Objective Validation of YouTube™ Educational Videos for the Instruction of Regional Anesthesia Nerve Blocks

A Novel Approach

George L. Tewfik; Adam N. Work; Steven M. Shulman; Patrick Discepola


BMC Anesthesiol. 2020;20(168) 

In This Article


Study Design and Setting

This observational retrospective study was conducted in the Department of Anesthesiology at Rutgers- New Jersey Medical School from July to August 2019. Our primary clinical site it University Hospital in Newark, NJ, and serves at New Jersey's only fully public hospital, located in an urban center of nearly 300,000 residents.

Study Population and Procedure

Four board certified anesthesiologists, each with at least 4 years of post-residency experience practicing regional anesthesia reviewed the content for ultrasound-guided nerve blocks of three well-vetted societies for regional anesthesia: The New York School of Regional Anesthesia (NYSORA ),[12] American College of Emergency Physicians (ACEP ),[13] and Ultrasound for Regional Anesthesia (USRA )[14] (Table 1). The following seven nerve blocks were reviewed: interscalene, supraclavicular, infraclavicular, axillary, femoral, popliteal and abdominus plane.

Eighteen key characteristics were determined to be present in nearly all of the educational material for these seven blocks. The decision was made to establish these eighteen characteristics as the control against which the Youtube videos would be evaluated (Table 1).

YouTube (www.youtube.com) searches were conducted for each nerve block ("interscalene nerve block", "supraclavicular nerve block", "infraclavicular nerve block", "axillary nerve block", "femoral nerve block" "popliteal nerve block" and "transversus abdominis plane block"). Each search returned between approximately 100 and 200 videos. The decision was made to limit evaluation to the top five videos by view count because after the 5th most popular video (by view count) the number of views often dropped off significantly below ~ 100 k views. In addition, it was believed by the researchers that the top five videos by view count would be the most utilized by potential learners, and that many users searching YouTube would not go past the second screen of search results to find an instructional video.

Next, search returns were organized using "filter", then "sort by" and "view count." The five videos for each block with the most views were evaluated. Inclusion criteria included content in the English language and ultrasound guided blocks (vs nerve stimulation only). Videos were excluded if they were not demonstrating an ultrasound guided block, were not in English, or were not relevant to the block/inappropriately titled or labelled. In each of the seven nerve block searches, the top video by view count had between 100,000 and 300,000 views, and the total of views for the top five videos was between 500,000 and 1,000,000 views total. With the significant drop-off for view count following the top five videos, this sample size was considered to be an appropriate representation of the quality of the most-reviewed reference videos.

Each YouTube video was analyzed for the presence or absence of each of these 18 characteristics, and this was recorded for further analysis. Characteristics were recorded as present only if the information contained was correct as determined by the attending anesthesiologists. However, after review, none of the information presented in these 18 categories, when found in the videos, was omitted due to inaccuracies.