1. 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

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

4. 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

5. 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):

6. 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

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

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

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

11. 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…

12. 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

14. UCONN Physical Exam Webpage
View examples
Key point: Web-based materials enable…
Synchronous education
Asynchronous education

15. 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,

16. Table 1: Student Demographics, UCONN School of Medicine
Classes Entering
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

17. 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 22 17
2003
N=80
87 +07 14 34
2004
91 +06 4 15
2005
N=77
91 +05 26
P < .05
PE Process Score: 1-5 (best)
Attention to patient comfort
Efficiency of exam
Draping Technique
Overall Skills Level

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

19. 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%

20. 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.

21. 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.

23. Discussion Questions Comments
Contact Information:
Eugene Orientale, Jr. MD
Program Director
UCONN/St. Francis Family Medicine
Hartford CT