item NEJM video.
Video technical quality was fair-good. Consistency of evaluation between the 2 resident/faculty raters was excellent.
| Video | Length | Views/day | Author Credential | Content Items | Highest Learning Behavior Level |
| 1 | 0:38 | 6.5 | Commercial | 4 | Comprehension |
| 2 | 0:31 | 1.0 | Commercial | 3 | Application |
| 3 | 4:51 | 4.1 | University Residency | 11 | Application |
| 4 | 0:35 | 2.9 | Physician | 4 | - |
| 5 | 1:32 | 6.7 | Commercial | 5 | Analysis |
| 6 | 0:25 | 9.7 | Physician | 3 | - |
| 7 | 0:34 | 33.6 | Physician | 3 | - |
| 8 | Excluded (copied from NEJM) | ||||
| 9 | Excluded (no audio) | ||||
| NEJM | 6:23 | University Residency | 16 | Analysis |
Conclusions:
This sample of knee arthrocentesis videos published on the NEJM and YouTube websites are at best of moderate instructional quality. For the Internet’s potential as a learning resource beyond convenience to be realized, authors of procedural videos should challenge themselves to produce higher quality instructional materials.
Disclosure: P. Sufka, None; A. G. Minenko, 1) ACR- REF Clinician Educator Scholar Award, Innovative Teaching Grant, , 2, 2) University of Minnesota Office of Information Technology Digital Media Center Faculty Fellowship., 9 .