Perceived Anxiety is Negligible in Medical Students Receiving Video Feedback During Simulated Core Practical Skills Teaching: A Randomised Trial Comparing Two Feedback Modalities.

Introduction The ability to undertake simple practical procedures is essential for graduating medical students and is typically assessed using simulated models. Feedback is a key component of the learning process in developing proficiency in these key skills. Video feedback (VF) has previously shown promise, however, negative effects of VF-related anxiety on performance have been previously reported. Our aim was to investigate for a difference in participant anxiety between supervised individualised video feedback (SIVF) and unsupervised generic video feedback (UGVF) when undertaking simulated basic practical procedures. Methods Undergraduate medical students participating in a clinical skills study to compare UGVF and SIVF completed a Likert scale questionnaire detailing perceived anxiety. During the study, students were recorded performing three basic surgical skills (simple interrupted suturing, intravenous cannulation, urinary catheterisation). Feedback was then provided by one of two methods: (1) SIVF - participant video footage reviewed together with a tutor providing targeted feedback, and (2) UGVF - participant video footage reviewed alone with concurrent access to a generic pre-recorded 'expert tips' video clip for comparison. Each participant received SIVF and UGVF at least once. Results The majority of participants did not find either SIVF (81.7%) or UGVF (78.8%) stressful. Students had a strong preference for SIVF (77.5%) and disagreed that similar 'face-to-face' feedback had impaired learning in the past (80.3%). Conclusion Medical student-perceived anxiety is negligible when video feedback is employed during simulated core practical skill training.

Educational Impact of a Pulsatile Human Cadaver Circulation Model for Endovascular Training.

OBJECTIVES: The face and construct validity of a novel pulsatile human cadaver model (PHCM) was recently demonstrated for endovascular training. This study aimed to assess the model's educational impact. METHODS: Twenty-four endovascular novices were recruited and split into two equal training groups: PHCM and virtual reality simulator (VRS). Each candidate performed eight consecutive training attempts of endovascular renal artery catheterisation on their designated model, and a final crossover attempt on the alternate model. Performances were video recorded and scored using a validated scoring tool by two independent endovascular experts, blinded to the candidate's identity and attempt number. Each participant was given a task specific checklist score (TSC), global rating score (GRS), and overall procedure score (OPS). RESULTS: In the PHCM group average OPS improved gradually from 19.42 (TSC 8.58, GRS 10.83) to 39.50 (TSC 15.00, GRS 24.5) over eight attempts (p < .0005). In the VRS group OPS improved from 20.54 (TSC 10.29, GRS 10.25) to 36.04 (TSC 14.21, GRS 21.88) between the first and eighth attempts (p < .0005), with limited improvement after the second attempt. PHCM training significantly improved OPS on their VRS crossover attempt (p ≤ .0001), achieving a similar OPS to candidates who had completed VRS training (p = .398). VRS training significantly improved OPS on PHCM (p < 0.05); however, OPS was significantly worse than candidates who had completed PHCM training (p ≤ .001). CONCLUSIONS: PHCM training has a longer learning curve, with gradual improvement, reflecting the enhanced difficulty of a more realistic model. These results support the use of PHCM preceded by VRS training, prior to performing endovascular surgery on patients.

Asynchronous Unsupervised Video-Enhanced Feedback As Effective As Direct Expert Feedback in the Long-Term Retention of Practical Clinical Skills: Randomised Trial Comparing 2 Feedback Methods in a Cohort of Novice Medical Students.

OBJECTIVES: To determine the degree of practical clinical skills' retention over a 7-week period after receiving either video-enhanced direct expert feedback (DEF) or asynchronous unsupervised video-enhanced feedback (UVF). DESIGN: A prospective single-blinded randomized trial was conducted over a 7-week period with novice medical students. Following a generic introduction, PowerPoint presentation and live demonstration of intravenous cannulation was given by an expert, and candidates performed the same task in isolation while being recorded and were randomized to receive either DEF or UVF. Further, 20 students were randomized to receive UVF and 22 to receive DEF. Candidates returned to repeat the video-recorded task at week 1, 4, and 7, with no further feedback provision on these occasions. Performances were fully anonymized and independently marked by 2 expert assessors. SETTING: Newcastle University, Medical School, England, United Kingdom. PARTICIPANTS: A total of 42 novice medical students from the preclinical years were selected, with no prior experience of intravenous cannulation. RESULTS: No significant difference existed between demographics of either cohort. Good between-assessor score correlation was noted, with an intraclass correlation coefficient (ICC) of 0.89. The DEF arm significantly improved from their prefeedback performance at Day 1 on repeating the skill a week later (p < 0.0001); this improved score was maintained throughout the duration of the study. The UVF arm showed a nonsignificant improvement; however, there was no significant difference in the scores between the UVF and the DEF groups at any point in the trial. CONCLUSIONS: Video-technology may play a significant role in the provision of feedback for practical skills. The ability for experts to provide remotely delivered but individualized feedback can be an efficient use of valuable resources, while students being able to self-assess their own performance alongside an expert video have the potential to provide students with an excellent opportunity to learn clinical skills without requiring intensive educator involvement.

Individualised Expert Feedback is Not Essential for Improving Basic Clinical Skills Performance in Novice Learners: A Randomized Trial.

OBJECTIVE: To determine whether unsupervised video feedback (UVF) is as effective as direct expert feedback (DEF) in improving clinical skills performance for medical students learning basic surgical skills-intravenous cannulation, catheterization, and suturing. BACKGROUND: Feedback is a vital component of the learning process, yet great variation persists in its quality, quantity, and methods of delivery. The use of video technology to assist in the provision of feedback has been adopted increasingly. METHODS: A prospective, blinded randomized trial comparing DEF, an expert reviewing students' performances with subsequent improvement suggestions, and UVF, students reviewing their own performance with an expert teaching video, was carried out. Medical students received an initial teaching lecture on intravenous cannulation, catheterization, and suturing and were then recorded performing the task. They subsequently received either DEF or UVF before reperforming the task. Students' recordings were additionally scored by 2 blinded experts using a validated proforma. RESULTS: A total of 71 medical students were recruited. Cannulation scores improved 4.3% with DEF and 9.5% with UVF (p = 0.044), catheterization scores improved 8.7% with DEF and 8.9% with UVF (p = 0.96), and suturing improved 15.6% with DEF and 13.2% with UVF (p = 0.54). Improvement from baseline scores was significant in all cases (p < 0.05). CONCLUSION: Video-assisted feedback allows a significant improvement in clinical skills for novices. No significant additional benefit was demonstrated from DEF, and a similar improvement can be obtained using a generic expert video and allowing students to review their own performance. This could have significant implications for the design and delivery of such training.

Randomized trial to assess the effect of supervised and unsupervised video feedback on teaching practical skills.

BACKGROUND: Feedback is a vital component of the learning process; however, great variation exists in the quality, quantity, and method of delivery. Video feedback is not commonly used in the teaching of surgical skills. The aim of this trial was to evaluate the benefit of 2 types of video feedback-individualized video feedback (IVF), with the student reviewing their performance with an expert tutor, and unsupervised video-enhanced feedback (UVF), where the student reviews their own performance together with an expert teaching video-to determine if these improve performance when compared with a standard lecture feedback. METHODS: A prospective blinded randomized control trial comparing lecture feedback with IVF and UVF was carried out. Students were scored by 2 experts directly observing the performance and 2 blinded experts using a validated pro forma. Participants were recorded on video when performing a suturing task. They then received their feedback via any of the 3 methods before being invited to repeat the task. RESULTS: A total of 32 students were recruited between the 3 groups. There was no significant difference in suturing skill performance scores given by those directly observing the students and those blinded to the participant. There was no statistically significant difference between the 2 video feedback groups (p = 1.000), but there was significant improvement between standard lecture feedback and UVF (p = 0.047) and IVF (p = 0.001). CONCLUSION: Video feedback can facilitate greater learning of clinical skills. Students can attain a similar level of surgical skills improvement with UVF as with teacher-intensive IVF.