An Analysis of the 50 Most Viewed Shoulder-Related Video Postings

While traditional resources have included didactic lectures, clinical settings, operating room experience, as well as texts and journals, recent resources such as electronic and web-based platforms have become more available. The purpose of this study was to characterize the 50 most viewed shoulder-related video postings. We searched VuMedi for content under the content heading “Shoulder” and the top 50 most viewed shoulder-related videos were then recorded. Each video was reviewed and the following information was collected: authors, year of publication, geographic origin, the number of thumbs up, as well as the number of comments. In addition, videos were classified as technique videos or didactic videos. The total number of views of the top 50 videos ranged from 129,583 to 15,127.Sumant Krishnan had the most videos (5) on the top 50 list. The publication years of the top 50 videos ranged from 2008 to 2018, with 2009 accounting for the most videos. The number of videos by country of origin was led by the United States (n=38), followed by France (n=5), Austria (n=2), Switzerland (n=2), and Australia (n=1). The number of video views strongly correlated with the number of thumbs up (R=0.91, p<0.01) and the number of comments (R2=0.80, p<0.01). Videos that were published around 2009, involved either fracture or labrum/instability, and focused on surgical technique were the most favorable and frequently viewed. The present study provides a foundation from which the characterization of surgical sub-specialty videos as well as development of a validated metric to objectively assess video content and quality may begin.


Methods
In August 2020 we search VuMedi for content under the content heading "Shoulder". The top 50 most viewed shoulder-related videos were recorded. Each video was reviewed and the following information was collected: authors, year of publication, geographic origin, the number of thumbs up, as well as the number of comments. In addition, videos were classified as technique videos or didactic videos. We defined technique videos as videos which demonstrate or describe surgical procedures and their nuances. We classified didactic videos as videos which focused on specific pathology or anatomy of the shoulder. Videos which had both technique and didactic elements were classified as such based on what element comprised the majority of the video. For example, a video totaling 12 minutes which possessed 5 minutes of technique content and 7 minutes of didactic content would be classified as a didactic video. Two authors (N.L. and N.D.) reviewed each video independently and determined video classification based on the aforementioned definitions. Any discrepancy between authors was resolved by consensus.

Results
The total number of views of the top 50 videos ranged from 129,583 to 15,127 ( Table 1). The publication years of the top 50 videos ranged from 2008 to 2018, with 2009 accounting for the most videos ( Figure 1). The majority of the videos were published from 2008 to 2010 and only two videos were published after 2014. The mean number of views for each video, per year, from 2008 to 2018 ranged from 15,798 to 38,124 ( Figure 2). All videos in the top 50 were published in English.
Videos originated from 5 countries. The number of videos by country of origin was led by the United States (n=38), followed by France (n=5), Austria (n=2), Switzerland (n=2), and Australia (n=1). Sumant Krishnan had the most videos (5) on the top 50 list. JP Warner had the second most videos (4) followed by Gilles Walch and Peter Millett each with 3 videos. Several authors (Christian Gerber, Gary Gartsman, Georg Lajtai, Joaquin Sanchez-Sotelo, Michael Gardner) had 2 videos in the top 50.
The majority of the videos (n=34) were technique oriented, while the remaining videos (n=16) were classified as didactic presentations. The mean number of views for the technique videos (n=32,984) was greater than that for the didactic videos (n=27,141) (p=0.79). Videos classified as "Fracture" or "Labrum/instability" accounted for over

Discussion
There are likely several factors which relate to how often a VuMedi post is viewed as well its favorability. Some of these include but are not limited to year of publication, topic, author(s), and video type. This was the first analysis of video postings within a specific subspeciality area-namely, shoulder surgery. This study provides insight into the content and nature of some of the most widely viewed shoulder related videos on VuMedi.
Our results suggest videos that were published around 2009, involved either fracture or labrum/instability, and focused on surgical technique were the most favorable and frequently viewed. It is not surprising that the majority of these videos were published in the prior decade, because time provides an advantage in terms ofmore of an opportunity to gain popularity andachieve positive feedback. Topics involving fracture or labrum/instability comprised the majority of video postings in the top 50. Other topics such as arthroplasty and rotator cuff, which represent a larger proportion of shoulder specific cases in most practice settings, where not as popular or as frequently viewed. The exception to this observation was Scott Sigman's Simplified Superior Capsule Reconstruction (SCR) Technique which was published in 2018. This video post accounted for the third highest view frequency behind Giles Walch's Latarjet-Patte Procedure and Mark Mighell's ORIF of Proximal Humerus Fracture using Locked Plating. A possible explanation for this finding is that SCR is a novel surgical technique which has garnered significant attention both from industry and the literature in recent years [6,7]. Furthermore, we found all of the authors of the videos in the present study possessed H-indices which were, on average, greater than 43. This H-index valuerepresents a more than 90 th percentile score for the H-index [8] and suggests authors were equally successful in published literature with regard to influence and citation frequency. The H-index also provides a surrogate for what can be considered a quality metric for each video as it is likely that authors in the 90 th percentile for the H-index would also produce video content with similar quality based on their published literature.
While no prior authors have attempted to characterize specialty specific videos, some authors have attempted to evaluate multimedia use and characterize surgical video resources available online. Serino et al. [5], performed a review to describe the type, volume, quality and value of surgical video resources available online with an emphasis on orthopaedic surgery. Of the resources studied, none demonstrated high scores for value, quality, and volume. VuMedi had the second highest combined score behind Medline Plus. However, details of the content differences between the two resources were not provided by the authors. The authors concluded that the best resource is highly dependent upon each user's individual preferences [5].
An analysis of more 150 accredited orthopaedic residency programs found electronic platforms were an overwhelmingly common resource utilized as supplement to both general knowledge and case preparation [4]. The authors concluded that current residents-regardless of sex, location, and year in training-use electronic resources as the mainstay of their fund of knowledge and   for case preparation. Concern over content quality and accuracy was also emphasized. Rapp et al. [9], found a discrepancy in the use of higher-quality videos when comparing surgical residents and faculty surgeons. They found that surgical residents were more likely to access videos on websites available to the public, such as YouTube, whereas faculty surgeons accessed more reliable sources such as society web pages and commercial videos [9].
While the present study provides insight into a frequently used electronic platform for shoulder surgical education, there are limitations. These include lack of a validated metric to objectively assess video content and quality. Another limitation relates to our evaluation of a small sub-specialty group of videos, which may not represent other populations that have been evaluated more generally in other studies.
Surgical education is changing with evolving technology and instant access to unlimited resources, as well as a large volume of yearly publications in the field [10]. More than 600,000 articles are published in biomedical literature every year, providing an insurmountable mountain of ever changing medical literature [10]. Resident physicians are clearly users of technology and have been raised in a generation in which healthcare is available on Internet platforms and resources are electronically at their fingertips [11]. Given their ubiquitous adoption and use, it's important to not only identify, but also to characterize electronic and web-based resources such as VuMedi [12]. Future studies should further explore similar platforms in other sub-specialty areas and apply objective criteria for evaluating videos in terms of content and quality.

Conclusion
The present study characterized the 50 most viewed shoulderrelated video postings on VuMedi. We found videos that were published around 2009, involved either fracture or labrum/instability, and focused on surgical technique were the most favorable and frequently viewed. The exception to this observation was Scott Sigman's Simplified Superior Capsule Reconstruction (SCR) Technique which was published in 2018. The present study provides a foundation from which the characterization of surgical sub-specialty videos as well as development of a validated metric to objectively assess video content and quality may begin.