Student perspectives on using Google Glass recordings to assess their communicative and clinical skills with standardized patients

Introduction: This exploratory study evaluated student perceptions of their ability to self and peer assess 1) interpersonal communication skills and 2) clinical procedures (a head and neck examination) during standardised patient (SP) interactions recorded by Google Glass compared to a static camera. _________________________________________________________________________________ This is the author's manuscript of the article published in final edited form as: Zahl, D. A. , Schrader, S. M. , & Edwards, P. C. (2016). Student perspectives on using egocentric video recorded by smart glasses to assess communicative and clinical skills with standardised patients. European Journal of Dental Education. https://doi.org/10.1111/eje.12217 GOOGLE GLASS FOR SELF & PEER ASSESSMENT OF AN OSCE 2 Methods: Students compared the Google Glass and static camera recordings using an instrument consisting of 20 Likert‐type items and four open and closed text items. The Likert‐type items asked students to rate how effectively they could assess specific aspects of interpersonal communication and a head and neck exam in these two different types of recordings. The interpersonal communication items included verbal, paraverbal, and nonverbal subscales. The open text items asked students to report on more globally the differences between the two types of recordings. Descriptive and inferential statistical analyses were conducted for all survey items. An inductive thematic analysis was conducted to determine qualitative emergent themes from the open text questions. Results: Students found the Glass videos more effective for assessing verbal [t(22) = 2.091, p = . 048] and paraverbal communication skills [t(22) = 3.304, p = . 003], while they reported that the static camera video was more effective for assessing nonverbal communication skills [t(22) = ‐2.132, p = . 044]. Four principle themes emerged from the students open‐text responses comparing Glass to static camera recordings for self and peer‐assessment: (1) first person perspective, (2) assessment of nonverbal communication, (3) audiovisual experience, and (4) student operation of Glass. Discussion and Conclusion: Our findings suggest that students perceive that Google Glass is a valuable tool for facilitating self and peer assessment of SP exams because of students’ perceived ability to emphasise and illustrate communicative and clinical activities from a first‐person perspective. Introduction Google Glass is a prototyped wearable, interactive, voice‐controlled, technology that is equipped with an optical head‐mounted display (Figure 1). It is part of an emerging information and communication technology sector commonly referred to as “smart glasses,” which uses ambient intelligence, eye tap, smart grid, Bluetooth, and Wi‐Fi technologies.1‐3 It was initially introduced to a limited number of invited users termed, “Google Explorers,” in April, 2013. While sales of Google Glass were discontinued in GOOGLE GLASS FOR SELF & PEER ASSESSMENT OF AN OSCE 3 January 2015, Google is reportedly committed to continuing with development of this technology, with a possible strengthening of its emphasis on medical, educational and industrial applications. Additionally, a number of other corporations such as Sony, Microsoft, ODG and others have now taken the lead in the smart glasses arena. Various applications for Google Glass have been noted in higher education literature.4 In the dental and medical education communities, Google Glass has been applied to remote mentoring, distance learning, live streaming of clinical procedures, simulation‐based training, virtual student‐faculty communication on the clinic floor and video debriefing sessions.5‐12 The Indiana University School of Dentistry (IUSD) had been using Google Glass in Objective Structured Clinical Examinations (OSCE) so as to evaluate the value of smart glasses’ educational functionality and utility in recording interactions between students and standardised patients (SP). These Glass recorded encounters were then reviewed by small groups of students during Behavioural Patient Management Rounds. The video review process allowed faculty to debrief with students about the simulated clinical interviews and for students to further engage in critical self and peer assessment. For developing dental clinicians, this type of reflective debriefing and assessment can be an effective approach to clinical communication skills training.13 Self‐ and peer‐assessment is an integral part of professional school training as it promotes the attainment of the skills necessary for lifelong learning and self‐regulation.14,15 These processes are grounded in the theories of social constructivism, active learning, andragogy, metacognition, and self‐ efficacy, whereby adult students are responsible for making critical judgements about their own achievements and the achievements of their peer colleagues.15‐19 Video‐based self and peer assessment of OSCEs is a method that has demonstrated positive educational outcomes in the professional school setting.20‐22 GOOGLE GLASS FOR SELF & PEER ASSESSMENT OF AN OSCE 4 For the past several decades, student‐ SP interactions in OSCEs have nearly always been recorded using 1 or possibly 2 static cameras. Eventually, technologies were developed to allow a third party outside of the exam room or operatory to potentially maneuver the camera during the recorded encounter. However, not until recently, has the technology been available to allow developing dental providers the ability to physically control the recording process. This self‐controlled videography affords the learner the ability to later review a unique perspective of their clinical activities (e.g. head and neck examination) and their communicative engagement with patients otherwise not possible with static cameras.5‐8 The use of Glass in OSCEs introduces an egocentric vision paradigm into the self and peer assessment processes. Egocentric vision is a first‐person perspective of the human experience recorded by a wearable device that is inherently human‐centric, or in the case of the present study, inherently student‐centric.23,24 Two advantages of the egocentric vision paradigm guided the rationale to explore shifting from a static third‐person perspective to a dynamic egocentric perspective: 1) objects of interest tend to be centred, large‐scaled, and unobstructed, and 2) activities of interest typically consist of the user manipulating objects in their field of vision.28 The shift to a student‐centred egocentric recording process supports active learning principles18,25‐27 in that it gives dental students more control over and responsibility for their own learning, and engages them with a dynamic unobstructed perceptual perspective that foregrounds objects and activities of interest. To our knowledge, there are no other studies comparing OSCE recordings of static cameras to egocentric smart glasses for the purposes of self and peer assessment. Therefore, the purpose of this exploratory study was to evaluate student perceptions of how standardised patient interactions recorded by egocentric smart glasses compare to those recorded by a static camera. Specifically, this study addressed the following research questions: (1) How do students perceive Google Glass compared GOOGLE GLASS FOR SELF & PEER ASSESSMENT OF AN OSCE 5 to static camera videos for the purposes of conducting self and peer assessments of interpersonal communication skills with standardised patients? (2) How do students perceive Google Glass compared to static camera videos for the purposes of conducting self and peer assessments of head and neck examinations with standardised patients? Methods Institutional Review Board This study (IU IRB # 1409196999) was determined by the Human Subjects Office, Office of Research Compliance, Indiana University, to be IRB exempt under 45 C.F. R. § 46.101 (b), paragraph(s) (1) and (2). Study design A subgroup of third year students assigned to participate in an OSCE self‐selected to record their SP station using Google Glass recording devises. Specifically, volunteers used one of two fully charged Google Glass units equipped with polycarbonate shields. These units worn by the students ran version XE22 software to record the standardised patient encounter while another more traditional single ceiling mounted static camera also captured the same interaction. All recorded SP OSCE sessions, using static camera video or Google Glass, were subsequently reviewed during Behavioural Patient Management small group discussion sessions, facilitated by the authors. During sessions in which SP stations were recorded by both Glass and a static camera, students completed a Video Review Assessment Effectiveness Scale (VRAES) instrument for each type of video. The VRAES asked students to rate how effective each type of video was for assessing verbal, nonverbal, and paraverbal communication skills, and a head and neck clinical examination. Video Review Assessment Effectiveness Scale (VRAES) GOOGLE GLASS FOR SELF & PEER ASSESSMENT OF AN OSCE 6 Students who reviewed a Google Glass recording during their Behavioural Patient Management small group discussion sessions completed the twenty‐four (24) item VRAES instrument. The instrument consisted of four (4) open and closed text items and twenty (20) Likert‐type items with a response set ranging from “Very Easily Assessed” (5) to “Very Difficult to Assess” (1). The Likert‐type items asked students to rate how easily they could assess specific aspects of interpersonal communication and a head and neck clinical examination in the Google Glass versus fixed camera recordings. The interpersonal communication items included verbal, paraverbal, and nonverbal subscales. The open text items asked students to discuss more globally their perceptions of the differences between the two types of recordings. The communication items of the VRAES were modified f