Practical training of medical students is critical to ensure they acquire the necessary diagnostic skills and abilities for the quality of their future practice as physician [1, 6]. We have developed a video tool that illustrates: (i) a normal, systematic, and comprehensive NM examination, (ii) the main pathological signs to look for in case of suspicion of NMD, and (iii) the semiological reasoning and topographic orientation based on symptoms and clinical signs.
To evaluate the impact of this tool on the learning of the NM examination, we have used NM and control questionnaires that the students filled out just before and after watching the NM or the control video. The results of these questionnaires showed a statistically significant improvement in their score after watching the video with an average increase of 2.76 points. The NM video was particularly useful in improving students' knowledge and skills on: (i) the Medical Research Council (MRC) quantitative scale, (ii) the examination of axial force, and (iii) the maneuvers to reveal a neurogenic and myasthenic syndrome. These last three items are not systematically evaluated during a basic standard neurological examination and sometimes are poorly known by medical students but also even for non-specialist doctors. Furthermore, there is a statistically significant improvement in the score of the three topographic and etiological questions. As expected, no significant improvement in the control (OMS) quiz score was observed. Conversely, the control group students did not improve their score on the NM questionnaire after watching the control (OMS) video and significantly improved their score on the OMS quiz. It would be of much interest to explore our student’s retention over long term, particularly by evaluating their performance on practical assessments in a standardized scenario (i.e. OSCE).
Our results are consistent with the literature. Indeed, video tools have been shown to be useful for self-learning various practical skills, with comparable effectiveness to traditional lessons on practical skills in a lecture format or workshop where an instructor explains to students how to perform an exam or technical gesture [17, 23, 26]. Randomized studies have shown that video tool effectiveness is similar, or even better in some cases, in terms of immediate and deferred yield compared to classical practical teachings [17, 26].
Regarding the perceived usefulness and student feedback about our tool, a large majority of students found the NM video helpful for consolidating their learning of the NM exam, learning or illustrating rare semiological signs, and boosting their self-confidence before meeting a patient. For half of the students, the NM video did not serve to acquire new knowledge not covered in theoretical courses. These observations support the NM video as a tool designed to mobilize and organize theoretical knowledge for use in clinical practice. In the free comments section of the survey, several students emphasized that the NM video was clear and precise, helping them structuring their knowledge for a thorough and systematic NM exam. Finally, students felt more prepared to approach the clinical exam of a patient suffering from a potential NM disease thanks to the video. They also considered the NM video useful for preparing for practical evaluations such as OSCEs. Our NM video could be an additional didactic resource for all medical students. Several students requested a copy of the NM video. The possibility to watch it several times, allowing to focus on certain parts, or watch it at a pace adapted to each student could contribute further to personalized learning and increase the didactic value of this tool. Our results are in line with those of the literature, as instructional videos are perceived by students in different studies as useful for: (i) reminding students of the fundamental notions that are useful for clinical skills, (ii) complementing theoretical teachings, and (iii) facilitating self-learning and preparation for faculty evaluations [5, 23, 26, 29, 31].
Interestingly, one student highlighted in the survey comments the lack of interaction with the teachers as a weak point of the video tool. Although it was designed as a complementary teaching tool to be made available to students for self-learning, it could also be used as a supplementary support material in a teaching workshop in which the viewing would be followed by a discussion with the teacher and a dedicated time for putting into practice the examination skills as in a simulation training, which have proven to improve student's long-term retention and delayed recall of neurological semiology and clinical skills [32, 33].