Department of Physical Medicine and Rehabilitation, Wang Fang Hospital, Taipei Medical University, Taipei, Taiwan
Phase: NA
Conditions: Feedback
Sponsor: Taipei Medical University WanFang Hospital

06/04/2024 
Title: Applying videos feedback Learning to Improve 
Skills Performance of Physiotherapy Interns 
 
I-Hsien Lin, PT, MS, 
Department of Physical Medicine and Rehabilitation, Wang Fang Hospital, 
Taipei 
Medical University, Taipei, Taiwan 
Tel: +886-2-29307930 ext. 1600 
Email: 88262@w.tmu.edu.tw 
 
 

06/04/2024 
Background 
This project uses self-practicing videos feedback to learn to improve the skill 
performance of physiotherapy interns. For traditional physiotherapy intern 
courses, teachers will conduct core courses and demonstrate teaching, but 
students are less familiar with the application of skills, even if adding 
practice course. The learning outcomes of the course are still not good in 
skill performance. By recording the self-practicing videos, the teacher uses 
observation and feedback to let the physiotherapy interns know whether 
the posture of the individual case, the fixed position of the limbs are 
appropriate, the resistance given and whether the verbal instruction is 
correct, and based on the evaluation outcomes to observe the students' 
learning status and clinical thinking ability can improve the skill 
performance and learning satisfaction. 
 
Methods 
This study is divided into three randomized controlled experiments, 
recruiting physical therapy interns. During the internship period, 
participants will execute various station-based internships according to the 
instructional plan. Prior to the trial, the project lead will explain the 
research plan to students, and willing participants will sign an informed 
consent form before participating in the study. Interns who are not willing 
to participate will still be involved in course design but will not undergo 
assessment tests. 
1. Participants 
Inclusion criteria for physical therapy interns require individuals to be over 
20 years old. Exclusion criteria include individuals unwilling to participate in 
the study. 
The study uses sealed envelopes for random allocation to ensure evaluator 
blinding. Evaluators are unaware of which group each participant is 
assigned to, with an internal reliability of 0.93. Participants are divided into 
two groups: practice group and video feedback group, each consisting of 45 
individuals. 
 
2. Interventions 
2.1 Practice Group: Participants in this group engage in the traditional core 
course (1-hour lecture on upper limb soft tissue differential diagnosis 
and assessment techniques. They have the opportunity to observe 
teacher demonstrations, and the course content and instructional 

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demonstrations are consistent and delivered by the same therapist), 
followed by a 20-minute practical session where they pair up for mutual 
hands-on practice. The assessment of upper limb soft tissue operations 
takes approximately 4 minutes per session, allowing for approximately 5 
practice sessions. 
2.2 Video Feedback Group: Participants receive the traditional core course 
along with a 20-minute video feedback session. Initially, a therapist 
records students' assessment techniques in action, capturing the 
dynamic process on video. The recorded video is then played on a 
screen for both the course teacher and students to watch together. 
Participants can annotate specific actions during the viewing, and the 
course teacher facilitates a reflective discussion where participants 
observe and identify any issues or correct actions as expected. The 
teacher provides feedback on areas of improvement in the action 
process for further practice. The self-viewing of the recorded video 
serves as a valuable tool for enhancing the skill performance of physical 
therapy interns 
 
3. Outcome Measures 
3.1 Objective Structured Clinical Examination (OSCE): Evaluators utilize a 
detailed, operationally defined standardized checklist to assess the 
performance of examinees in a structured clinical skills assessment. 
OSCE is a performance-based testing method that objectively evaluates 
clinical skills in simulated clinical scenarios using molds and standardized 
patients. This instructional design aims to aid students in learning and 
understanding their learning outcomes, evaluating the knowledge, skills, 
and attitudes of the examinees through a performance-based testing 
approach. 
The scoring sheet includes an standardized checklist and an overall 
performance assessment. The standardized checklist comprises 15 items, 
with results presented in percentages, where higher scores indicate 
better performance. The overall performance assessment ranges from 5 
points (excellent) to 1 point (poor). 
Time Frame: pre-test, within 1 week post test, 3-month follow-up. 
3.2 Mini-Clinical Evaluation Exercise (Mini-CEX): The Mini-CEX focuses on 
the performance of interactions with patients. Clinical instructors can 
use it to directly observe the interaction between learners and patients, 
conduct a simple assessment of the Mini-CEX, and provide direct 

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feedback to the learners. Clinical instructors can assess a specific aspect 
(medical interview, physical examination, operational skills, counseling 
and health education, clinical judgment, organizational efficiency, 
humanitarian professionalism) each time. 
The assessment consists of 7 items, with scores ranging from 1 to 9 
points each. The total score ranges from 7 to 63 points, with higher 
scores indicating better performance. 
Time Frame: pre-test, within 1 week post test, 3-month follow-up. 
3.3 Direct Observation of Procedural Skills (DOPS): Clinical instructors 
assess and provide feedback on the procedural skills of participants, 
ensuring effective learning. Clinical instructors evaluate and provide 
feedback on the procedural skills of the examinee. Each clinical 
procedural skill is assessed and feedback is provided to ensure learning 
effectiveness. 
The assessment consists of 10 items, with scores ranging from 1 to 6 
points each. The total score ranges from 10 to 60 points, with higher 
scores indicating better performance. 
3.4 Course Satisfaction: Understand your satisfaction with various 
arrangements of this course activity, including speakers, lecture content, 
and related activities. 
The assessment consists of 12 items, with scores ranging from 1 to 5 
points each. The total score ranges from 12 to 60 points, with higher 
scores indicating higher satisfaction. 
 
4. Statistical analysis  
All analyses were conducted via the IBM SPSS statistical software, version 
23.0. The continuous data were presented in means and standard 
deviations, and number and percentage for categorical data. Independent 
t-test was used to compare continuous data and chi-square for categorical 
data. Inferential statistics were performed using a generalized estimating 
equations to estimate the intervention effectiveness of the simulation 
course. The significance level was set to 0.05. Intention-to-treat (ITT) 
analysis is an approach to managing dropouts and missing data. Sample size 
was calculated using G*Power to compare differences between variables 
and independent means. A power of 80% was used, with medium effect size 
(Cohen’s d) of 0.5, and alpha significance level of 5%. This resulted in a 
sample size of 54 students (Rotthoff, 2014).