Using Web-based Video to Enhance Teaching the Physical Examination in Medical Student Education Eugene Orientale, Jr. MD Program Director, UCONN/St. Francis (Former) Director, Principles of Clinical Medicine, UCONN School of Medicine

The Problem: Physical Examination Skills are… Eroding De-emphasized, with increasing use of technology Lacking uniformity in instruction Hardly evidence-based…

Objectives of this session Consider the merits of utilizing video in PE instruction Observe several of the instructional web-based clips Become familiar with our student performance data, pre- and post- implementation of web-based video

University of Washington School of Medicine Looked at using educational videotapes to illustrate benchmark communication skills. Found that an assessment tool was needed to help provide more consistent teaching by faculty; this would provide a consistent framework for active observation and assessment of medical students. Losh, DP et al. Teaching inpatient communication skills to medical students: an innovative strategy. Acad Med 2005;80(2):118-24.

UCONN, circa 1995 ‘New Curriculum’ Clinical Medicine Course Early introduction of clinical skills Longitudinal experience through first three years of medical school Combine University and Outpatient instruction

Clinical Medicine Course Clinical Skills Assessment Program Principles of Clinical Medicine Student Continuity Practice

Problems with Instruction… Diversity of faculty 40 course faculty (PCM) 300+ community faculty (SCP) Three distinctly different disciplines Family Medicine Internal Medicine Pediatrics

Problems with Evaluation Standardized Patients (CSAP)- But how much standardized? Interobserver variability Intraobserver variability Human Error…

Hypothesis By standardizing instruction of physical exam techniques by developing internet based video, we expect to see an improvement in medical student performance on the summative complete adult PE…

Web-based Video Clips PE parsed into 77 segments Consensus from course leadership about specifics of PE Script, filming, Exam of Standardized Patients by MDs Video editing Review, re-editing

UCONN Physical Exam Webpage http://fitsweb.uchc.edu/PCM/physicalexam.htm View examples Key point: Web-based materials enable… Synchronous education Asynchronous education

Retrospective Study Design: Impact of web-based video UCONN first year medical students 2002, 2003: Pre-implementation 2004, 2005: Post-implementation Year end, summative adult PE results UCONN IRB Approval, 07-116-1

Table 1: Student Demographics, UCONN School of Medicine Classes Entering 2002-2005 2002 2003 2004 2005 Percent female 64 66 63 71 Average age (yrs) 24 MCAT 29.7 30.5 30.8 30.2 Ethinicity: %URM* 15 16 22 23 % Asian 17 5.2 14 %White 68 72 GPA, undergraduate 3.60 3.66 *URM- underrepresented minorities

Table 2: Physical Exam Performance in Four Classes of Medical Students PE checklist PE process Percent scoring below 80% on checklist Percent Scoring below 3.5 on Process 2002 N=81 87 +08 4.0 +0.6 22 17 2003 N=80 87 +07 3.9 +0.8 14 34 2004 91 +06 4.2 +0.6 4 15 2005 N=77 91 +05 3.9 +0.6 26 P < .05 PE Process Score: 1-5 (best) Attention to patient comfort Efficiency of exam Draping Technique Overall Skills Level

Figure 1: Percent of students scoring below the mean PE Checklist score of 80% PRE POST P < .05

Study Conclusions Web-based video had a positive overall impact on first year medical student performance on OSCE Eliminated ‘tail’ of marginal performers scoring below benchmark of score of 80%

Evaluating PE Skill Competency Fourth year medical student performance on a multi-station clinical performance examination, and compared the results with student performance on a thorough physical examination OSCE of the same organ systems. Wilkerson, L. and M. Lee. Assessing physical examination skills of senior medical students: knowing how versus knowing when. Acad Med 78(10 Suppl): S30-2.

UCLA study Findings suggest that there are significant differences between knowing when to perform a physical exam maneuver and knowing how to perform it. Wilkerson, L. and M. Lee. Assessing physical examination skills of senior medical students: knowing how versus knowing when. Acad Med 78(10 Suppl): S30-2.

Discussion Questions Comments Contact Information: Eugene Orientale, Jr. MD Program Director UCONN/St. Francis Family Medicine Hartford CT eorienta@stfranciscare.org 860-714-6738