RESUMO
AIMS: A study was designed to assess the effects of a standardized instructional videotape on training senior medical students to acceptable levels of reliability in performing several commonly used obsever dependent outcome measures in patients with ankylosing spondylilis (AS). METHODS: During a single day, six third-year medical students independently examined five patients with AvS in predetermined order using a Latin Square design, before and after viewing a standardized videotape demonstrating 14 examination techniques. Reliability coefficients were calculated based on the variance components of the analysis of variance (ANOVA) table. RESULTS: Prestandardization reliability coefficients were < 0.80 for three measures. Following standardization 12 reliability coefficients exceeded 0.80. For the majority of measures prestandardization reliability coefficients were high and no further improvement in reliability could be demonstrated. CONCLUSIONS: High levels of interobserver agreement were noted prior to viewing the instructional videotape. This may represent the success of undergraduate clinical skills training programmes, or it may be the result of having reviewed an illustrated instructional text just prior to the initial patient examinations. With the exception of chest excursion, high levels of prestandardization reliability, by necessity, precluded the demonstration of significant effects from viewing the videotape. Nevertheless, the data indicate that senior medical students arc capable of reliably performing quantitative measurement in AS. Recent surveys in Canada and Australia, showing a general lack of quantitative clinical measurement in the longitudinal follow up of AS outpatients by rheumatologists, suggest that the lack of quantitation is not due to inability to reliably perform the measurements.
RESUMO
AIMS: A study was designed to assess the effects of a standardized instructional videotape on training senior medical students to acceptable levels of reliability in performing several commonly used observer dependent outcome measures in patients with fibromyalgia (FM). METHODS: During a single day, six third-year medical students independently examined six patients with FM in predetermined order using a Latin Square design, before and after viewing a standardized videotape which demonstrated methods for performing doiorimelry and for delecting skinfold tenderness and reactive hyperaemia. Reliability coefficients were calculated based on the variance components of the Analysis of Variance (ANOVA) table. RESULTS: Prestandardization reliability coefficients were <0.80 for 8 measures. Following standardization all reliability coefficients, but one, approximated or exceeded 0.80. CONCLUSIONS: An important and beneficial effect of the standardization procedure was noted for several outcome variables. Such improvements in observer agreement have important implications for training senior medical students to perform quantitative measurement in the longitudinal management of FM patients in clinical practice. The use of a videotape to achieve this goal has obvious cost and convenience advantages compared with personal onc-on-one or small group training procedures.
RESUMO
AIMS: A study was designed to assess the effects of a standardized instructional videotape on training senior medical students to acceptable levels of reliability in performing several commonly used observer dependent outcome measures in patients with rheumatoid arthritis (RA). METHODS: During a single day, six third-year medical students independently examined six patients with RA in predetermined order using a Latin Square design, before and after viewing a standardized videotape demonstrating 15 examination techniques. Reliability coefficients were calculated based on the variance components of the analysis of variance (ANOVA) table. RESULTS: Prestandardization reliability coefficients were >0.80 for all measures and remained above 0.80 following standardization except for one measure. CONCLUSIONS: High levels of interobserver agreement were noted prior to viewing the instructional videotape. This may represent the success of undergraduate clinical skills training programmes or it may be me result of the students having reviewed an illustrated instructional text just prior to the initial patient examinations. High levels of prestandardization reliability, by necessity, precluded the demonstration of significant effects from viewing the videotape. Nevertheless, the data indicate that senior medical students are capable of reliably performing quantitative measurement in RA. Recent surveys in Canada and Australia, showing a general lack of quantitative clinical measurement in the longitudinal follow up of RA outpatients by rheumatologists, suggest that the lack of standardization is not due to inability to reliably perform the measurements.
RESUMO
AIMS: A study was designed to assess the effects of a standardized instructional videotape on training senior medical students to acceptable levels of reliability in performing several commonly used observer dependent outcome measures in patients with osteoarthritis (OA). METHODS: During a single day, six third-year medical students independently examined six patients with OA in predetermined order using a Latin Square design, before and after viewing a standardized videotape demonstrating 13 examination techniques. Reliability coefficients were calculated based on variance components of the analysis of variance (ANOVA) table. RESULTS: Preslandardization reliability coefficients were <0.80 for seven measures. Coefficients for the performance of knee goniometry were uniformly low. Following the intervention, all but four reliability coefficients were >/= 0.93. CONCLUSIONS: For many measures, high levels of interobserver agreement were noted prior to viewing the instructional videotape. This may represent the success of undergraduate clinical skills training programmes, or it may be the result of having reviewed an illustrated instructional text just prior to the initial patient examinations. The notable exception was knee goniometry. Despite apparent familiarity with the technique, prestandardization reliability coefficients were very low. However, following the intervention, all coefficients improved dramatically, two-thirds achieving very high levels. These data suggest that skills development in senior medical students is not uniform and that, while reliability is high for many, the assessment of knee range of movement can be improved by viewing an instructional videotape.
