RESUMO
AIMS: A study was designed to assess the effects of a standardized instructional videotape on training senior medical students to acceptable levels of reliability in performing several commonly used observer dependent outcome measures in patients with rheumatoid arthritis (RA). METHODS: During a single day, six third-year medical students independently examined six patients with RA in predetermined order using a Latin Square design, before and after viewing a standardized videotape demonstrating 15 examination techniques. Reliability coefficients were calculated based on the variance components of the analysis of variance (ANOVA) table. RESULTS: Prestandardization reliability coefficients were >0.80 for all measures and remained above 0.80 following standardization except for one measure. CONCLUSIONS: High levels of interobserver agreement were noted prior to viewing the instructional videotape. This may represent the success of undergraduate clinical skills training programmes or it may be me result of the students having reviewed an illustrated instructional text just prior to the initial patient examinations. High levels of prestandardization reliability, by necessity, precluded the demonstration of significant effects from viewing the videotape. Nevertheless, the data indicate that senior medical students are capable of reliably performing quantitative measurement in RA. Recent surveys in Canada and Australia, showing a general lack of quantitative clinical measurement in the longitudinal follow up of RA outpatients by rheumatologists, suggest that the lack of standardization is not due to inability to reliably perform the measurements.
