It was a pristine Colorado winter day with an azure blue sky framing the paper-white ski slope. Freshly snow-glazed coniferous trees peppered the "Faro Glade” ski run, providing a natural slalom course. As my three boys and I were about to begin our powder run and I was taking in the majesty of the moment, I was interrupted by, "Dad, will you take a video?" I have heard this request on many occasions. With three active boys under the age of 16, my spouse and I have hours of cell phone footage of athletic endeavors and outdoor adventures. Fortunate or not, we live in an age where technology allows us to show our boys their accomplishments - or fails - through the use of a handheld video device. While video and digital recordings are often used for entertainment, we can also harness this technology to enhance clinical performance, much like athletes use video reviews to improve both individual and team performance. My background as an athlete, combined with my roles as an educator and part-time "filmmaker" for my kids, has fueled my passion for exploring how digital recordings can enhance performance and self-reflection in medical and health professionals. Content creation and design are essential for videos to be considered helpful in educating clinicians, especially when delivering content to large audiences. The relevant educational video needs to capture and maintain the audience's attention and provide meaningful content. However, in my experience, the parameters shift when viewing a recording of an individual or team in a clinical encounter. Prebriefing, analytical tools, user focus, and action planning are at the forefront of using recordings to maximize clinical performance.
Prebriefing
The incorporation of elements from the prebriefing literature needs to be applied to the viewing and analysis of recordings of individual and team encounters. Essential to maximizing gains from video analysis is for the educator to determine the purpose and objectives of reviewing the video. A 5-minute recording of a clinician performing a patient history would not be helpful in providing information on the clinician’s psychomotor performance, especially in an instance in which the clinician did not perform examination items. However, if the goal is to assess a clinician’s interpersonal communication skills, with an objective like, 'In viewing the recording, the clinician will identify communication behaviors that can improve the therapeutic alliance,' then both the purpose and objectives need to be explicit to establish a clear framework.
Analytical Tools
The power of video analysis is that it provides objective information to the viewer. Additionally, analytical tools can be used to gather more information. Analytic tools can be as rudimentary as written notation of the number of times a clinician says “um” during a standardized patient interview or as sophisticated as technological software that uses algorithms to analyze trauma care procedures. I expect that more advanced tools for video analysis will continue to enter the market. However, regardless of their sophistication, these tools must always align with the purpose of the video review.
User Focus
Have you ever missed the first five minutes of a movie and felt like you were catching up for the remainder of the movie? Understanding the context through the prebrief, and using sophisticated analytical tools to decipher some performance is helpful, but these do not serve as a proxy for user focus on the recording. The user should focus on the goals and objectives as outlined in the prebrief, but gain further insight by exploring contextual factors specific to the recording. For example, observations such as lack of eye contact, clinician body language, and inactive listening could be extrapolated based on user focus.
Video Analysis to Develop Action Planning
The ultimate step in utilizing video is the implementation of action planning derived from the information gained from the preceding steps. After prebriefing, review, and analysis, did the learner develop tangible action steps toward improved performance? For example, in physical therapy education, I can review a recording of a learner who performed an orthopedic examination of the lumbar spine and work with that novice learner in developing action goals to refine their positioning and psychomotor skills during the orthopedic examination. Collectively, we can establish goals to improve their performance. The information gained from review and analysis is only as good as the action plan generated to improve performance.
I recognize that recordings can be used for pure entertainment and memory value-trust me, I still revisit the video on my phone from that unforgettable powder run down "Faro Glade" with my boys. However, I firmly believe that we have yet to fully appreciate the power of using digital recordings to enhance clinical performance. By dedicating more time analyzing performance through handheld recordings and fostering reflective practice, we could significantly improve patient d care and achieve more positive outcomes.
Did you know that the Harvard Macy Institute Community Blog has had more than 400 posts? Previous blog posts have explored topics including teaching clinical reasoning, assessing clinical reasoning, and uncertainty in clinical care.
Anthony Kinney, DPT, MBA, PhD
