期刊论文详细信息
BMC Medical Education
A randomized controlled pilot trial comparing the impact of access to clinical endocrinology video demonstrations with access to usual revision resources on medical student performance of clinical endocrinology skills
Stephen Clarke2  Stephen Twigg3  Diana L Learoyd2  John N Carter4  Tim Lambert1  Emily J Hibbert5 
[1] Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia;Department of Endocrinology, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia;Sydney Medical School Central, University of Sydney, Sydney, Australia;Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia;Nepean Hospital, Penrith, Australia
关键词: E-learning;    Medical education;    Endocrinology;    Medical student;    Clinical skills;    Video;   
Others  :  1138660
DOI  :  10.1186/1472-6920-13-135
 received in 2013-02-11, accepted in 2013-10-01,  发布年份 2013
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【 摘 要 】

Background

Demonstrating competence in clinical skills is key to course completion for medical students. Methods of providing clinical instruction that foster immediate learning and potentially serve as longer-term repositories for on-demand revision, such as online videos demonstrating competent performance of clinical skills, are increasingly being used. However, their impact on learning has been little studied. The aim of this study was to determine the value of adjunctive on-demand video-based training for clinical skills acquisition by medical students in endocrinology.

Methods

Following an endocrinology clinical tutorial program, 2nd year medical students in the pre-assessment revision period were recruited and randomized to either a set of bespoke on-line clinical skills training videos (TV), or to revision as usual (RAU). The skills demonstrated on video were history taking in diabetes mellitus (DMH), examination for diabetes lower limb complications (LLE), and examination for signs of thyroid disease (TE). Students were assessed on these clinical skills in an observed structured clinical examination two weeks after randomization. Assessors were blinded to student randomization status.

Results

For both diabetes related clinical skills assessment tasks, students in the TV group performed significantly better than those in the RAU group. There were no between group differences in thyroid examination performance. For the LLE, 91.7% (n = 11/12) of students randomized to the video were rated globally as competent at the skill compared with 40% (n = 4/10) of students not randomized to the video (p = 0.024). For the DMH, 83.3% (n = 10/12) of students randomized to the video were rated globally as competent at the skill compared with 20% (n = 2/10) of students not randomized to the video (p = 0.007).

Conclusion

Exposure to high quality videos demonstrating clinical skills can significantly improve medical student skill performance in an observed structured clinical examination of these skills, when used as an adjunct to clinical skills face-to-face tutorials and deliberate practice of skills in a blended learning format. Video demonstrations can provide an enduring, on-demand, portable resource for revision, which can even be used at the bedside by learners. Such resources are cost-effectively scalable for large numbers of learners.

【 授权许可】

   
2013 Hibbert et al.; licensee BioMed Central Ltd.

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【 参考文献 】
  • [1]Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiat H: The nature of adverse events in hospitalised patients: results of the Harvard Medical Practice Study II. N Engl J Med 1991, 324:377-384.
  • [2]Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD: The Quality in Australian Health Care Study. Med J Aust 1995, 163:58-71.
  • [3]Definition of a skill. http://www.businessdictionary.com/definition/skill.html webcite
  • [4]Partnerships for Care. Taking Forward the Scottish Clinical Skills Strategy. Executive Summary. Edinburgh: NES. http://www.csmen.scot.nhs.uk/media/1867/scottish_clinical_skills_strategy_exec_summary.pdf webcite
  • [5]Michels MEJ, Evans DE, Blok GA: What is a clinical skill? Searching for order in chaos through a modified Delphi process. Med Teach 2012, 34:e573-81.
  • [6]Cowan DT, Norman I, Coopamah VP: Competence in nursing practice: a controversial concept – A focused review of literature. Accid Emerg Nurs 2007, 15:20-26.
  • [7]Miller GE: The assessment of clinical skills/competence/performance. Acad Med 1990, 65:S63-7.
  • [8]Dreyfus SE, Dreyfus HL: A Five-Stage Model of the Mental Activities Involved in Directed Skill Acquisition. Berkeley: California University Berkeley Operations; 1980.
  • [9]Dreyfus SE: The five-stage model of adult skill acquisition. Bull Sci Technol 2004, 24:177-181.
  • [10]Benner P: From Novice to expert: excellence and power in clinical nursing practice. Boston, USA: Reading MA: Addison- Wesley; 1984.
  • [11]Anderson JR: Acquisition of cognitive skill. Psychol Rev 1982, 89:369-406.
  • [12]Singley MK, Anderson JR: The transfer of cognitive skill. Cambridge, MA: Harvard University Press; 1989.
  • [13]Byrne AJ, Pugsley L, Hashem MA: Review of comparative studies of clinical skills training. Med Teach 2008, 30:764-767.
  • [14]Walker M, Peyton JWR: Teaching in theatre. In Teaching and learning in medical practice. Edited by Rickmansworth JWRP. UK: Manticore Europe limited; 1998:171-180.
  • [15]Lake FR, Hamdorf JM: Teaching on the run tips 5: teaching a skill. Med J Aust 2004, 181:327-328.
  • [16]Ausubel DP: Cognitive structure and transfer. In How Students Learn. Edited by Entwhistle NH, Hounsell D. Lancaster: Institute for Research and Development in Post Compulsory Education, University of Lancaster; 1975.
  • [17]Hughes C, Toohey S, Hatherly S: Developing learning centred trainers and tutors. Stud Contin Educ 1992, 14:14-27.
  • [18]Kolb DA: Experiential Learning. Englewood Cliffs NJ: Prentice-Hall; 1984.
  • [19]Ericsson KA: Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 2004, 79:S70-81.
  • [20]Bradley P, Postlethwaite K: Setting up a clinical skills learning facility. Med Educ 2003, 37(1):6-13.
  • [21]Gibbons AFP: Computer-based instruction. In Training and retraining: A handbook for business, industry, government and the military. Edited by Tobias S, Fletcher J. New York: Macmillan Reference USA; 2000.
  • [22]Kelly M, Lyng C, McGrath M, Cannon G: A multi-method study to determine the effectiveness of, and student attitudes to, online instructional videos for teaching clinical nursing skills. Nurse Educ Today 2009, 29:292-300.
  • [23]Masie E: Blended learning: the magic is in the mix. In The ASTD E- Learning Handbook. Edited by Rosett A. New York: McGraw- Hill; 2002:58-63.
  • [24]Childs S, Blenkinsopp E, Hall A: Effective e-learning for health professionals and students—barriers and their solutions. A systematic review of the literature—findings from the HeXL project. Health Inf Libr J 2005, 22(Suppl 2):20-32.
  • [25]Rössler B, Lahner D, Schebesta K, Chiari A, Plöchl W: Medical information on the Internet Quality assessment of lumbar puncture and neuroaxial block techniques on YouTube. Clin Neurol Neurosurg 2012.
  • [26]Kingsley K, Galbraith GM, Herring M, Stowers E, Stewart T, Kingsley KV: Why not just Google it? An assessment of information literacy skills in a biomedical science curriculum. BMC Med Educ 2011, 11:17. BioMed Central Full Text
  • [27]Beran TN, McLaughlin K, Al Ansari A, Kassam A: Conformity of behaviors among medical students: impact on performance of knee arthrocentesis in simulation. Adv Health Sci Educ Theory Pract 2012, 18:589-596.
  • [28]The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) Report. http://www.bakeridi.edu.au/Assets/Files/AusDiab_Report_2000.pdf webcite
  • [29]CDCP National Diabetes Fact Sheet 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf webcite
  • [30]Rethans JJ, Norcini JJ, Barón-Maldonado M, Blackmore D, Jolly BC, LaDuca T, Lew S, Page GG, Southgate LH: The relationship between competence and performance: implications for assessing practice performance. Med Educ 2002, 36:901-909.
  • [31]Thyroid examination video 1. http://www.hivvids.com/tag/thyroid webcite+examination.htm
  • [32]Thyroid examination video 2. http://www.youtube.com/watch?v=krXoyP5j5lk webcite
  • [33]Thyroid examination video 3. http://www.medicalvideos.us/play.php?vid=470 webcite
  • [34]Joslin Diabetes Center: Diabetes Foot Exam. http://www.youtube.com/watch?v=VdYrnRfgwXM webcite
  • [35]Silverman J, Kurtz S, Draper J: Skills For Communicating With Patients. Oxford: Radcliffe Medical Press; 1998.
  • [36]Talley NJ, O’Connor S: Clinical Examination: A Systematic Guide To Physical Diagnosis. Australia: Churchill Livingstone Elsevier; 2010.
  • [37]Maloney S, Storr M, Paynter S, Morgan P, Ilic D: Investigating the efficacy of practical skill teaching: a pilot-study comparing three educational methods. Adv Health Sci Educ Theory Pract 2012, 18:71-80. http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed;id=22354336;retmode=ref;cmd=prlinks webcite
  • [38]Holland A, Smith F, McCrossan G, Adamson E, Watt S, Penny K: Online video in clinical skills education of oral medication administration for undergraduate student nurses: a mixed methods, prospective cohort study. Nurse Educ Today 2012, 33:663-670. http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed;id=22341996;retmode=ref;cmd=prlinks webcite
  • [39]Marteau TM, Humphrey C, Matoon G, Kidd J: Factors influencing the communication skills of first-year clinical medical students. Med Educ 1991, 25:127-134.
  • [40]Steedman M, Abouammoh M, Sharma S: Multimedia learning tools for teaching undergraduate ophthalmology: results of a randomized clinical study. Can J Ophthalmol 2012, 47:66-71.
  • [41]Hansen M, Oosthuizen G, Windsor J, Doherty I, Greig S, McHardy K, McCann L: Enhancement of medical interns’ levels of clinical skills competence and self-confidence levels via video iPods: pilot randomized controlled trial. J Med Internet Res 2011, 13:e29.
  • [42]Shippey SH, Chen TL, Chou B, Knoepp LR, Bowen CW, Handa VL: Teaching subcuticular suturing to medical students: video versus expert instructor feedback. J Surg Educ 2011, 68:397-402.
  • [43]Levitan R, Goldman T, Bryan D, Shofer F: Training with video imaging improves the initial intubation success rates of paramedic trainees in an operating room setting. Ann Emerg Med 2001, 37:46-50.
  • [44]Khogali SEO, Davies DA, Donnan PT, Gray A, Harden RM, McDonald J, Pippard MJ, Pringle SD, Yu N: Integration of e-learning resources into a medical school curriculum. Med Teach 2011, 33:311-318.
  • [45]Roshier AL, Foster N, Jones MA: Veterinary students’ usage and perception of video teaching resources. BMC Med Educ 2011, 11:1. BioMed Central Full Text
  • [46]Ruiz JG, Mintzer MJ, Leipzig RM: The Impact of E-Learning in Medical Education. Acad Med 2006, 81:207.
  • [47]McKimm J: ABC of learning and teaching: web based learning. BMJ 2003, 326:870-873.
  • [48]Chumley-Jones HS, Dobbie A, Alford CL: Web-based learning: sound educational method or hype? A review of the evaluation literature. Acad Med 2002, 77:S86-93.
  • [49]Mamary EM, Charles P: On-site to on–line: Barriers to the use of computers for continuing education. J Contin Educ Health Prof 2000, 20:171-175.
  • [50]Miller GE: The asessment of clinical skills/competence/perfomance. Acad Med 1990, 65:S63-S67.
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