The Feasibility and Acceptability of Videotape review of Pediatric Residents’ Clinical Skills
in a Continuing Clinic Setting
Pamela Veale, MD, MSc, FRCPC
Harish Amin, MBBS, FRCPC
Department of Pediatrics, University of Calgary
Introduction
Evaluation of residents’ clinical skills is an essential component of pediatric residency training.
Use of videotape reviews may increase validity in the assessment of clinical skills, as the
evaluation may occur during an actual patient encounter. Multiple observers may review the
videotape, thus increasing the objectivity of the evaluation. Additionally, specific checklists
covering diverse domains of evaluation may be completed during the review.
At the University of Calgary, all pediatric residents participate in the Pediatric Resident Clinic.
This is a continuity clinic where patients are referred with a variety of medical and
developmental problems. The pediatric residents under supervision from a consultant
pediatrician see the patients. A primary emphasis of this educational setting is the development
and evaluation of pediatric residents’ clinical skills.
Objectives
1. To implement a videotape review process in the Pediatric Resident Clinic
2. To evaluate the impact of videotaping on the patient visit
3. To determine if the videotape review improves the evaluation of pediatric residents’ clinical
skills in this setting
Methods
Informed consent was obtained from residents and from patients/families attending for
appointments in the Pediatric Resident Clinic. Twelve residents were videotaped during
outpatient clinic visits.
Following the patient appointment, each resident reviewed his/her videotape with a preceptor
(Review A) and completed a clinical skills checklist that was based on the Calgary-Cambridge
Observation Guide. A second preceptor independently reviewed the tapes and completed the
checklist (Review B).
Nine residents and ten patients/parents provided feedback regarding the process.
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Results
The videotaping was uniformly acceptable to the patients/families and did not interfere with the
patient appointments. The patients/families rated the residents’ clinical skills highly and 9/10
indicated they would choose to see the same resident again. The residents indicated that the
process was appropriate and that they received useful feedback. All recommended that the
videotaping continue and agreed that it had not interfered with the clinic visit.
When reviewing the videotapes, both residents and preceptors found assessment of physical
examination skills difficult. Both indicated that direct observation of these skills was preferable.
However, skills relating to history taking and information-provision were easily assessed.
Additionally, the residents indicated that the opportunity to observe their own communication
with patients and families was particularly valuable.
There was generally good agreement between the checklist scores assigned during the two
videotape reviews. However, in case of disagreement, the independent preceptor (Review B)
typically assigned a lower score. Possible explanations of inter-rater differences include:
• potentially different preceptor expectations
• the opportunity for the preceptor and resident to discuss resident expectations and
reasoning during Review A as opposed to the independent videotape review conducted
by a preceptor alone (Review B)
• the combination of Preceptor A’s role as provider of feedback and evaluation compared
to Preceptor B’s role as evaluator only
• the opportunity during Review A for the resident to fill in gaps created in the
videotape because of technical difficulties (example: child moved out of the
picture, poor sound pickup, etc.)
Conclusions
Videotape review is acceptable to residents and patients/families in this clinical setting.
Patients/families indicated a high degree of satisfaction with the pediatric residents’ clinical
skills.
Some clinical skills (such as physical examination technique) are difficult to assess by videotape.
Use of this process as a formative evaluation tool is clearly valuable. In order to provide
summative evaluation of pediatric residents, better inter-observer agreement is required.
Acknowledgment
The authors wish to acknowledge the invaluable technical assistance of Mr. Daren Powell.