This study aimed to measure the educational satisfaction with and effectiveness of real-time online point-of-view filming (POVF) clinical skills education in medical students.
Medical students participated in a 120-minute clinical skills education session. The session consisted of emergency procedures, wound management, and vascular access. The authors provided real-time online POVF using a smartphone. A questionnaire survey was issued to the students after the class, and their satisfaction with education, educational environment, and effectiveness were analyzed.
Responses about satisfaction with POVF education were very positive in all grades. However, approximately half of the students were satisfied with the smoothness of listening to a lecture and the video quality. More than half of the students responded positively to the question about educational effectiveness.
In these times of non-classroom teaching brought on by the coronavirus disease 2019 (COVID-19) pandemic, POVF clinical skills education is likely to be a very useful educational tool. If disadvantages such as insufficient feedback or environmental problems can be addressed, it could serve as an alternative method of clinical skills education even after the COVID-19 pandemic.
Medical students receive clinical skills education through various methods such as lectures, bedside observation of patients, direct practice activities, and simulation. Among these methods, direct practice and feedback are known to be more effective at enhancing technical skills [
The coronavirus disease 2019 (COVID-19) pandemic has almost suspended face-to-face medical education and clinical skills education has been negatively affected. Clinical clerkship has been cancelled or moved online, and the opportunities for clinical skills observation or activities have considerably decreased since the start of the pandemic [
A previous study revealed that video-based e-learning was effective in teaching certain practical clinical skills [
The main aims of newly developed clinical skill educational methods are to achieve the following goals: (1) replace current teaching methodology in situations where face-to-face education is impossible; (2) observe clinical skill processes in greater detail than in direct practice activity; and (3) bridge the gap created by the pandemic in teaching clinical skills effectively.
The authors considered that real-time online clinical skills education using point-of-view filming (POVF) with a smartphone would be appropriate in the pandemic environment since one educator can readily facilitate education for large cohorts of students. We expected that students would be able to observe the relevant skills in detail because the educator could easily perform camera manipulations such as zooming in/out of the scene. Standardization of skills education would be also be achieved through the maintenance of consistency, because only one educator would be involved.
Few studies have explored the practicality and effectiveness of one-person POVF in medical education [
A total of 220 M5 (3rd grade) and M6 (4th grade) medical students (110 students in each grade) attending the School of Medicine were included in this study. The session runtime was 120 minutes, and the lecture was progressed for each grade. A clinical skills expert with more than 10 years of clinical skills training experience participated in the lecture, and another educator participated for video filming. An Android smartphone was used for POVF, and Zoom (Zoom Video Communications Inc., San Jose, CA, USA) was utilized as a real-time online teaching tool (
Clinical skills contents included (1) emergency procedures (adult basic life support, defibrillation, and endotracheal intubation), (2) wound management (wound dressing, local anesthesia, and sutures), and (3) vascular access (arterial puncture, venipuncture for blood culture, and blood transfusion). For reference, M6 students had already learned these skills during their clerkship, whereas M5 students had not yet been taught emergency procedures.
We used an educational module devised from a modified Peyton’s four-stage approach [
After POVF education, a questionnaire survey was issued to the students who took the class. The survey was conducted from December 2021 to February 2022, and all participants were voluntarily surveyed. The survey was based on the questionnaire established by the authors and consisted of four categories as detailed below. The answers were assessed using a 5-point Likert scale (1=very unsatisfied to 5=very satisfied) and through open-ended questions. The four categories comprised the following components:
It includes (1) difficulty level of pre-learning materials, (2) adequacy of educator attitude, (3) satisfaction compared to face-to-face procedural education, (4) satisfaction compared to self-directed learning, (5) adequacy of feedback, (6) adequacy of teaching time (1=very short, 3=appropriate, 5=very long), and (7) difficulty level of lecture (1=very easy, 3=appropriate, 5=very difficult). Difficulty level and teaching time questions were excluded in the process of summing the final satisfaction.
It includes (1) ease of network access, (2) difficulty in listening to a lecture, (3) video quality, and (4) skillfulness of smartphone camerawork.
It includes (1) usefulness for acquiring clinical skills, (2) usefulness for preparing for Korean Medical Licensing Examination, and (3) predictive educational effectiveness compared to face-to-face procedural education after COVID-19.
Of the 220 participants, 186 (84.5% response rate) completed the questionnaire. The score differences between the grades were analyzed using an independent two-sample t-test. The analysis was conducted using IBM SPSS ver. 26.0 (IBM Corp., Armonk, USA) software, and statistical significance was set at p<0.05 and p<0.01.
This study was approved by the Institutional Review Board of Kyung Hee University (KHSIRB-21-483[NA]). Informed consent was obtained from all participants.
Satisfaction with education was positive in the case of students of all grades (M5: 22.0±2.558, M6: 22.4±2.379). Most students responded positively regarding satisfaction with pre-learning materials (4.45±0.641), educator’s attitude (4.70±0.546), self-directed learning with video clips (4.10±0.937), satisfaction compared to face-to-face education (4.31±0.778), feedback (4.63±0.537) (
Satisfaction with educational environment was positive in the case of students of all grades (M5: 15.8±2.23, M6: 15.5±2.53). Students answered that network access was easy (4.46±0.736) and the skillfulness of smartphone camerawork (zoom in/out) was good (3.96±0.777). However, items related to the smoothness of listening to the lecture such as disconnection or buffering (3.61± 0.901) and video quality (3.62±0.941) showed low relative satisfaction (
Effectiveness of education was positive in the case of students of all grades (M5: 11.9±2.1, M6: 12.5±1.9). Responses about the usefulness for acquiring clinical skills (4.31±0.649) and for the practical exam for the Korean Medical Licensing Examination (4.30±0.669) were very positive, and there was no difference by grade. More than half of the students responded positively to the question about whether it would be possible to apply the test methodology instead of face-to-face education after COVID-19 (3.63±1.198), although a statistically significantly higher negative response was observed in M5 students (p=0.008) (
The most commonly reported merit of this educational exercise was that students were able to watch the key scenes in detail through the camera compared to face-to-face skills practice. There were some positive comments vis-à-vis all students being able to receive the same education at the same time. However, the fact that they could not perform or receive feedback on the practice directly was noted to be a significant limitation. There were requests about improving video quality and the POVF technique (
There were positive correlations among all variables (satisfaction with education, educational environment, educational effectiveness). In particular, satisfaction with education and educational effectiveness showed a correlation coefficient of 0.617 (p<0.000), and it was found that students with high satisfaction saw more effectiveness in learning (
As the COVID-19 pandemic persists, students continue to voice their growing concern regarding reductions in their face-to-face clinical skills education and the effect this is likely to have on their learning and subsequent clinical performance outcome. Many medical educators are also worried about these problems. This study proposes a complementary mode of education. Though teaching clinical technology remotely can be a considerable challenge, we attempted to conduct the study using a real-time online POVF method using a smartphone.
This method has been investigated previously in relation to medical education. A UK-based study explored POVF as a tool to clinically teach medical students [
There are two types of POVF education. The first uses fixed cameras to film the lecture while, in the second, educators teach using wearable devices. The method with wearable devices requires purchasing new equipment such as action cameras or microphones, and it is difficult to depict a scene accurately because the operation of wearable devices and their features, such as expanding movement, are not easy to maneuver. Education using a smartphone does not incur additional costs, and any educator can easily take a video. The educator may operate a smartphone with one hand or may need an assistant during class, but the education method using smartphones has an advantage because smartphones are very familiar devices. Therefore, we chose to implement real-time online POVF clinical education using a smartphone. The results of a virtual teaching study on physical exam demonstration helped us decide on this plan [
In a survey conducted after the lesson, overall satisfaction with this method of education, online environment, and effectiveness was positive. There was no statistically significant difference in satisfaction with education and educational environment by grade, but there was a statistically significant difference in educational effectiveness by grade. In particular, there was a substantial difference in the questions related to COVID-19. As M6 students were about to take the Korean Medical Licensing Examination, they may have evaluated the predictive educational effectiveness of POVF education more positively.
Although the smoothness of listening to the lecture and video quality were mentioned as disadvantages in the real-time online environment, these obstacles can be overcome with relative ease. From an educational point of view, this method has various advantages. POVF can readily facilitate education for large cohorts of learners and is easy to implement without using special equipment. It is also possible to record videos from a close distance and provide detailed videos to learners. However, as the students pointed out, there was a distinct disadvantage as learners could not practice and receive feedback directly.
This study had some limitations. First, it was conducted at one medical college and, thus, it is not readily generalizable. Second, as the running time was short, there was not enough time for the students to learn multiple clinical skills. Third, it was not confirmed through a pre/post-test how much the students’ competency increased. Therefore, further research is needed that takes these factors into account.
In conclusion, the POVF method was perceived by medical students as a flexible and useful online education mode. Although this method cannot completely replace face-to-face education, it could be useful if used to complement face-to-face education. In addition to the situations where face-to-face education is impossible, it could also play a significant role in pre- or post-training education after COVID-19. It is necessary to investigate the effects of POVF education using other devices and/or on education for other health professions.
None.
(A) With a smartphone and (B) video shown to students.
Analysis of Survey about Effect of Clinical Skills Education by Grade
Variable | M5 (N=93) | M6 (N=93) | M5+M6 (N=186) | p-value |
---|---|---|---|---|
A | ||||
Satisfaction of pre-learning materials | 4.38±0.624 | 4.53±0.653 | 4.45±0.641 | 0.110 |
Adequacy of educator’s attitude | 4.73±0.534 | 4.67±0.558 | 4.70±0.546 | 0.422 |
Comparative satisfaction with self-directed learning with video clips | 4.05±0.925 | 4.14±0.951 | 4.10±0.937 | 0.533 |
Comparative satisfaction with face-to-face procedural education learned during clerkship | 4.24±0.813 | 4.39±0.738 | 4.31±0.778 | 0.188 |
Adequacy of feedback during teaching | 4.56±0.598 | 4.70±0.461 | 4.63±0.537 | 0.076 |
Total | 22.0±2.558 | 22.4±2.379 | 22.2±2.474 | 0.409 |
B | ||||
Ease of network access | 4.46±0.700 | 4.45±0.773 | 4.46±0.736 | 0.921 |
Smoothness of listening to a lecture (disconnection or buffering) | 3.59±0.850 | 3.63±0.953 | 3.61±0.901 | 0.746 |
Video quality (sharpness) | 3.70±0.857 | 3.55±1.016 | 3.62±0.941 | 0.276 |
Skillfulness of smartphone camerawork (zoom in/out) | 4.01±0.759 | 3.90±0.795 | 3.96±0.777 | 0.347 |
Total | 15.8±2.230 | 15.5±2.530 | 15.7±2.430 | 0.527 |
C | ||||
Usefulness of acquiring clinical skills | 4.30±0.688 | 4.32±0.611 | 4.31±0.649 | 0.822 |
Usefulness of preparing for Korean Medical Licensing Examination | 4.25±0.670 | 4.25±0.670 | 4.30±0.669 | 0.325 |
Predictive educational effectiveness compared to face-to-face procedural education after coronavirus disease 2019 | 3.40±1.252 | 3.86±1.099 | 3.63±1.198 | 0.008 |
Total | 11.95±2.060 | 12.53±1.851 | 12.24±1.975 | 0.045 |
Data are presented as mean±standard deviation. The p-values are represented by independent two sample t-test.
A: Satisfaction with education (score range, 5–25), B: Satisfaction of educational environment (score range, 4–20), C: Educational Effectiveness (score range, 3–15).
p<0.05,
p<0.01 (statistically significant).
Students’ Feedback for Clinical Skills Education Using Point-of-View Filming Education
Answer | No. of answers |
---|---|
Best lecture | 3 |
Camera work | 4 |
Video quality | 8 |
Repeat playback | 7 |
Disconnection or buffering | 2 |
Network access | 1 |
Running time | 1 |
Preference for face-to-face classes | 18 |
Curriculum change | 2 |
Convenience of feedback | 6 |
Benefits of non-face-to-face | 12 |
Composition of education | 4 |
Contents of education | 4 |
Progress of education | 3 |
Correlation between Educational Satisfaction and Educational Effectiveness after Point-of-View Filming Education (N=186)
Satisfaction education of clinical skills | Educational environment of clinical skills education | Educational effectiveness of clinical skills education | ||||
---|---|---|---|---|---|---|
|
|
| ||||
r | p-value | r | p-value | r | p-value | |
Satisfaction of clinical skills education | 1 | - | - | - | - | - |
| ||||||
Educational environment of clinical skills education | 0.371 | >0.000 |
1 | - | - | - |
| ||||||
Educational effectiveness of clinical skills education | 0.617 | >0.000 |
0.270 | >0.000 |
1 | - |
The p-values are represented by Pearson’s correlation coefficient.
p<0.01 (statistically significant).