Discussion
rheumatoid arthritis
RHEUMATOID ARTHRITIS, BLIND
Face to face teaching has previously shown to be the gold standard for teaching clinical examination skills [The importance of dialogue and social interaction in teaching and learning has been described throughout historical literature related to education [A study looking at the quality of information provided in videos relating to rheumatoid arthritis accessible on YouTube, found that only 50% of videos were ‘useful’, with 30% being classified as ‘misleading’ [The cost of poor clinical examination skills should not be underestimated. Increased diagnostic error, false positives and excessive diagnostic tests have both monetary and safety costs to patients and the wider healthcare system [Cost analysis was not looked at during this study but we estimated that, at the time of creating our video, it would cost approximately £5000 for professional filming and production. This estimate is based on the use of a commercial agency to record and edit a video of this type and quality. This cost is likely to be significantly reduced if institutions have the relevant in-house expertise and technology, something that has become more commonplace since the recent pandemic. Given that examination skills would not be expected to evolve significantly over time, it is unlikely that any initial cost would need to be repeated. There is the potential for a significant return on investment but studies specifically addressing cost effectiveness would be needed.We made some changes to the design of this study compared to the first in our series. In our original study dominant learning styles were obtained for each participant through use of a ‘VARK’ (Visual, Aural, Read/write, Kinesthetic sensory modalities) questionnaire [We recognise that one of the limitations of this study is that longer term retention of information has not been assessed. However, being able to maintain a robust and controlled study design such as this in our study group over a long period of time would not have been realistic. The sample size used here was equivalent to that in our original study but we note that further, larger scale studies are warranted [We may consider that the benefit of a video resource for the F2FV intervention group was due to more training thanks to an additional educational resource. However, participants across both intervention groups were permitted to use any other forms of non-video educational material (e.g. textbooks, their own notes from the face-to-face session) during the study period, though the extent to which participants did this was not assessed. Whether repeated face-to-face teaching sessions may offer the same benefit as a video adjunct was also not assessed, however in a real life setting this is likely to be impractical given the wide breadth of curriculum medical schools are required to cover and the increasing number of medical students they are required to teach (the number of spaces available in UK medical schools in 2021 was 9500 but this is predicted to increase further as the demand for more doctors within the NHS also increases) [This is now the second study in our series looking at the relative effectiveness of different teaching modalities in isolation and combination when teaching physical examination skills. To our knowledge this is the only randomised control trial assessing the use of a custom-made educational video as an adjunct to more traditional methods for clinical examination teaching. Major strengths of this study include the robust methodology, with adherence to study protocols for each participant, and blind assessment at all stages.Virtual learning in its many forms (ranging from video material to virtual and augmented reality [