Video recording and videofeedback in teaching-learning of physical examination skills

Abstract: Introduction: Physical examination skills, an integral and mandatory part of medical school curricula, are traditionally taught through an approach based on “demonstration and practice”, and although other models exist, there is, to date, no evidence that one is superior to the other. Innovations in this area are pointed out as a way to supply deficiencies in teaching and learning. Objectives: To describe the incorporation of video recording and video feedback in the teaching-learning of physical examination skills and to evaluate the effectiveness of such approach. Method: A historically controlled study was carried out before and after the intervention with students in the first year of a medical course. The intervention group, in which video recording and video feedback was applied, consisted of 91 students from semester 2019.2 and the control group had 72 students from semester 2018.1. Both classes underwent two summative theoretical (T1 and T2) and two practical assessments, in the format of an objective structured clinical examination (OSCE). In the comparative statistical analysis of the grades of both classes, the non-parametric Wilcoxon and Mann Whitney rank test was used. Results: The median of the marks of the practical evaluations (1st and 2nd OSCE) of the 2019 class were higher than those of 2018. It was also found that the class of 2019 showed a positive evolution in its practical marks, with the median score increasing from 11.6 in the 1st OSCE to 13.85 in the 2nd OSCE, which also happened with the theoretical tests (p <0.05). In the class of 2018, there was a drop in the median mark from T1 to T2 and from the 1st OSCE to the 2nd OSCE, but without statistical significance. Conclusion: The incorporation of video recording and video feedback in teaching-learning physical examination skills among first-year medical students, in simulated environments, proved to be effective in improving student performance in both theoretical and practical assessments. This approach is also shown as a means of developing and applying observational, reflective, experiential and metacognition motor learning in the teaching-learning of physical examination skills among medical students.

摘要：
引言：体格检查技能是医学院课程体系中不可或缺的核心必修组成部分，传统教学多采用「演示-练习」范式开展授课。尽管目前存在其他教学范式，但迄今尚无实证研究证实某一模式的教学效果优于其余模式。该领域的教学创新被视作弥补现有教与学环节不足的可行路径。
研究目标：探讨将视频录制与视频反馈融入体格检查技能的教与学流程，并评估该教学模式的实际有效性。
研究方法：本研究为历史性对照研究，针对某医学院临床医学专业一年级学生在干预前后的考核数据开展分析。干预组为2019年第二学期的91名学生，采用视频录制结合视频反馈的教学方案；对照组为2018年第一学期的72名学生，采用传统教学模式。两组学生均完成两次总结性理论考核（记为T1与T2）及两次客观结构化临床考试（Objective Structured Clinical Examination, OSCE）形式的实践考核。在两组成绩的统计比较分析中，采用非参数Wilcoxon秩和检验与Mann Whitney秩和检验。
研究结果：2019级学生两次实践考核（第一次与第二次OSCE）成绩的中位数均高于2018级学生。同时，2019级学生的实践成绩呈现显著正向提升，其考核中位数从第一次OSCE的11.6提升至第二次OSCE的13.85；理论考核成绩亦呈现相同的提升趋势（p<0.05）。反观2018级学生，其成绩中位数从T1到T2、从第一次OSCE到第二次OSCE均出现下降，但该差异未达到统计学显著性水平。
研究结论：在模拟教学环境下，将视频录制与视频反馈融入一年级医学生的体格检查技能教学中，可有效提升学生在理论与实践两类考核中的综合表现。该教学模式同时可作为培养并应用观察性、反思性、体验性及元认知运动学习方法的有效载体，应用于医学生体格检查技能的教学环节。