Examiners and scoring
All examiners were experienced clinicians. To improve the homogeneity level of examiners and the efficiency of scoring, the video-based score adopted a classified scoring method, and each examiner only evaluated one type of test. After intensive training, classified training, and test evaluation, the examiners assessed on-site or via video answer files in Nanjing Medical University. Examiners who assessed via video answer files should send their evaluation within three days.After examination, video answer files were sent to examiners for scoring through the management system network. Each examiner was only assigned one type of exam question. The scoring system provided video viewing angle and audio position switching functions to facilitate examiners to change the audiovisual position. Audio and video could be synchronized fast forward, slow forward, playback, and zoom in any position, and the examiner recorded the scoring results on the structured scoring table. Two examiners independently evaluated each video answer file, and the system automatically submitted the assessment difference to the chief examiner for confirmation to determine whether the evaluation difference exceeded the threshold. The process is represented in a flow chart (Flowchart of study.1. Video-based scoring examiner selection and video answer file samplingAs the experimental group, three groups were selected from the second and third stations. The surround recording and broadcasting equipment recorded all students in the experimental group to form a video answer file. Moreover, the examiner was assigned to conduct on-site scoring. In the experimental group, each group selected an examiner to participate in the video-based scoring. The video-based evaluation was performed on 30 randomly selected examination video answer file that the examiner assessed on-site.2. Sample answer file selection and assessmentNine typical video answer files were selected from the second and third stations’ video answer files as reference samples. The test experts and examiners chosen from the second and third stations conducted video-scoring of reference samples.