Research Article: E-Library of Authentic Patient Videos Improves Medical Students’ Mental Status Examination

Date Published: November 13, 2019

Publisher: Springer International Publishing

Author(s): Jessica R. Hansen, Maria Gefke, Ralf Hemmingsen, Cecilie Fog-Petersen, Erica B. Høegh, August Wang, Sidse Marie Arnfred.


During psychiatric rotation, clerkship students must learn the clinical skill of recording an accurate Mental Status Examination (MSE). The authors built a video e-library consisting of 23 authentic patient videos that were accessible on a secure website during the rotation period, aimed at assisting students’ acquisition of MSE skills.

The authors conducted a prospective case comparison study investigating the impact of the video e-library as “add-on” intervention, on acquisition of MSE skills, as measured by a test consisting of three videos with adjoining forced choice questionnaires. Eighty-five clerkship students had instructions and access to the video e-library whereas 82 did not. A group of clinicians, unfamiliar with the video e-library, was also subjected to the new MSE skills test and they served as a reference group. Outcome was defined as scores of MSE skills measured by the purpose made MSE skills test and entailed evaluation questions on the students’ use of the e-library.

The MSE skill test score differed between the three groups, and the clinicians scored higher than both student groups (clinicians mean score (M) 12.6; p < 0.001). However, the students with video access scored higher compared to students without access (M 10.7 versus M 9.9, p = 0.04). The e-library was appreciated by the students as helpful (83.6%) and they used it not only for practicing the MSE but also for observation of interviewing techniques. The e-library with video vignettes of authentic patients strengthens MSE skills as “add-on” to the psychiatric rotation, and evaluations by the students were positive.

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This study was approved by the University of Copenhagen Ethics Committee for Health and Science and by the Danish Data Security Agency. The patients made informed written consent to the participation in educational videos and we took measures to ensure the protection of personal data by removing auditory, traceable information (surname etc.) from the video vignettes. The enrolled students also signed a study consent form and a confidentiality agreement. All videos and data were stored on a secure server.

In total, 167 students were included at the beginning of the psychiatric rotation and were expected to participate in the MSE skills testing at the end of the study. By way of drop-out, 128 students attended the test. In all 85 students having video e-library access were included and 69 tested, i.e., a dropout of 19%. Eighty-two students without access were included and 59 tested, i.e., a dropout of 28%. The drop-out difference was not significant. Student groups did not differ in age (mean (M) 26.3 years), gender distribution (females 70%), regarding previous psychiatric experience, which was limited (M 2.1; SD 0.6), or regarding interest in psychiatry, which was moderate (M 3.0; SD 1.40). The clinicians participating in the MSE skills test were 30 psychiatrists and 27 psychiatric residents. MSE skills test score range was 2–15 across the overall student sample (n = 128). The score differences between the three groups were highly significant (p < 0.001), with the group of clinicians scoring higher than both student groups (M 12.6; standard deviation (SD) 1.6; p < 0.001). The students with video e-library access (M 10.7; SD 2.3) scored significantly higher than the students without access (M 9.9; SD 2.4; p = 0.04) (see Fig. 1, panel a).Fig. 1Mental Status Examination Skills Test. a Average MSE skills test score. N-V = students without access to videos, N = 59; V = students with access to videos, N = 69; MDs = reference group of clinicians, N = 57. b Average MSE skills test score in the student groups, where the students with video access is sub-divided by the number of videos watched, i.e., less than seven videos (< 7V, N = 24) or seven or more videos (≥ 7, N = 45) We have shown an improvement in MSE skills among students that had access to a video e-library during psychiatric rotation in accordance with our study hypothesis. The improvement was particularly seen when students watched more than seven videos. Furthermore, as hypothesized, psychiatrists and psychiatric residents did better on the test than students, thus conferring criterion validity to the test.   Source:


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