Abstract Purpose Considering traditionally poor uptake of video review to support operative skill acquisition, we studied surgical trainees’ perspectives during implementation of the BlackBox Explorer (BBX) video-based teaching and assessment system. Methods This interview study included residents and fellows completing their surgical rotations at a Community Hospital affiliated with the University of Toronto. We used a team-based approach to complete a reflexive thematic analysis. Results Analysis of 11 interviews ( N = 10 residents and N = 1 fellow) generated three themes: (i) Technology is merely a tool, and tools need to work well, (ii) Routinizing a new technology into clinical practice, and (iii) Motivating a new learning practice. Implementation challenges did not dissuade some participants from valuing the BBX. Conclusions We found that a relatively passive ‘implementation by diffusion’ strategy does not lead to uptake in a busy surgical training environment. No matter the potential benefits of any video-based teaching and assessment system, siloed implementation likely breeds inconsistent utilization.
Tewari et al. (2026) studied this question.