Videos

The main reason for using hazard videos and those containing mistakes was to provide cognitive hazard training to improve operation safety. Videos are used to mentally train System One to detect hazards and alert System Two to take the appropriate safety actions, as discussed in Chapter Two. To achieve such an

intention video clips must represent real hazards encountered in the target operation, which is laparoscopic cholecystectomy in our case. Current surgical operation simulation machines lag behind in reality and struggle to equip surgeons with the operation skills needed, beyond basic training. In fact, extensive training to full competency in surgical operation simulation failed to provide a benefit beyond the first real operation in Zendejas’s randomised control trial (37). As a result, I ruled out the use of simulated videos and I started to search for real operation hazard videos for my module.

Using my topic shopping list described earlier (Appendix 4, table 3), I started a video search for hazard and complication videos. It became apparent, as the search

continued, that the materials needed are available on YouTube. However those videos were rarely labelled according to the hazard presented, except in severe complication cases such as common bile duct injury or serious hazardous anatomical variations in the cystic artery origin. This forced a wider search on all available laparoscopic cholecystectomy videos across YouTube. This wider search entailed watching every encountered operation video looking for specific moments of hazards or unusual anatomy.

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It also became apparent that it was not possible to use multiple whole-operation videos of twenty five to fifty minutes in my assessment. Such use would make the assessment time unrealistically lengthy. This would put off candidates and risk them missing the intended mental hazard training. I was faced with the need to find a legally acceptable way to download YouTube videos and edit them in a way to highlight the targeted hazard and complication moments.

Despite the availability of many YouTube download tools and sites on the net, the YouTube copyright document does not give a clear permission path to follow. Even though those operation videos were uploaded onto YouTube under the education category, there was no clear line to say you are allowed to download them for educational purposes. It was only clear that I would be allowed to stream them online, which was not practically possible in my case due to the video length.

Faced with these vague permission criteria, I emailed Durham University legal department for help. I was advised by the legal department to email the YouTube copyright email address but was warned that they will most probably refer me to the copyright holders for permission. Within the same period I had a discussion with Durham University Educational IT experts and I was advised to create the assessment in a computerised form and host it on the University website with an invitation-only access to simplify the images’ and videos’ copyright permission granting process. Needless to say I was chasing free access permission. However the University IT department recommended that I purchase the material needed on a set number of users rather than viewers basis. This was because trainees might start the

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video then stop the module to resume it later due to emergency calls or other

circumstances. This was clearly important advice but fortunately I managed to get all my targeted materials permissions free of charge.

I sent a detailed email to YouTube copyrights asking for permission to download those videos and explaining my research had an academic, non-profit educational aim, which would be in line with the educational category under which those YouTube videos were uploaded. After sending two email reminders I received an answer a month later to say:

‘We cannot grant rights to any screenshots or footage of third-party content on our

site. Please follow up with the individual content owners regarding the rights to this footage. You may be able to contact the user through YouTube's private messaging feature’.

The YouTube private messaging feature is a hidden built-in feature within YouTube. I had to search the net to find some guidance to using it. The process starts after watching the operation video on YouTube and identifying it as a possible material candidate. I then had to subscribe to the video uploader channel. Such subscription was not possible without logging in to YouTube first with my google username and password. I then had to go to the subscribed channel where I found multiple

subheadings: ‘Home’, ‘Videos’, ‘Playlists’, ‘Channels’, ‘Discussion’ and ‘About’. Under the ‘About’ subtitle there is a Send Message button to send a private message to the channel owner. Those messages get sent to the owner’s Gmail account but, despite the recent increase in popularity, this is still not the default email account for

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most people. As a result, I had one response only and that response was sent to my Gmail account. I did put my University email address in the messages sent using the YouTube private messaging feature and I was not expecting a reply through Gmail. I noticed the reply a month later as I do not check my Gmail account. I use a Nexus (Google brand) phone and Gmail started to send push notifications for new mails after a software update by Google. I noticed a push notification of a new mail. When I clicked enter to check the email, I was faced with the receipt for the book bought and two emails from one YouTube channel owner giving permission and offering to help in training me to upload and edit my videos.

Due to that lucky email discovery I came to the conclusion that it was highly

unlikely that I would get any more answers through the YouTube private messaging feature. Firstly, it was two months down the line since the first wave of emails, with one answer only, despite frequent reminders. Secondly, if I do not check my Gmail account then most probably other people did not either. I had to look for a different way to contact the video/channel owners to make sure my message would reach them.

Checking the information provided by owners on the ‘About’ subtitle in their YouTube channel, I found a variety of information about the individual. Some provided their name, others their work title, work address, a website link and even an alternative email address or a contact number in some rare cases. Those pieces of information were used to search the web for further contact details to ask for

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owner’s newly uploaded videos. I expressed my interest in the videos and asked for an email address for further communication.

I frequently needed to send two to three reminders, with a couple of weeks in

between, to get an initial response; however permissions were usually quick after the first response. All the above communications were followed by a detailed email from my Durham University account to provide the video-owner with a brief description of my research aims and objectives. I stressed in my email the invitation-only access and the non-profit academic educational purpose of my research. I also stated that the research is aimed for UK surgical registrars’ training benefit. I explained the need to download and edit the videos to shorten them to suit my assessment within a set time limitation.

I managed to gain permissions from all the successfully contacted owners except one owner. This copyright owner showed some hesitancy and asked me to provide the full context for using the video and the reason for selecting a near miss video in my assessment. He gave reluctant permission in the end and I opted not to use his video in my assessment as better alternatives were found during the design process. All other successfully contacted owners gave full permission to use all their videos. One owner gave full permission to use his own generated materials as he had uploaded other owners’ material into his channel.

Despite that success in gaining permissions from the successfully contacted channel owners, I was faced with challenges in reaching other owners. Some channels were

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inactive for many years and communication led to dead ends despite following all possible leads over a reasonably long period of time. Other channels had no owner information to follow up. Those videos were marked as for streaming only, as streaming is allowed within YouTube copyright, without the need for further permissions.

As I discussed above, I needed to view all the available laparoscopic

cholecystectomy operations to look for possible hazards and anatomical variation due to the lack of clear labelling of such videos. It became a repeated cycle of searching for videos, viewing them and chasing the copyright holders while looking for more videos. This repeated process enabled me to reduce the time wasted in gaining the permissions as it was incorporated in the same period to search and watch a huge number of full length surgical operation videos.

As I was given full permission to use all channel content by many of the channel owners, I conducted a further detailed video review to search through all the permitted videos. I created a list of the permitted videos with their detailed review and the non-permitted streaming only videos that I considered important material for my assessment (Appendix 4).

Armed with the granted copyright holders’ permission I went back to Durham University’s legal department for further guidance. I was instructed to email YouTube copyrights again, mentioning the granted permissions and asking for

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permission to download those videos from YouTube. I was faced with the exact same reply wording:

‘We cannot grant rights to any screenshots or footage of third-party content on our

site. Please follow up with the individual content owners regarding the rights to this footage. You may be able to contact the user through YouTube's private messaging feature’.

I sent the reply to the University legal department and they were happy to consider it as evidence that YouTube have no extra copyrights over those videos. I was given the green light, by the legal department, to download and edit the videos and I was also provided with a supportive email from the university legal department to include in my ethical approval application (Appendix 5).