Mark is a first year emergency medicine resident waiting in the trauma bay for an incoming thirty year old male with a penetrating stab wound to the chest. He wonders if he will have to insert a chest tube for this patient. It has been a long time since he did one in medical school and his memory of the steps is fuzzy. He wishes there was a tool to help him learn the steps and nuances of placing a chest tube.
This Feature Educational Innovation (FEI), titled, “A Peer-Reviewed Instructional Video is as Effective as a Standard Recorded Didactic Lecture in Medical Trainees Performing Chest Tube Insertion: A Randomized Control Trial” was originally posted by the CAEP EWG FEI Team in 2018 and answers the question: “Is an Instructional Video an effective way to teach chest tube insertion? ” A PDF version is available.
Description of Study
In this study, the authors aimed to show that video-based teaching for procedural skill acquisition would be at least as good as the standard didactic method of teaching procedures. As technology becomes more prevalent in education the format by which trainees learn and utilize knowledge has changed.1 This study hoped to lend evidence that video-based teaching could be used instead of didactic teaching without compromising knowledge acquisition and procedural performance.
Video-based teaching has been shown to be at least, if not more effective than didactic teaching.2–5 Presenting a combination of visual and auditory material has been shown to be superior to didactic teaching and improves knowledge retention since multiple senses are engaged.6 Videos also minimize extraneous loads of information by framing the instruction into clearly defined segments.7 Segmented videos allow students to have control over the sequence of their learning as they engage with the material at their own pace and re-watch different segments.8 This approach is supported by the discovery theory (learning by inquiry) and Cook’s Connectivism theory (learning by interaction).7
The authors designed an RCT that assessed medical student knowledge acquisition and technical dexterities required for chest tube insertion. The participants were randomized to either a peer-reviewed video-based module on chest tube insertion published under the Videos in Clinical Medicine with the New England Journal of Medicine (NEJM) or a video recording of a standard didactic session similar to the method by which Advanced Trauma Life Support (ATLS) courses are taught. Participants (30) were graduating medical students at the University of Western Ontario.
Participants were asked to complete a questionnaire which asked for the indications, contraindications, materials required, and complications from chest tube insertion. They were then randomized to watch either the NEJM or didactic teaching video and then repeated the questionnaire. Following this, they each completed an objective structured clinical examination (OSCE) station with a cadaver, where they were filmed and assessed on their technical skills for chest tube insertion. The checklist used for assessment was adapted from a chest tube insertion OSCE station used by the University of Toronto for the technical skill evaluation of first year residents and reviewed by several physicians experienced in
both teaching and performing chest tube insertion.
The results of the study showed that graduating medical students could learn the procedural skill as effectively with an online peer-reviewed NEJM video module as by watching a didactic lecture. The authors also showed that the knowledge required to perform the procedure was improved in the NEJM group.
Instructional Videos have the potential to free up the teaching resources that are often required to run recurrent, in-person, didactic sessions. Furthermore, the ability to standardize sessions and ensure their quality through peer-review is a significant advantage to the potential teaching variability that exists within didactic modalities.
This modality of teaching has significant upfront resources required to establish a program; however, once this start-up work is accomplished, videos can be stored and easily utilized for planned teaching sessions.
In this study, the authors showed that modular video teaching were as effective as video-recorded didactic teaching for the knowledge and technical skills required for chest tube insertion. The utility of peer-reviewed standardized video teaching modules could free up significant teaching resources and improve teaching on various topics.
How does your institution teach procedural skills to trainees?
Could you see your program involve instructional videos as part of your curriculum?
More about CAEP FEI
This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Feature Educational Innovations project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive FEI each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers.
- 1.Regan-Smith MG. Teachers’ Experiential Learning about Learning. Int J Psychiatry Med. March 1998:11-20. doi:10.2190/a1ck-jy52-bk1g-442y
- 2.Chenkin J, Lee S, Huynh T, Bandiera G. Procedures Can Be Learned on the Web: A Randomized Study of Ultrasound-guided Vascular Access Training. Academic Emergency Medicine. October 2008:949-954. doi:10.1111/j.1553-2712.2008.00231.x
- 3.Shippey SH, Chen TL, Chou B, Knoepp LR, Bowen CW, Handa VL. Teaching Subcuticular Suturing to Medical Students: Video versus Expert Instructor Feedback. Journal of Surgical Education. September 2011:397-402. doi:10.1016/j.jsurg.2011.04.006
- 4.Xeroulis GJ, Park J, Moulton C-A, Reznick RK, LeBlanc V, Dubrowski A. Teaching suturing and knot-tying skills to medical students: A randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback. Surgery. April 2007:442-449. doi:10.1016/j.surg.2006.09.012
- 5.Jang HW, Kim K-J. Use of online clinical videos for clinical skills training for medical students: benefits and challenges. BMC Med Educ. March 2014. doi:10.1186/1472-6920-14-56
- 6.Shariff U, Kullar N, Haray PN, Dorudi S, Balasubramanian SP. Multimedia educational tools for cognitive surgical skill acquisition in open and laparoscopic colorectal surgery: a randomized controlled trial. Colorectal Dis. April 2015:441-450. doi:10.1111/codi.12863
- 7.Lau KHV. Computer-based teaching module design: principles derived from learning theories. Med Educ. February 2014:247-254. doi:10.1111/medu.12357
- 8.SEABRA D, SROUGI M, BAPTISTA R, NESRALLAH LJ, ORTIZ V, SIGULEM D. Computer Aided Learning Versus Standard Lecture for Undergraduate Education in Urology. Journal of Urology. March 2004:1220-1222. doi:10.1097/01.ju.0000114303.17198.37