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


Social media and internet sources for education are rising influences which have affected the study of medicine, especially in the last decade. These new tools may enhance professional networking and education, organizational promotion, patient care/education and public health programs.[1,5–8,10,11]

As the second most popular website in the world,[15] with over one billion hours of video watched per day,[16] YouTube is an extremely influential resource in entertainment and information gathering for millions of people. Not surprisingly, the site has become a frequently relied upon source of patient medical information gathering, especially by younger physicians, residents and students.[17]

Given its popularity and global reach, YouTube has the potential to be an important educational tool for patients, conveying essential health information that could help decrease morbidity and economic burden of preventable diseases.[18] The challenge remains that, while abundant in quantity, the information available is often published by a non-vetted, non-peer reviewed source, and lacks the quality patients require.

There are numerous potential risks for patients and healthcare providers which can be caused by the dissemination of information of poor quality. These may cause damage to professional image, breaching patient privacy, violation of personal/professional boundaries and legal issues.[1,2,6,8,9,11–16] Just as importantly, multiple studies evaluating the content of YouTube videos as a source of patient information across different specialties have found them to be of subpar quality and have questioned their usefulness in finding reliable and accurate information.[19–22]

Just as YouTube has become a quickly turned to source of medical information for patients, medical students and providers are turning to its content more frequently.[3,4] With younger generations of medical professionals having access to an exponentially increasing amount of content on YouTube and other social media platforms to augment their learning, caution must be taken prior to utilizing these sources. Urgent advocacy is needed for guidelines to prevent the risks presented by these new and alternate avenues of information dissemination and education.[1,7,11,16,17]

Their content and publishers should be thoroughly vetted to ensure the information presented is complete and accurate. Other studies have evaluated YouTube content for physical exam skills, procedures, and surgeries and have found, similar to health informational videos accessed by patients, that their content is often questionable in quality and completeness.[23–26]

Visual aids and hands on simulations can be invaluable tools in learning proper techniques in regional anesthesia. Recognizing the important role videos can play in augmenting regional anesthesia education, we set out to evaluate the content of the five most viewed videos for each of 7 ultrasound guided nerve blocks. While a few of the videos were very thorough, touching on nearly 90% of the 18 categories we designated as evaluation criteria, many were lacking a significant amount of information. The overall completeness of the YouTube videos was compared to the content published on the websites of three well respected authorities in regional anesthesia (NYSORA, ACEP and USRA) and noted to be significantly lacking. Figure 2 summarizes these findings, and raises troubling trends.

This study found that even among the five most viewed instructional videos per nerve block that there was a significant variation in completeness. Among all categories evaluated, "references" was missing from nearly 86% of YouTube videos. This is concerning given the fact that the site is an open source platform, allowing anyone to upload content without oversight. Without adequate sourcing of information, one cannot be certain of the accuracy of the information demonstrated to the learner. In contrast, the regional anesthesia society websites cited multiple references for each nerve block in question 100% of the time.

Whereas YouTube has the potential to be an invaluable tool for patients and providers, offering a plethora of extremely easily accessible content, it must be used in the proper manner in order to avoid receiving incomplete, and possibly inaccurate information. For students and young physicians, consulting the content published by the established authorities on regional anesthesia to learn foundational knowledge for each nerve block would be most advisable. YouTube likely cannot replace trusted sources for primary information, such as NYSORA, ACEP and USRA. However, there may be a role in consulting further video content after the provider has knowledge and experience with the procedure to evaluate different techniques or refresh their skills.

Anesthesiologists and physicians must remain resolute when evaluating educational sources for both their own education and disseminating information to patients or colleagues. Although more readily available than only a few years ago, clinical videos of high quality may be available only on sites that are behind a paywall. Whereas sites like those maintained by NYSORA, ACEP and USRA likely have editorial processes of high-quality, YouTube's publishing process requires no editorial review except to ensure an absence of explicit, dangerous, violent, hateful, harassing, bullying, threatening or private material, or material that contains spam, scams or copyrighted material.[27]

Past research has set forth potential guidelines for healthcare providers for the use of social media, which may be broadly applicable to the dissemination of online information.[28] Sample recommendations include ensuring content credibility by sharing only information from reputable sources and immediately refuting inaccurate information that a provider encounters.[28]

Even more recent research has elucidated the possible effects of social media and internet sources of information as it related to the COVID-19 pandemic.[29] Fake news has been spread easily via social media as it relates to disease origins, manifestations, symptoms and treatments.[29] Social media has spread fake news leading to risky behaviors, such as taking unproven medications such as hydroxychloroquine.[29]

When utilizing alternate education sources that are widely accessible, standards and guidelines may need to be established on both a local and national level. Further education may be incorporated for medical students, residents and even practicing anesthesiologists to be able to review, assess and differentiate the sources one uses on the Internet. Digital literacy should not be assumed, and may need to become a part of medical school and/or residency curricula.

Despite its limitations, however, YouTube will likely grow in influence in medical education. Advantages to publishing on YouTube include the speed of publishing new content and the widespread free access to videos and information. With growing Internet access throughout the world, especially on cell phones and mobile devices, practitioners who may have had limited access to information regarding new techniques and technologies, may be able to access an unending archive of instructional material on sites such as YouTube. This may lead to improved patient care and communication amongst medical professionals.