Use of wearable point-of-view live streaming technology for virtual physical exam skills training.

We piloted a virtual teaching tool comprised of a chest-mounted smartphone streaming point-of-view footage over videoconferencing software to deliver a physical exam skills session. Compared to medical students taught via third person view through pre-recorded video followed by preceptor-led discussion, a higher proportion of students taught via point-of-view wearable technology reported improved knowledge of demonstrated skills and feeling engaged, comfortable interacting with their tutor, and better able to visualize demonstrated exam maneuvers. This accessible, affordable, and easily replicable innovation can potentially enhance virtual clinical skills teaching and enable novel distant clinical learning opportunities for healthcare professions students and educators.

Introduction

The COVID-19 pandemic heavily impacted global undergraduate medical education delivery.[1] At the Temerty Faculty of Medicine, University of Toronto, the pre-clerkship curriculum was held either partially or entirely online since March 2020. This has impacted teaching sessions that are difficult to replicate virtually, particularly clinical skills education and observerships.[2],[3],[4]

Point-of-view (POV), livestreamed video has successfully facilitated learning for medical trainees.[5] POV live video can more clearly visualize hands-on maneuvers and aid facilitator interactions. Few studies have evaluated live POV filming with wearable devices for medical education. The purpose of this study was to evaluate student perceptions of a wearable, POV, livestream camera tool to facilitate virtual physical exam skills workshops. This study received approval from the University of Toronto Health Sciences REB: Protocol #00039550.

Description of the innovation

Our medical student-led initiative piloted a novel modality for delivery of virtual physical exam skills education. As our commentary proposed,[6] a smartphone mounted on a wearable chest strap ($59 USD) streamed POV video to medical students over videoconferencing software during a physical exam skills session. Three groups of approximately 29 students (89 total) were taught by a tutor donning the chest strap and performing the liver exam on a standardized patient while streaming their first-person view. The tutor narrated exam maneuvers step-by-step while students were able to ask questions in real-time. The remaining students (six groups of approximately 29 students, 180 total, of which three had the intervention tutor) were taught the liver exam using a pre-recorded patient exam video using a fixed-camera third-person perspective, followed by group discussion.

Students provided implied consent by completing a post-session survey assessing third person view pre-recorded video versus POV videoconference for utility and effectiveness. Participants responded to five Likert scale questions from “Strongly Disagree” to “Strongly Agree”; 37 POV videoconferencing students (~42% response rate) and 26 students (~14% response rate) in the pre-recorded third-person view group completed the survey.

A higher proportion of POV videoconferencing group students strongly agreed that they felt engaged and comfortable interacting with their tutor, effectively visualized the exam maneuvers, and that their clinical skills improved. Participants ranked overall session satisfaction from 1-10, with a higher average score from the POV videoconferencing group. Finally, a higher proportion of these students also felt that the session increased their confidence performing the liver exam going into clerkship (Table 1).

Table 1

Survey results

Survey Question		Strongly Disagree (1)	Disagree (2)	Neutral (3)	Agree (4)	Strongly Agree (5)	Average
The content of the clinical skills session was relevant and clearly linked to course objectives	A	0%	0%	0%	49%	51%	4.51
	B	0%	4%	4%	81%	12%	4.00
I felt comfortable interacting with the tutor during the session	A	0%	0%	5%	57%	38%	4.32
	B	0%	12%	23%	50%	15%	3.69
I felt engaged in the session	A	0%	0%	5%	59%	35%	4.30
	B	8%	12%	23%	50%	8%	3.38
I was able to effectively visualize the physical exam maneuvers performed in this teaching session	A	0%	0%	8%	49%	43%	4.35
	B	4%	12%	27%	58%	0%	3.38
My knowledge of the clinical skills demonstrated has improved after this session	A	0%	3%	16%	43%	38%	4.16
	B	4%	15%	23%	58%	0%	3.35
		1 or 2	3 or 4	5 or 6	7 or 8	9 or 10
How would you rate your overall satisfaction with this session? (Scale of 1-10)	A	0%	0%	5%	54%	41%	8.24
	B	4%	4%	35%	46%	12%	6.77
		No	Unsure	Yes
Do you think that such a virtual session has increased your confidence in performing the liver exam going into clerkship?	A	14%	22%	65%
	B	31%	23%	46%

A = Wearable chest strap groups (n = 37); B = pre-recorded video groups (n = 26)

Suggestions for next steps

Student feedback on wearable POV live-streaming technology for teaching physical exam skills was overwhelmingly positive. Preliminary results indicate that this interactive, cost-effective, and accessible modality can enhance virtual physical exam skills training. It can be easily replicated by other programs and be an adjunct to face-to-face physical exam skills training, thereby providing supplementary opportunities to engage students in virtual clinical skills training post-pandemic. Implementation requires a smartphone, chest strap, and videoconferencing software, items feasible for most programs. Furthermore, this innovation will enable future, post-pandemic forms of distance learning. Limitations include small samples and potential response bias due to optional participation. Next steps include evaluating this teaching method for student observerships and continuing professional development for physicians in rural or remote communities.