Crowdsourcing in Surgical Skills Acquisition: A Developing Technology in Surgical Education

Background The application of crowdsourcing to surgical education is a recent phenomenon and adds to increasing demands on surgical residency training. The efficacy, range, and scope of this technology for surgical education remains incompletely defined. Objective A systematic review was performed using the PubMed database of English-language literature on crowdsourced evaluation of surgical technical tasks up to April 2017. Methods Articles were reviewed, abstracted, and analyzed, and were assessed for quality using the Medical Education Research Study Quality Instrument (MERSQI). Articles were evaluated with eligibility criteria for inclusion. Study information, performance task, subjects, evaluative standards, crowdworker compensation, time to response, and correlation between crowd and expert or standard evaluations were abstracted and analyzed. Results Of 63 unique publications initially identified, 13 with MERSQI scores ranging from 10 to 13 (mean = 11.85) were included in the review. Overall, crowd and expert evaluations demonstrated good to excellent correlation across a wide range of tasks (Pearson's coefficient 0.59–0.95, Cronbach's alpha 0.32–0.92), with 1 exception being a study involving medical students. There was a wide range of reported interrater variability among experts. Nonexpert evaluation was consistently quicker than expert evaluation (ranging from 4.8 to 150.9 times faster), and was more cost effective. Conclusions Crowdsourced feedback appears to be comparable to expert feedback and is cost effective and efficient. Further work is needed to increase consistency in expert evaluations, to explore sources of discrepant assessments between surgeons and crowds, and to identify optimal populations and novel applications for this technology.