Self-assessment of specific interpersonal skills of medical undergraduates using immediate feedback through closed-circuit television

How I Do It: Pilot Study of Video-Based Feedback as an Educational Tool for Medical Students' Presentations on Morning Rounds

OBJECTIVE

Morning rounds are a bedrock learning opportunity during clinical rotations in medical school. Specific feedback is critical for students to improve presentation skills and build confidence, however, current feedback mechanisms are fragmented and nonstandard. We aimed to assess whether video-based coaching of morning rounds could improve student feedback and self-awareness without increasing anxiety during patient presentations.

DESIGN

Medical students during core clinical clerkships were filmed presenting on morning rounds during their surgery clerkship. A designated faculty coach reviewed the video prior to an in-person coaching session. Students reviewed the video with faculty and were coached on content, presentation style, and presence. A short survey assessed students' pre- and postcoaching confidence, skill, and the utility of the coaching session.

SETTING

University of Michigan Health System, Department of Surgery, Division of General Surgery, Ann Arbor, Michigan PARTICIPANTS: Eight medical student volunteers during their core clinical clerkships at University of Michigan Medical School during the surgery clerkship.

RESULTS

Comparison of pre- and post self-assessments showed that students underestimated their knowledge of basic and clinical science and overestimated their clinical assessment skills and ability to appropriately address the core components of a presentation. Most students (75%) did not think that the filming process altered their performance and only 25% of students felt increased anxiety due to filming. All students agreed that the feedback session was useful and helped them understand how to improve their oral presentations.

CONCLUSION

This pilot demonstrates the feasibility and value of video-based coaching as an educational tool for medical students on clerkships. A larger sample size is needed to further evaluate the effectiveness of video-based coaching in establishing baseline clinical abilities and identifying potential areas for improvement.

Is the use of videotape recording superior to verbal feedback alone in the teaching of clinical skills?

Background

In recent times, medical schools have committed to developing good communication and history taking skills in students. However, there remains an unresolved question as to which constitutes the best educational method. Our study aims to investigate whether the use of videotape recording is superior to verbal feedback alone in the teaching of clinical skills and the role of student self-assessment on history taking and communication skills.

Methods

A randomized controlled trial was designed. The study was conducted with 52 of the Dokuz Eylul University Faculty of Medicine second year students. All students' performances of communication and history taking skills were assessed twice. Between these assessments, the study group had received both verbal and visual feedback by watching their video recordings on patient interview; the control group received only verbal feedback from the teacher.

Results

Although the self-assessment of the students did not change significantly, assessors' ratings increased significantly for videotaped interviews at the second time.

Conclusions

Feedback based on videotaped interviews is superior to the feedback given solely based on the observation of assessors.

First-year medical students' assessment of their own communication skills: a video-based, open-ended approach

OBJECTIVE

Interpersonal and communication skills are a core area of competency for medical students, residents, and practicing physicians. As reflection and self-assessment are essential components of skill-building, we examined the content of medical students' assessments of their own developing communication skills.

METHODS

Between 2000 and 2003, a total of 674 first-year medical students completed self-assessments of their communication skills after viewing videotapes of their interaction with simulated patients. Self-assessment forms were open-ended, providing ample space for students to write about the strengths and weaknesses they observed. Completed forms were coded by two members of the research team trained in content analysis. Students identified an average of 5.0 things that went well (range 1-15, S.D.=2.2) and 2.8 areas for improvement (range 1-9, S.D.=1.3).

RESULTS

The most frequently observed strengths were: elicited information/covered important topics (54%); made a personal connection/established rapport (51%); was supportive/encouraging/helpful (40%); attended to conversational flow and transitions (34%); ensured patient comfort (32%). The most frequently noted weaknesses involved problems with: eliciting information/covering important topics (35%); paralanguage, particularly in terms of tone, rate, volume, and disfluencies such as "uh", "um" (32%); discussing health risks (26%); attending to conversational flow and transitions (23%); students' own comfort/organization/preparation (20%).

CONCLUSION

We observed that a video-based, open-ended approach to self-assessment is feasible, practical, and informative. While the self-assessments covered a broad scope, students clearly attended to tasks and skills relevant to effective communication and relationship building.

PRACTICE IMPLICATIONS

Videotaped clinical encounters allow learners to review their own behavior and make specific comments supported by tangible examples. An open-ended approach to self-assessment of communication skills can serve as one important component of a systematic education and evaluation program.

The Teaching Effectiveness of Standardized Patients

Teaching nursing students therapeutic communication skills begins in the classroom and extends to the clinical environment. The usual method of instruction consists of random patient encounters observed by faculty and measures of competence that rely on paper-and-pencil tests. Using standardized patients (SPs) offers an alternative approach to the traditional method of teaching. Standardized patients are individuals who have been carefully trained to present an illness or scenario in a standardized, unvarying manner. This pilot study compared use of SPs with the usual method of instruction in a class of undergraduate nursing students. Results indicated that students who participated in the SP method overwhelmingly described the experience as positive, creative, and meaningful. No significant differences were found between the two groups on measures of interpersonal skills, therapeutic communication skills, and knowledge of depression

Behavioural assessment of the effectiveness of a communication programme for medical students

This study evaluated the effectiveness of a communication programme taught to medical students at the University of Melbourne in their preclinical years. The effectiveness of the programme was assessed by comparing videotaped history-taking interviews completed by a cohort of first-year clinical students in 1986, who had not undertaken the communication programme, with a similar cohort of first-year clinical students in 1992 who had undertaken the programme. The students from the 1986 cohort who had not undertaken communication training in their preclinical course completed their videotaped interviews as part of the experimental evaluation of a consulting skills training programme carried out in 1986-87. A comparison of ratings given by two experimentally naive, independent observers revealed that the 1992 student cohort demonstrated some significantly better skills at questioning and facilitating communication with patients. By contrast, the 1986 student cohort showed significantly greater skills at maintaining relevance in their interviews and greater capacity to explore patients' psychosocial concerns. These data suggest that students acquire the most effective interview skills when interacting with patients during their clinical training.