Analysis of the Effect of Pre-course Videos on Improving Clinical Skills in Emergency Ultrasound Training
Phase: NA
Conditions: Medical Education
Sponsor: Taipei Veterans General Hospital, Taiwan

1. Trial Name: Analysis of the Effect of Pre-course Videos on 
Improving Clinical Skills in Emergency Ultrasound Training 
NCT number: VGHTPE IRB ID: 2024 - 06 - 006B 
Document date: 2024-Aug-05 
2. Trial Location: 
Trial Location: Department of Emergency Medicine, Taipei Veterans General Hospital 
3. Research Background: 
The current status of the studied disease, including its natural course, available treatments, 
and prognosis. Point-of-Care Ultrasound (POCUS) has become increasingly popular in 
recent years. In clinical care, beyond traditional physical examination tools like 
stethoscopes, reflex hammers, or penlights, ultrasound has gained a significant role. Proper 
ultrasound training rapidly aids in clinical decision-making and diagnosis. However, the 
quality of ultrasound training is often limited by the number of ultrasound machines, the 
scarcity of clinical instructors, and the high number of trainees, which dilutes the 
opportunities and time for hands-on practice, thereby affecting teaching quality. Efficiently 
imparting ultrasound operational skills through hands-on practice has become a major 
challenge for improving training quality. A teaching randomized controlled trial published 
in BMC Medical Education in 2020 discussed the importance of video or peer 
empowerment in ultrasound education in medical schools. Usually supervised by 
experienced faculty, bedside exams or peer practice sessions are conducted. However, due 
to the high number of enrolled trainees, one-on-one mentoring opportunities are often 
unavailable. To overcome this obstacle, using instructional videos supplemented by peer 
teaching conducted by trained trainees has proven feasible and effective. However, this 
study focused on training ultrasound techniques for diagnosing abdominal and cardiac 
diseases and did not explore the impact of videos on training for invasive ultrasound-
guided procedures. There are also related discussions on how to shoot instructional videos 
for procedural skills, with some articles suggesting that first-person point-of-view (POV) 
filming could enhance realism and learning effectiveness. For instance, in the UK, medical 
schools have used GoPro cameras to record first-person POV during ward rounds, 
handovers, and patient condition explanations, providing an immersive and reproducible 
educational experience for large groups of learners with less time and resource investment 
compared to traditional small-group simulations. Additionally, a study in nursing 
education, published in the fields of cognitive learning and experimental psychology, 
compared pre- and post-test results of technical training under three video conditions: face-

to-face view, shoulder-overview, and mixed view (alternating face-to-face and shoulder-
overview for each step). A control group without video viewing was also included. The 
results showed that learners in the mixed view group performed better than those in other 
groups. Learners in the face-to-face and shoulder-overview groups also performed better 
than the control group, but there was no significant difference between these two groups. 
Moreover, learners in the mixed view group reported higher confidence in safely and 
accurately completing the procedures. 
4. Research Objectives: 
Primary Objective: Evaluate the effectiveness of pre-class video learning in enhancing 
ultrasound teaching efficiency (i.e., differences between groups that watched the pre-class 
video and the control group that did not). Secondary Objective: Investigate the impact of 
pre-class instructional videos using first-person POV filming versus face-to-face filming 
on learning outcomes in ultrasound skills training. 
5. Research Steps: 
Recruit PGY physicians and medical interns at our hospital who are highly interested in 
learning emergency ultrasound-guided central venous catheter insertion. Randomly assign 
participants into three groups based on a random number table: a group watching first-
person POV operational videos, a group watching face-to-face operational videos, and a 
group not watching any videos before the class. The video-watching groups will receive an 
email with the video one week before the class, while the control group will receive a 
general pre-class reminder notification. On the day of the class, participants will fill out a 
questionnaire regarding basic information, self-assessment of learning skills, and whether 
they watched the pre-class video. After completing the questionnaire, participants will 
immediately undergo a pre-test, performing operations on models with ultrasound while 
being recorded. Instructors will assess the participants' performance using a skills 
checklist. This will be followed by one-on-one teaching, where instructors will provide 
detailed guidance on each operational step, and then a post-test where participants 
independently complete the ultrasound-guided central venous catheter insertion and record 
the results using the skills checklist. After the teaching session, a post-test questionnaire 
will be administered to assess satisfaction and self-confidence in performing the procedure. 
6. Research Design: 
1. Design Type: Parallel study design. 

2. Control Group: Yes, the group not watching pre-class videos. The control group 
will receive the same quality and content of face-to-face teaching during the actual 
operational skills course. 
3. Blinding Method: Single-blind. The instructor evaluating the pre- and post-test 
performance will not know the group assignment of the participants. 
4. Random Assignment: To ensure that late-joining participants do not have a better 
foundational ultrasound skill level and to maintain group size balance, we will use 
blocked randomization with a block size of 3: 
o Block size=3 and Treatment=3, resulting in 6 possible assignments: 
0=ABC, 1=CAB, 2=BAC, 3=ACB, 4=BCA, 5=CBA 
o A: No pre-class video group 
o B: Face-to-face operational video group 
o C: POV first-person operational video group Random number tables 
generated by computer (0-5) will assign participants to the above treatment 
orders, and assistants will distribute the appropriate pre-class videos and 
reminders. 
7. Subjects: 
1. Selection Criteria: PGY physicians and medical interns at our hospital who 
voluntarily enroll. 
2. Exclusion Criteria: None. 
3. Number of Subjects: Based on similar studies in nursing education comparing 
different video modalities for learning catheter placement (Table 1), we estimate 
the number of subjects using one-way ANOVA power analysis, setting α=0.05 
and power at 0.8, with within-group variance set at 256: 
o Table 1. Estimated effect size and sample size based on literature: 
§ 
Control group average: 62.0 
§ 
Face-to-face video group average: 89.8 
§ 
POV video group average: 99.4 
§ 
High effect size: Each group requires 5 participants 
§ 
Low effect size: Each group requires 24 participants Therefore, 
this study conservatively estimates needing 24 participants per 
group, totaling 72 participants for ANOVA analysis. 
8. Research Methods: 
1. Teaching Method: On the day of the class, participants will fill out a questionnaire 
(Attachment 1) regarding basic information, self-assessment of learning skills, and 

whether they watched the pre-class video. After completing the questionnaire, 
participants will immediately undergo a pre-test, performing operations on models 
with ultrasound while being recorded. Instructors will assess the participants' 
performance using a skills checklist (Attachment 2). This will be followed by one-
on-one teaching, where instructors will provide detailed guidance on each 
operational step, and then a post-test where participants independently complete 
the ultrasound-guided central venous catheter insertion and record the results using 
the skills checklist. After the teaching session, a post-test questionnaire 
(Attachment 3) will be administered to assess satisfaction and self-confidence in 
performing the procedure. 
2. Concurrent Therapy: None. 
3. Clinical Observations: The scores from the pre- and post-tests and the 
questionnaire responses will serve as the observational indicators. 
4. Follow-up Schedule: Follow-up is completed after recording the results of the 
teaching activity. 
5. Primary Efficacy or Evaluation Indicators: 
o Skills checklist score (Attachment 1). 
o Significant improvement in the skills checklist score for the intervention 
group compared to the control group. 
9. Adverse Event Management: 
1. Criteria and Incidence of Adverse Events: This teaching program employs 
standardized one-on-one teaching, ensuring no loss of learning opportunities for 
participants. The ultrasound and needle tools are used on models, posing no 
physical harm to participants. Therefore, there are no adverse physical effects. 
2. Reporting Method: If participants are dissatisfied or need to report issues, the 
contact information of the instructors will be provided in the notification email and 
questionnaire for participants to communicate their concerns. 
3. Handling Method: The teaching activity is beneficial for participants' skill 
enhancement and poses no harm. If there is any dissatisfaction with the teaching 
design, the instructors will communicate with participants and make necessary 
adjustments. 
10. Subject Rights: 
1. Safety Maintenance and Insurance: Participants will not suffer any harm. 
2. Special Matters and Others: None. 

11. Statistical Analysis: 
1. Descriptive Statistics: Emphasize clinical significance, such as describing the 
expected treatment effects or the magnitude of treatment differences. 
o Chi-square test, Yates' correction, or Fisher's exact test will be used to 
compare categorical variables. Student’s t-test or Mann-Whitney rank-
sum test will be used to analyze continuous variables. R software will be 
used for statistical analysis. A P-value < 0.05 will be considered 
statistically significant. 
2. Inferential Statistics: Statistical methods for testing the primary efficacy 
indicators. 
o One-way ANOVA or Kruskal-Wallis test will be used to compare means 
of continuous data among the three groups. A P-value < 0.05 will be 
considered statistically significant. Multiple comparison corrections will be 
considered for pairwise comparisons between groups if needed. 
3. Interim Analysis: No interim analysis will be conducted.