Videos or Slides? Study Puts Neuroangiography Training Formats Head to Head

Learning to steer a catheter through the twisting arteries of the brain has always been one of the most demanding skills in medicine. Neuroangiography, the technique used to visualize the blood vessels of the brain and neck before interventions such as aneurysm treatment or stroke thrombectomy, requires surgeons to navigate thin, shapeable catheters through delicate vascular anatomy while watching a live X-ray screen. Traditionally, this skill was passed on through years of apprenticeship in the angiography suite, with trainees learning under the watchful eyes of experienced neuroradiologists. But as digital tools reshape medical education, researchers are asking a deceptively simple question: if you had to teach yourself the basics of neuroangiography, would you learn better from watching a video of an expert performing the procedure, or from working through a set of carefully designed presentation slides?

A team of researchers at University Hospital Magdeburg, led by Franka Stolze and colleagues including Manuel Lehm, Daniel Behme, Erelle Fuchs, and Roland Schwab, set out to answer exactly that. In an exploratory study published in BMC Medical Education, they compared two standardized, self-directed instructional formats for teaching basic neuroangiographic skills: video-based instruction and presentation-based instruction. The work arrives at a moment when simulation-based learning and digital teaching tools are playing an increasingly prominent role in medical curricula, and when earlier studies have already suggested that video and even virtual reality can be just as effective as traditional presentation-based teaching for clinical skills. What makes this study distinctive is its focus on a highly technical, procedurally complex skill that has rarely been examined through this lens.

The experimental design was elegantly simple. Twenty participants with varying levels of prior angiography experience were randomly assigned to one of two groups. Nine participants formed the video-based group, while eleven formed the presentation-based group. Those in the video group watched expert-narrated recordings of a physician performing neuroangiography on a silicone flow model, a physical simulator that mimics the vascular anatomy and hemodynamics of the human circulation. Those in the presentation group independently worked through static, simplified slides derived from the same instructional material, consisting of schematic illustrations accompanied by brief written annotations. The content was matched, meaning both groups received the same underlying information; only the format of delivery differed. This careful matching is what allows the study to isolate the effect of the medium itself rather than the content being taught.

After completing their assigned instruction, all twenty participants faced the same test: performing neuroangiography on the silicone flow model using three different catheter types, the Vertebralis, the Simmons 2, and the Headhunter. Each of these catheters has a distinct shape and handling profile, and each demands different manipulation strategies to reach the target vessels. The researchers assessed overall performance using objective criteria, including total procedure time and fluoroscopy time, the latter being a particularly meaningful measure because it reflects how much X-ray exposure a trainee would generate in a real procedure. In addition to these objective measures, participants provided self-reported data on their learning experience and confidence levels, giving the researchers both a behavioral and a subjective picture of how each format performed.

The results revealed a fascinating and somewhat counterintuitive pattern. For the Vertebralis catheter, participants in the presentation-based group actually used significantly less fluoroscopy time than their video-trained counterparts. On average, the presentation group needed 237 seconds of fluoroscopy, while the video group required 369 seconds, a difference that reached statistical significance with a p-value of 0.031. In practical terms, the slide learners were faster and more economical with X-ray use when tackling their first catheter task. This finding challenges the widespread assumption that video, with its dynamic depiction of real-time catheter movement, must necessarily translate into better procedural efficiency.

Yet the story does not end there, and the subjective data tells a very different tale. Despite their longer fluoroscopy times, participants rated the video method as significantly more helpful overall, with a p-value of 0.022. This disconnect between objective performance and subjective preference is one of the most intriguing aspects of the study. It suggests that the perceived value of watching an expert’s hands move in real time, hearing the narration of decision-making as it unfolds, may create a sense of understanding and preparedness that static slides cannot match, even when the measurable outcomes do not always align with that feeling.

Perhaps the most clinically important finding emerged when the researchers examined how prior experience shaped the results. Among participants who were inexperienced in angiography, video-based training led to more successful catheterization of the left vertebral artery, with a p-value of 0.048, and fewer path deviations, also with a p-value of 0.048, compared to the presentation-based approach. In other words, for true beginners, watching the video appeared to confer genuine procedural advantages: they were more likely to actually reach the target vessel and more likely to keep their catheter on the intended route through the vascular tree. Path deviations matter enormously in real angiography, because a catheter straying from the intended path can risk vessel spasm, dissection, or other complications in living patients.

This experience-dependent effect has real implications for how training programs might be structured. The study suggests that video-based instruction may be particularly valuable as an adjunct to early neuroangiography training, precisely at the stage where novices are building their first mental models of catheter behavior and vascular anatomy. For beginners, the dynamic, narrated demonstration may provide crucial cues about hand movements, catheter shaping, and navigation strategy that static schematics struggle to convey. More experienced learners, by contrast, may already possess enough procedural schema to extract what they need from simplified diagrams, and may even benefit from the cognitive economy of slides, which strip away the visual complexity of a live procedure and highlight only the essential steps.

The authors are careful to frame their conclusions appropriately. This was an exploratory study with a modest sample size of twenty participants, and the groups were uneven, with nine in the video arm and eleven in the presentation arm. The findings should therefore be seen as hypothesis-generating rather than definitive. Nonetheless, the researchers conclude that video-based instruction may be a valuable adjunct to early neuroangiography training, especially for beginners, and they highlight the potential benefits of integrating video-based elements into a blended learning curriculum for neuroangiography. At the same time, they note that further optimization of instructional design is needed in medical education, acknowledging that neither format is a finished solution and that the ideal combination of media remains to be determined.

Beyond its immediate findings, the study speaks to a broader transformation underway in medical training. As access to patients for hands-on learning becomes more constrained and as simulation technology grows more sophisticated, educators must make deliberate, evidence-based choices about which digital formats to invest in. This study offers a nuanced answer: the best format may depend on who is learning. Videos appear to give novices a genuine edge in mastering the fundamental maneuvers of catheter navigation, while presentations may offer efficiency advantages in certain objective measures. The future of procedural training, the work suggests, lies not in picking a single winner but in thoughtfully blending formats, using dynamic video demonstrations to build foundational intuition in beginners and complementing them with structured, simplified materials as skills mature. For the next generation of neuroradiologists, how they learn their first catheter navigation may be just as important as who teaches them.

Subject of Research: Comparing video-based and presentation-based self-directed instruction for learning basic neuroangiography skills

Article Title: Comparison of video-based and presentation-based self-directed instruction for learning basic neuroangiography

Article References: Stolze, F., Lehm, M., Behme, D., Fuchs, E., & Schwab, R. (2026). Comparison of video-based and presentation-based self-directed instruction for learning basic neuroangiography. BMC Medical Education, 26(1), Article 1572. https://doi.org/10.1186/s12909-026-10418-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10418-0

Keywords: neuroangiography, medical education, video-based learning, simulation training, fluoroscopy, catheter navigation, self-directed instruction, neuroradiology, blended learning, surgical training, eLearning, Comparison