Background/Purpose: Enhancing physical examination skills improves the identification of clinical findings, decision-making and overall management. Feedback is a crucial factor in achieving effective learning but delivering high-quality feedback on clinical examinations is an obvious challenge in the online environment. As part of its Rheumatology module, the Internal Medicine programme developed a multi-modal approach to teaching musculoskeletal hand examination, including remote feedback on student-recorded examination videos.

Methods: The project was advertised to both postgraduate students on the Internal Medicine programme and undergraduate medical students. Those who were interested self-selected to participate.
Participants were given access to an online module to facilitate learning of hand examination techniques. Following the module, they were invited to upload a video of their examination to our virtual learning environment (VLE). Peers and tutors then provided feedback on the students’ performance. A self-confidence questionnaire was given at baseline, after the online module and following the online feedback to all participants. A randomly selected group was assessed with an online one-station objective structured clinical examination (OSCE) following the online module only, while the remaining students were similarly evaluated following the feedback. The primary outcomes were improved mean self-rating of overall musculoskeletal hand examination skills and progress in the mean OSCE score.

Results: Fourteen students participated in the study, and they were equally male and female. We received 100% responses to all the questionnaires.

Before the intervention, only three students (21.4%) agreed they were confident in performing the correct technique. For the overall self-rating of the MSK hand examination, three students (21.4%) rated their skills as poor, six (42.9%) rated as (not very good), while the remaining five students (35.7%) rated their skills as fair.

After the intervention, the mean self-rating of the overall hand examination skills improved from 2.14 before the study to 3.71, which was statistically significant (P-value = 0.001).

The mean OSCE score for the group before and after the feedback was 26.4/30 and 27.3/30, respectively. The difference between the groups was not statistically significant (P-value = 0.592).

Compared to the online module alone, all the students strongly agreed (10, 71.4%) or agreed (4, 28.6%) that it was worth recording the video and getting online feedback.

Compared to face-to-face teaching, most students (10, 71.4%) felt that remote learning is valuable as an additional method but does not replace face-to-face training. This was mainly attributed to the latter giving them opportunities to learn soft skills, receive immediate feedback, see abnormalities, and ask for clarification.

Despite these limitations, 13 students (92.9%) felt confident enough to examine an actual patient after this learning method.

Conclusion: Our students valued the (online module + video recording + remote feedback) method in distance learning. Despite its limitations, distant physical examination teaching can improve confidence in performing the examination technique.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/online-teaching-of-hand-examination-using-student-recorded-videos-and-remotely-delivered-feedback-a-pilot-study/