Materials and methods
RECRUITMENT, PATHOLOGY, RECRUITMENT
This study was a prospective randomised trial comparing two arms of intervention for teaching clinical examination skills to first and second year medical students with no previous experience of shoulder examination. The two arms were face-to-face teaching alone (F2F) and face-to-face teaching plus access to an online video resource (F2FV).First and second year medical students at the University of Sheffield with no prior formal clinical examination skills teaching were chosen as the study group. All first and second year students were eligible for inclusion. The only exclusion criteria was previous teaching on MSK examination. Participants from both year groups were grouped together based on having the same limited clinical experience as part of their curriculum and therefore no differences in ability to perform a clinical examination were expected. Recruitment was performed through opportunity sampling with the study proposal being presented to each year group and providing students with an information booklet detailing the aims, objectives and requirements for participation in the study (see Supplementary Materials We recruited 42 participants to the study. These participants were block randomised to one of the two interventions by a computer random number generator (21 participants per study arm).54.8% of participants identified as female (Consort flow diagram showing trial recruitment and retentionOn day zero all participants underwent a pre-intervention assessment during which they were asked to examine the shoulder of a volunteer patient with no abnormal pathology. They were assessed against a standardised score sheet which was validated in our previous study [All participants were then asked to attend a 30 minute face-to-face small group teaching session on clinical examination of the shoulder joint. All sessions were taught by the same senior author to 4 separate groups of 10–12 participants on day zero. Participants were randomly allocated to these groups based on a participant number assigned on recruitment. Participants were taught a standardised method of examining the shoulder based on a previously published technique [Those participants randomised to the video adjunct group were emailed access to a custom-made 30-minute online video resource at the same date and time following completion of all face-to-face teaching sessions on day zero. The video resource was produced and edited to a high quality for the purposes of this study with the same senior author, structure and content as the face-to-face teaching sessions. The video included demonstration of the examination technique taught in the face-to-face session with demonstration of these on a model patient from a number of angles. Graphic overlays of anatomical pictures were also included. The process and sequence of shoulder joint examination taught in the video resource mirrored that of the face-to-face seminar. This resource was uploaded to an online platform (SproutVideo LLC) which allowed each candidate to have a personalised and password-protected profile. This platform also allowed advanced analytics including who accessed the video and when, how many times the video was watched, and on what kind of device it was watched.Those participants in the face-to-face teaching alone group were asked not to access any video material in relation to examination of the shoulder joint during the study period. All participants were advised that they could access and use other study materials as they wished throughout the study period to allow this to be as ‘real-life’ as possible.At day 7 post-intervention participants were asked to attend for a second assessment. This was performed in the same manner and using the same score sheet as the initial pre-intervention assessment. Assessors were blinded to intervention group and there was a dropout rate of 2 between the pre- and post-intervention assessments.