Video-based on-ward supervision for final year medical students

Groener et al. BMC Medical Education (2015) 15:163 DOI 10.1186/s12909-015-0430-2 RESEARCH ARTICLE Open Access Video-based on-ward supervision for final year medical students JB Groener1†, TJ Bugaj2†, R. Scarpone2, A. Koechel2, J. Stiepak3, S. Branchereau2, M. Krautter4, W. Herzog2 and C. Nikendei2* Abstract Background: Constructive feedback is an essential element of the educational process, helping trainees reach their maximum potential and increasing their skill level. Video-based feedback has been described as highly effective in various educational contexts. The present study aimed to evaluate the feasibility and acceptability of video-based, on-ward supervision for final year students in a clinical context with real patients. Methods: Nine final year medical students (three male, six female; aged 25.1 ± 0.7 years) and eight patients (five male, three female; aged 59.3 ± 16.8 years) participated in the pilot study. Final year students performed routine medical procedures at bedside on internal medicine wards at the University of Heidelberg Medical Hospital. Students were filmed and were under supervision. After performing the procedures, an oral feedback loop was established including student, patient and supervisor feedback on communicative and procedural aspects of skills performed. Finally, students watched their video, focusing on specific teachable moments mentioned by the supervisor. Written evaluations and semi-structured interviews were conducted that focused on the benefits of video-based, on-ward supervision. Interviews were analysed qualitatively, using open coding to establish recurring themes and overarching categories to describe patients’ and students’ impressions. Descriptive, quantitative analysis was used for questionnaire data. Results: Supervised, self-chosen skills included history taking (n = 6), physical examination (n = 1), IV cannulation (n = 1), and ECG recording (n = 1). The video-based, on-ward supervision was well accepted by patients and students. Supervisor feedback was rated as highly beneficial, with the video material providing an additional opportunity to focus on crucial aspects and to further validate the supervisor’s feedback. Students felt the video material would be less beneficial without the supervisor’s feedback. The setting was rated as realistic, with filming not influencing behaviour. Conclusion: Video-based, on-ward supervision may be a powerful tool for improving clinical medical education. However, it should be regarded as an additional tool in combination with supervisors’ oral feedback. Acceptance was high in both students and patients. Further research should address possibilities of efficiently combining and routinely establishing these forms of feedback in medical education. Background To ensure a smooth transition from university to clinical practice, workplace learning is of the utmost importance [1, 2]. In Germany, the final year of medical education comprises three 4-month clerkships in medical specialties (internal medicine, surgery and a third elective subject), serving to integrate final year medical students into their future working environment [3, 4]. Final year students are * Correspondence: † Equal contributors 2 Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany Full list of author information is available at the end of the article expected to assist medical doctors with their daily on-ward routines, learning to admit patients, handle medical cases, manage ward rounds and perform routine procedures such as IV cannulation, drawing blood, or recording ECGs. In terms of these ambitious educational objectives, workplace learning represents a challenging facet of undergraduate education. Various educational interventions have been introduced to enhance the didactic value of workplace learning, for example, introductory courses [5], accompanying seminars [6], logbooks [7] and portfolios [8]. However, international observations have highlighted that workplace learning during clerkship assignments and final year education still shows severe deficits, with © 2015 Groener et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Groener et al. BMC Medical Education (2015) 15:163 a lack of structure, integration, supervision and personal feedback [9–12]. Some innovative models have begun to emerge to address these limitations in final year medical education, for example, establishing educational wards offering the supervised treatment of real patients [13–16]. However, these approaches are often costly and require considerable resources and expertise. Therefore, we investigated an innovative model for structured, on-ward supervision of final-year students [17]. To acquire clinical competencies, feedback is seen as a central factor supporting individual learning processes [18]. Here, informational as well as motivational feedback factors represent potent stimuli for behaviour modification (see [19] for a comprehensive review). Nevertheless, the correct form of feedback delivery is still strongly debated (for example quantity vs. repetition) [20–24]. However, the fact that the quality of feedback has a significant impact on objective training success remains undisputed [25–28]. In terms of different forms of feedback, video-feedback has been found to be highly effective, as shown in the acquisition of resuscitation skills [29, 30] and surgical techniques [31–33]. In a recently published study on oral presentations of clinical cases publicly presented by medical students, video-assisted, oral feedback reduced severe anxiety during presentations when compared with ‘usual practice’ [34]. However, it remains unclear whether it is feasible to integrate video-feedback into clinical internal medicine routines in the ward setting and if such an innovative model would be accepted. Aims of the present study While the overall aim of the present study was to develop and establish a video-based, on-ward supervision model, our study sought to (1) evaluate the feasibility and acceptability of video-based, on-ward supervision via the assessment of process, resources, management and scientific factors; and, (2) assess whether videobased, on-ward supervision was perceived as beneficial by participating final year students. Conceptual framework We used Ericsson’s model of deliberate practice as the conceptual framework for our approach [3 (...truncated)