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Clinical examination skills can be imparted effectively using videos for bedside examination
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Clinical examination skills can be imparted effectively using videos for bedside examination

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By Naresh Kumar …

By Naresh Kumar

Background & Purpose
Efforts to impart psychomotor skills through IVLE using McGill Videos have been tried since October 2007 at NUS. The post OSCE survey for year 3 and 4 students in academic year 2008-2009 revealed that it was difficult to use the videos in local context. A common observation arose that there was a need for – ‘standardization of clinical examination techniques’. This study was aimed towards developing a standardised clinical examination video for Orthopaedics and also to prove its effectiveness in standardizing the clinical examination techniques for students and examiners.

Methodology

The steps were as follows:
Production of the standardized video
Video workshop demonstrating clinical examination techniques
Post workshop student feedback
Analysis of feedback
Analysis of workshop attendees vs. non attendees performance in the final phase 3 exam

Results
Out of 260 students, 128 students attended the pre-exam video workshop. The post workshop feedback questionnaire had 6 questions per joint/region. The positive response rate per question was: A-94.5%, B-85.5%, C-84.5%, D 90.9%, E- 95.5%, F- 91.8%.
216 students out of 260 students were examined in the Orthopaedic stations in OSCE. Workshop attendee students scored average 74.01% marks. Non-attendees scored 61.88% marks. Out of 128 workshop attendee students - 37.2% students received positive comments, and 9.1% non-attendees received positive examiner comments.

Conclusions
Psychomotor clinical examination skills in Orthopedics are acquired at the bedside and in the classroom. Clinical standardization can only be achieved by having a standardised video which is available over a common platform i.e. IVLE.

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Transcript

  • 1. Clinical examination skills can be imparted effectively using Videos for Bedside Examination
    • A/P Dr Naresh Kumar
    • MBBS, MS, DNB, FRCS Ed.,
    • FRCS (Trauma & Orth), DM (Orth – Spinal Surgery)
    • Senior Consultant Orthopaedics & Spine Surgeon
    • National University of Singapore
  • 2. Acknowledgements & Grants
    • TEG (Teaching Enhancement Grant) 2010 – 11
    • Mr. Manuel (Noli) Gamboa & Team
      • Assoc Director, CIT
      • NUS.
    • Dr Deepti Nayak
      • Research Asssistant,
      • Appointed for NIG (NMRC Grant)
  • 3. Introduction
    • Docere - means ‘teach’ in latin Doctor
    • Medicine like other sciences is in forefront of science & research
    • Medical teaching is an evolving field
    • Handover of medical knowledge to newer generations needs to be efficient
  • 4. Evolution of Medical Teaching & Learning
    • Totally Self Directed Learning = No teaching
    • Learning by Shaming = Limited Teaching
    • Didactic Teaching = Effortless Teaching
  • 5. Evolution of Medical Teaching & Learning
    • Problem Based Learning
    • &
    • Teaching Aids; Simulation
    • Teaching _ Effort
    • Spoon Feeding
  • 6. Evolution of Medical Teaching & Learning
    • More of Problem Based Learning
    • &
    • Teaching Aids; Simulation
    • Teaching _ Superhuman Effort
    • Breast Feeding
  • 7. Medical Learning
    • What is Unique about learning in Medicine?
      • basic step of gaining knowledge
      • practical skills acquisition for clinical examination
      • learning requires visual, auditory & tactile faculties
      • demonstrate expertise requires practise
      • Objective Structured Clinical Examination (OSCE) for Assessment of Orthopaedic Clinical Examination Skills.
      • APMEC 2008 Poster
  • 8. Orthopaedic Learning
    • What is Unique about learning in Medicine?
      • practical skills acquisition for clinical examination
      • pschomotor learning requires
        • visual & tactile faculties
      • Variability in the experts do & assess
      • demonstrate expertise requires practise
      • performance in exam requires predictability
      • Objective Structured Clinical Examination (OSCE) for Assessment of Orthopaedic Clinical Examination Skills.
      • APMEC 2009 Poster
  • 9. Bloom ’s Cognitive Ladder Knowledge Comprehension Application Analysis Synthesis Evaluation
  • 10. Millers Triangle Performance Competence
  • 11. Orthopaedic Clinical Teaching in NUS?
    • Clinical skills are always imparted bedside
    • From October 2007
      • efforts to impart psychomotor skills
      • via IVLE using McGill Videos
    • Not useful in local context
    • Need for- ‘ standardization of clinical examination techniques ’
      • Objective Structured Clinical Examination (OSCE) for Assessment of Orthopaedic Clinical Examination Skills.
      • APMEC 2008 Poster
  • 12. Mc Gill Video CLip
  • 13. Solution
    • ‘ Standardization of clinical examination techniques ’
      • Development of teaching tool to match the bedside teaching
      • Adequate bite size to match attention span of local students
      • Use of local experts for them to implement standardisation
      • To be effective & have usage in local system
      • Predictors of performance in an Objective Structured Clinical Examination (OSCE) for psychomotor skills in musculoskeletal examination
      • APMEC 2009 Poster
      • Does performance in an OSCE depend on the use of Integrated Virtual Learning Environment (IVLE)?
      • APMEC 2009 Poster
  • 14. Methodology
    • Production of the standardized video
    • Video workshop demonstrating clinical examination techniques
    • Post workshop student feedback
    • Analysis of feedback
    • Analysis of workshop attendees vs. non attendees performance in the final phase 3 exam
  • 15. Production of the Standardized Video Knee Spine Shoulder Hip Hand Foot & Ankle 11 Dec 2010 5 Feb 2011 Editing of rough cuts of video
  • 16. Behind the scene Production of the Standardized Video
  • 17. Production of the Standardized Video
  • 18. Video workshop demonstrating clinical examination techniques
  • 19. Post workshop student feedback
    • Question A : Based on your experience, this video presentation will help standardize the teaching of <Joint/Region> amongst the various hospitals?
    • Question B: This video presentation has helped increase my understanding of the common clinical conditions in <Joint/Region>?
    • Question C: This video presentation has helped conceptualize (organize & extrapolate) my knowledge of the common clinical conditions <Joint/Region>?
    • Question D: This video presentation is relevant to our curriculum & assessments?
    • Question E: This video presentation was clear and concise?
    • Question F: If this video presentation was available to you at the beginning of your Orthopaedic Surg. posting, you think it would improve your overall performance?
  • 20. Post workshop student feedback
    • Questions A-E were marked by students on the Likert scale as follows:
    • Question F was marked YES/NO
    1-Strongly Agree 2-Agree 3-Neutral 4-Disagree 5-Strongly Disagree
  • 21. Analysis of feedback Analysis of workshop attendees vs. non attendees performance in the final phase 3 exam
  • 22. Results
    • Did the developed video find favour with medical students?
    • The video will help standardize teaching amongst the various hospitals? 94.5% agreed
    • The video increased understanding of the common clinical conditions ? 85.5% agreed
    • The video helps to conceptualize knowledge of the common clinical conditions? 84.5% agreed
    • The video is relevant to our curriculum and assessments? 90.9% agreed
    • The video was clear and concise? 95.5% agreed
    • If it was available earlier, do you think it would improve your overall performance? 91.8%
  • 23. Results Combined positive response rate per question Table 1: Positive response rate per joint/region per question (A) (B) (C ) (D) (E) (F) SPINE 94.5% 65.5% 76.4% 99.1% 97.3% 95.5% SHOULDER 95.5% 84.5% 84.5% 96.4% 96.4% 94.5% HIP 92.7% 70.9% 71.8% 94.5% 96.4% 92.7% KNEE 94.5% 79.1% 78.2% 92.7% 97.3% 92.7% HAND 95.5% 93.6% 91.8% 96.4% 87.3% 93.6% FOOT & ANKLE 94.5% 85.5% 84.5% 90.9% 95.5% 91.8% A B C D E F 94.5% 85.5% 84.5% 90.9% 95.5% 91.8%
  • 24. Examination Performance
    • Examiner comments on the overall performance of students (workshop attendee and workshop non attendees combined) in the phase 3 end of year exam.
  • 25. Examination Performance
    • Examiner comments on performance of workshop attendee students
  • 26. Examination Performance
    • Examiner comments on performance of workshop non-attendee students
  • 27. Comparison
  • 28. Results
    • Marks obtained by students who attended workshop vs those who did not attend
  • 29. Conclusion
    • Psychomotor skills for clinical examination in Orthopedics are acquired at the bedside and in the classroom.
    • Clinical standardization can only be achieved by having a standardised video which is available over a common platform i.e. IVLE.
  • 30. Thank You!!