# Video-based feedback of oral clinical presentations reduces the anxiety of ICU medical students: a multicentre, prospective, randomized study

Matthieu Schmidt, Yonathan Freund, Mickael Alves, Antoine Monsel, Vincent Labbe, Elsa Darnal, Jonathan Messika, Jerome Bokobza, Thomas Similowski, Alexandre Duguet

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## ► To cite this version:

Matthieu Schmidt, Yonathan Freund, Mickael Alves, Antoine Monsel, Vincent Labbe, et al. Video-based feedback of oral clinical presentations reduces the anxiety of ICU medical students: a multicentre, prospective, randomized study. BMC Medical Education, 2014, 14, pp.103. 10.1186/1472-6920-14-103. [hal-01311026](https://hal.sorbonne-universite.fr/hal-01311026)

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# Video-based feedback of oral clinical presentations reduces the anxiety of ICU medical students: a multicentre, prospective, randomized study

Matthieu Schmidt<fnref n="1" />,<fnref n="2" />,³*, Yonathan Freund⁴, Mickael Alves⁵, Antoine Monsel⁶, Vincent Labbe⁷, Elsa Darnal⁶, Jonathan Messika⁷, Jerome Bokobza⁸, Thomas Similowski<fnref n="1" />,<fnref n="2" />,³† and Alexandre Duguet<fnref n="1" />,<fnref n="2" />,³†

**Abstract**

**Background:** Oral presentations of clinical cases by medical students during medical rounds in hospital wards are a source of anxiety and little is known about how this anxiety can be alleviated. The objective of this study was to investigate whether video-based feedback of public oral presentations can reduce anxiety in 4th year medical students.

**Methods:** Multicentre randomized study conducted in six intensive care units (ICU) and emergency departments (ED) in France over a 9-month period in 2012. One hundred and forty two 4th year medical students were randomized to two groups: intervention and control. Students in the intervention group were recorded while making an oral presentation of a patient during morning ward rounds, followed by video-based feedback. Students in the control group conducted presented classical oral presentations without being filmed and with no formal feedback. Anxiety levels during a public oral presentation were assessed using the Spielberger State Anxiety Inventory (STAI-S). The primary outcome was the difference in STAI-S scores between groups at the beginning and at the end of a 3-month ICU or ED internship.

**Results:** Seventy four students were randomized to the 'video-based feedback' group and 68 were randomized to the control group. In both groups, STAI-S scores were significantly lower after 3 months of internship. However, the reduction in STAI-S scores was significantly greater in the "video-based feedback" group than in controls (−9.2 ± 9.3 vs. −4.6 ± 8.2, *p* = 0.024. Compared to the control group, significantly fewer students with high-level anxiety were observed in the "video-based feedback" group after 3 months of internship (68 vs. 28%, *p* <0.001).

**Conclusions:** Compared to "usual practice", video-assisted oral feedback reduced anxiety and significantly decreased the proportion of students experiencing severe anxiety.

**Keywords:** Oral feedback, Video tape, Medical education

**Background**

Oral presentations of clinical cases are performed daily by medical students during medical rounds in hospital wards. Public oral presentations are anxiogenic, particularly when they are associated with direct professional implications. However, the anxiety induced by oral presentations is alleviated only after years of experience, and little is known about how this anxiety can be reduced. Anxiety can have

multiple consequences on the student's personal and academic development [1-3]. Medical students [4,5] often report that anxiety increases their feelings of personal inadequacy [6]. Anxiety may also have a negative impact on the quality of the presentation, which may be a source of medical errors and which may affect the patient's outcome [7-9]. It is therefore important to improve communication skills during medical training by ensuring a positive frame of mind.

Video-based feedback is already used in medicine, and good results [10-12] have been obtained in resuscitation of cardiac arrest [11,13] and surgical techniques using video-based feedback [14-16] have been shown to improve the efficacy of simulation-based teaching [17,18].

<footnote>* Correspondence: matthieuschmidt@yahoo.fr</footnote>

<footnote>†Equal contributors</footnote>

<footnote n="1">¹Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris F-75005, France</footnote>

<footnote n="2">²INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris F-75005, France</footnote>

<footnote>Full list of author information is available at the end of the article</footnote>
Similarly, the oral communication skills of psychiatrists
are significantly improved after receiving feedback on their
previous videotaped interviews [14-16,19]. Although there
is undisputed evidence supporting the efficacy of video-
based feedback when teaching clinical skills, the specific
value of video-based feedback to reduce the anxiety of
medical students has not been previously investigated. We
hypothesized that systematic videotape-assisted feedback,
as a composite teaching tool, decreases the anxiety of
medical students. To test this hypothesis, we evaluated
whether the students' anxiety was reduced after receiving
feedback from videotaped oral presentations compared
with "usual" oral presentations without formal feedback.
We also evaluated the students' perceptions of this new
educational tool.

Methods

This multicentre, prospective, randomized, controlled
study was conducted in six departments (three medical in-
tensive care units (ICU), two surgical ICUs, and one emer-
gency department (ED)) in urban university-affiliated
hospitals (Université Paris 6 Pierre et Marie Curie), over a
9-month period in 2012. The protocol was approved by an
independent institutional review board (“Comité de Pro-
tection des Personnes”, Paris Ile de France VI). All partici-
pants gave their written informed consent.

Study population

After their first two years in medical school, French med-
ical students spend half of their time in hospital and
change wards 3 times a year. During this in-hospital train-
ing period, they learn how to examine patients, write med-
ical reports, and apply their theoretical knowledge to
various clinical settings. They also attend ward rounds
with a senior physician and receive training in general
medical practice.

At our university, 4^th^ year medical students must
complete a mandatory 3-month training period in an ICU
or ED. All students completing a 3-month internship in
each participating department (i.e. three 3-month in-
ternships) were asked to participate in this study.
Foreign-exchange students were not involved, as they
follow a different curriculum.

Study design

Eligible students were invited to participate in the study
during the first 2 days of their ICU/ED training. Students
were informed that the primary objective of the study was
to test the impact of VBF on the level of anxiety induced
by oral presentation. After being given a brief description
of the study and after signing the informed consent form,
medical students were asked to fill in an online question-
naire on sociodemographic data and anxiety assessment
(see below). The students were then randomized on the

same day using the Excel® (Excel 2007, Microsoft) random-
number generation function. The medical students were
assigned to either the “video-based feedback” (VBF) group
or the control group (i.e. with no video feedback). In both
arms, students had to perform a formal oral presentation of
a patient on a regular basis during morning ward rounds or
during handovers. Paper or clinical file supports were avail-
able for the student during the presentation. Depending on
the group to which the student was randomized, the oral
presentation was taped by means of a small portable cam-
era on a mini-tripod (Q3 Handy Video Recorder, Zoom,
Japan) or was not taped.

In the VBF group, after completing the ward rounds/handover, a senior physician performed formal feedback on the content and structure of the student's oral presentation, in the presence of all other VBF students at the same centre, but with no students from the control group. Students of the control group were not filmed and did not receive any formal feedback, in line with standard practice in our wards: comments and criticisms of the oral presentation were left to the physician's discretion in each centre. At the end of their training (i.e. 3 months), all students again filled in the same online questionnaire.

Questionnaire content

Sociodemographic data were collected from all students at
the beginning of their internship. Anxiety levels were
assessed using the validated French version of the Spielber-
ger State Anxiety Inventory (STAI-S) [20]. This score mea-
sures the transitional emotional status evoked by a stressful
situation, such as an oral presentation, using 20 items each
rated by a 4-point Likert scale (possible score range: 20–
80). Higher scores are positively correlated with higher
levels of anxiety. A score >37 for men and >42 for women
reflects high anxiety, and a score >48 for men and >55 for
women corresponds to anxiety liable to interfere with per-
formance [21]. The level of anxiety was evaluated in all stu-
dents at the beginning and at the end of the 3-month
emergency room or ICU internship.

All online questionnaires were self-administered by the
students. In addition to the STAI-S questionnaire, the stu-
dents were asked for feedback on their perception and sat-
isfaction with the filmed observation method. The first
questionnaire was completed before randomization and on
the first day of hospital training.

Endpoints

The primary endpoint was a reduction in the STAI-S
score. Secondary endpoints were: 1) the proportion of stu-
dents with high anxiety and anxiety that might interfere
with their oral presentation; and 2) the student's percep-
tion of the "educational tool".
## Statistical analysis

This study followed CONSORT recommendations for reporting randomized and controlled trials.

Sample size was calculated using the STAI-S value of typical healthy French students [20], which indicated that 141 students were needed to show a 5-point reduction in STAI-S score between the beginning and end of internship, with a power of 80% and a *P*-value of 0.05.

All data distributions were normal according to the Kolmogorov-Smirnov test. The data were therefore expressed as mean ± SD. Continuous variables were compared with Student's t-test, whereas categorical variables were compared with a chi-square test. The primary endpoint (i.e. reduction in the STAI-S) in each group was compared using Student's t-test. The proportion of students with high anxiety and anxiety that might interfere with the oral presentation at the beginning and at the end of the 3-month internship were compared using the paired McNemar test.

All *P* values were two-tailed and *P* <0.05 was considered significant. Statistical analyses were performed using StatView 5.0 (SAS Institute Inc., Cary, NC) software.

## Results

A total of 150 4th year medical students were enrolled in the study over a 9-month period. Two students refused to participate, while 8 students were excluded from the analysis due to insufficient data. Seventy four students were randomized -to the ‘video-based feedback’ group and 68 four students were randomized to the control group.

## Population characteristics

The characteristics and mean pre-intervention STAI-S scores for each group are summarized in Table 1. No significant differences were observed between the two groups. Of note, 44% of all students reported being shy, and 38% reported being anxious during their hospital training. In addition, before randomization, 55% (n = 79) of students reported being afraid of speaking in public. Each of the 74 students in the VBF group received a mean of 6 ± 1 VBF sessions devoted to their own performance during the 3-month period: each lasted 16 ± 7 min, while students in the control group did not receive any formal feedback.

## Self-assessment of anxiety generated by an oral presentation

Fifty-eight per cent (n = 82) of students reported significant anxiety (i.e., STAI-S score >37 for men and >42 for women) during oral presentations at the beginning of their ER or ICU internship: 62% in the VBF group vs. 53% in the control group (*p* = 0.26). In addition, 17% reported that this high level of anxiety interfered with the quality of their oral presentation (Table 1).

## Impact of video-based feedback

The STAI-S scores and the numbers of students with major anxiety that could interfere with their performance significantly decreased in both groups by the end of their internship. However, the reduction in the STAI-S score was significantly greater in the VBF group compared to the control group (–9.2 ± 9.3 vs. –4.6 ± 8.2, *p* = 0.024). Similarly, the number of students with high anxiety was

<table><caption>Table 1 Student characteristics and pre-randomisation perceptions of anxiety and public speaking</caption><thead><tr><th></th><th>Total (n = 142)</th><th>Control group (n = 68)</th><th>Video-based feedback group (n = 74)</th><th>P</th></tr></thead><tbody><tr><td>Age, years</td><td>22 ± 1</td><td>22 ± 1</td><td>22 ± 1</td><td>0.61</td></tr><tr><td>Male, n (%)</td><td>45 (32)</td><td>24 (35)</td><td>21 (29)</td><td>0.37</td></tr><tr><td>Students' perceptions before randomization, n (%):</td><td></td><td></td><td></td><td></td></tr><tr><td>"I am shy at hospital"</td><td>63 (44)</td><td>32 (51)</td><td>31 (49)</td><td>0.38</td></tr><tr><td>"I am anxious during hospital internship"</td><td>54 (38)</td><td>28 (41)</td><td>26 (35)</td><td>0.54</td></tr><tr><td>"I am afraid to speak in public"</td><td>79 (55)</td><td>36 (53)</td><td>43 (58)</td><td>0.38</td></tr><tr><td>"I am anxious to be filmed"</td><td>99 (70)</td><td>49 (72)</td><td>50 (67)</td><td>0.56</td></tr><tr><td>"I fear the criticism of doctors from my department"</td><td>93 (65)</td><td>41 (60)</td><td>52 (70)</td><td>0.21</td></tr><tr><td>"I fear the criticism of other students"</td><td>75 (53)</td><td>34 (50)</td><td>41 (55)</td><td>0.51</td></tr><tr><td>Spielberger State Anxiety Inventory (STAI-S) score during an oral presentation before randomization<sup>5</sup></td><td>44 ± 9</td><td>42 ± 9</td><td>45 ± 9</td><td>0.10</td></tr><tr><td>- High anxiety*</td><td>82 (58)</td><td>36 (53)</td><td>46 (62)</td><td>0.26</td></tr><tr><td>- Major anxiety that could interfere with the student's performance**</td><td>24 (17)</td><td>9 (13)</td><td>15 (38)</td><td>0.26</td></tr></tbody></table>

<footnote n="5">⁵Spielberger State Anxiety Inventory (STAI-S), score from 20–80.</footnote>

<footnote>*Significantly elevated anxiety is defined as a STAI-S score of >37 for men and >42 for women.</footnote>

<footnote>**Anxiety that could interfere with the student's performance was defined as a STAI-S score of >48 for men and >55 for women. Data are expressed as n (%) or mean ± SD.</footnote>
markedly and significantly lower in the VBF group than in
the control group after 3 months of internship (62 vs.
28%, *p* <0.001) (Figure 1).

Students' perceptions of VBF

Video recording of oral presentations was described as a stressful experience, but, overall, most students in the VBF group reported a favourable memory of the experience (Table 2). Seventy-seven percent of students in the video group reported that this “teaching experience” should be extended to internships in other wards. Similarly, 74% of students in the control group regretted not having received personalized debriefing of their oral presentations. Only two students refused to take part in this study, reflecting the good adherence of the students.

Discussion

This study confirms that oral presentation is a major
source of anxiety for medical students. Video-based feed-
back significantly amplified the anxiety-attenuating effects
of repeating public oral presentations and the associated
"oral" feedback during a 3-month internship period. It also
decreased the proportion of students with anxiety suffi-
ciently severe to impair their performance.

To our knowledge, this is the first study to evaluate
the benefit of VBF on anxiety generated by oral presen-
tation during ward rounds. The principle of debriefing is a
classical element in project management, sport training,
and, more recently, in simulation-based medical teaching
[22,23]. Debriefing can focus on positive aspects, can iden-
tify failures, and can suggest corrective actions to remedy
mistakes made during the presentation. The immediate ef-
fect of debriefing immediately after the oral presentation
in the presence of other students who can make con-
structive criticisms is to reduce the accumulated pressure
and stress experienced by the student who is being ap-
praised. However, the methods used to conduct feedback
are of utmost importance. Empathy during video debriefing
is more effective that harsh criticism to avoid demotivating
the student and decreasing his/her future performance
[5,24]. The students in our study showed good adhesion to
these debriefings, as suggested by the significant decrease
in anxiety after VBF. The students were also keen to extend
this concept to subsequent training sessions (Table 2).

Feedback now appears to be an essential part of med-
ical simulations and education [22,25,26]. Some authors
suggest that the addition of video review does not pro-
vide any advantages over oral feedback alone [22,27].
However, we believe that VBF increases the didactic im-
pact of the feedback [28,29]. Previous studies in the field
of medical education demonstrate that VBF improves ef-
ficiency when participants have several opportunities to
review their performance [28,29]. Repeated and targeted
VBF (mean: 6 ± 1 times) in our study may therefore have

contributed to significantly reducing the anxiety of stu-
dents in the VBF group.

Public oral presentation is difficult and causes high
levels of distress to many students. The STAI-S score be-
fore randomization was 41 ± 9 for men and 45 ± 9 for
women, respectively. In comparison, similar STAI-S scores
were found in a French population of patients with burn
injuries (42 ± 12 and 45 ± 10 for men and women, respect-
ively) or before a surgical operation (41 ± 9 and 45 ± 8)
[20]. In addition, 58% of our students experienced high
anxiety levels during an oral presentation at the beginning
of their internship, and 17% experience anxiety that was
so severe as to interfere with their performance (Table 1).

<figure><img src="image_3.png" /><figcaption>**Figure 1** Self-assessment of anxiety generated by oral presentation at the beginning and end of an intensive care unit or emergency department internship. STAI-S, Spielberger State Anxiety Inventory: scores from 20-80. The VBF group, with video-based feedback; the *control group*, with no video-based feedback; *ICU*, intensive care unit; *ED*, emergency department.</figcaption></figure>
<table><caption>Table 2 Students' perceptions of video-based feedback</caption><thead><tr><th></th><th>No</th><th>Rather no</th><th>Rather yes</th><th>Yes</th></tr></thead><tbody><tr><td colspan="5"><strong>Video-based feedback (VBF) group (n = 74)</strong></td></tr><tr><td>"I have a fond memory of the internship"</td><td>1 (1)</td><td>10 (13)</td><td>23 (30)</td><td>43 (56)</td></tr><tr><td>"This was a weak point of the internship"</td><td>65 (84)</td><td>11 (14)</td><td>1 (2)</td><td>0 (0)</td></tr><tr><td>"This "experience" has helped me to "generalize"</td><td>7 (9)</td><td>11 (14)</td><td>23 (30)</td><td>36 (47)</td></tr><tr><td>"This was a stressful time of the internship"</td><td>24 (31)</td><td>19 (25)</td><td>28 (36)</td><td>6 (8)</td></tr><tr><td>"I'm glad it is over"</td><td>18 (23)</td><td>32 (41)</td><td>21 (27)</td><td>6 (8)</td></tr><tr><td colspan="5"><strong>No video-based feedback (nVBF) group (n = 68)</strong></td></tr><tr><td>"I'm disappointed that I wasn't filmed"</td><td>18 (28)</td><td>16 (25)</td><td>16 (25)</td><td>14 (22)</td></tr><tr><td>"I'm disappointed that I was not debriefed"</td><td>12 (19)</td><td>4 (6)</td><td>15 (23)</td><td>33 (51)</td></tr><tr><td>"My oral presentations could have been improved by video-assisted feedback"</td><td>9 (14)</td><td>3 (5)</td><td>30 (47)</td><td>22 (34)</td></tr></tbody></table>

Just as a coach teaches athletes how to cope with stress before a competition, senior physicians should try to decrease the anxiety induced by oral presentations. A VBF could help achieve this goal (Figure 1). To the best of our knowledge, no formal training is available to help medical students with oral presentations. We consider this anxiety to be a matter for concern. VBF also generates a positive dynamic within the debriefed group and reduces inter-student resentments [3,30]. Lastly, because anxiety can interfere with performance [31-33], VBF may also have enhanced the quality of oral presentations.

This study has several limitations. Firstly, this study was not designed to demonstrate a specific benefit of the videotaped presentation alone. The study was designed to assess the combined effect of videotaping, formal debriefing and feedback, rather than the sole added value of videotaping. In order to address the specific benefits of video to reduce anxiety, a future study would need to compare formal versus video-assisted oral case presentations, with similar debriefing and feedback in both groups. Secondly, feedback in the control group was not standardized. Because the study was probably the subject of many informal discussions between students, it is possible that even those in the control group received some advice from their fellow students. This possible crossover could partially explain the significant decrease in the STAI-S score after the 3-month period, even in the control group. Thirdly, the higher baseline STAI-S score in the VBF group, although not significant, could partially explain the more marked reduction of the STAI-S score at the end of the study. Lastly, the Hawthorne effect [34], a situation in which the results of an experiment are not caused by experimental factors, but rather because the subjects were aware that they were tested, is an inherent limitation to this type of study and cannot be eliminated.

## Conclusions

Oral case presentations by medical students are part of the daily routine in ICUs and ERs, though they can often

be stressful. Video-assisted review of oral presentations is simple, not time-consuming, and is very popular. Investment in this educational methodology could reduce major anxiety after only a short period. However, the specific impact of feedback on the quality of the oral presentation needs to be investigated in future studies.

## Abbreviations

ED: Emergency department; ICU: Intensive-care units; STAI-S: Spielberger State Anxiety Inventory; VBF: Video-based feedback.

## Competing interests

The authors declare that they have no competing interests.

## Authors' contributions

Conception and design: MS, YF, TS, AD. Acquisition of data: MS, YF, MA, AM, VL, ED, JM, JB. Analysis and interpretation of data: MS, YF, TS, AD. Drafting the article: MS, YF, TS, AD. Revising it critically for important intellectual content: MA, AM, VL, ED, JM, JB, TS, AD. Final approval of the version to be published: MS, YF, MA, AM, VL, ED, JM, JB, TS, AD.

## Authors' information

Dr Schmidt Matthieu is a fellow in the Department of Pneumology and Medical ICU, Hôpital Pitié-Salpêtrière and Université Pierre et Marie Curie, Paris, France.

Dr Freund Yonathan is a fellow in the Emergency Department, Hôpital Pitié-Salpêtrière and INSERM U956, Université Pierre et Marie Curie, Paris, France. Dr Alves Mickael is a fellow in the Department of Medical ICU, Hôpital Saint Antoine and Université Pierre et Marie Curie, Paris, France.

Dr Labbe Vincent and Dr Messika Jonathan are fellows in the Department of Medical and Surgical ICU, Hôpital Tenon and Université Pierre et Marie Curie, Paris, France.

Dr Monsel Antoine and Dr Darnal Elsa are fellows in the Department of Surgical ICU, Hôpital Pitié-Salpêtrière and Université Pierre et Marie Curie, Paris, France.

Dr Bokobza Jerome is a fellow in the Emergency Department, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France.

Prof. Similowski Thomas is professor and Chairman of the Department of Pneumology and Medical ICU, Hôpital Pitié-Salpêtrière and Université Pierre et Marie Curie, Paris, France.

Prof. Duguet Alexandre is professor in the Department of Pneumology and Medical ICU, Hôpital Pitié-Salpêtrière and Université Pierre et Marie Curie, Paris, France.

## Acknowledgements

The authors wish to thank the 4th year medical students at the Medical University Paris 6, Pierre and Marie Curie, Paris, for participating in this study and Prof. Bruno Riou for review of the manuscript.
Author details

¹Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris F-75005, France. ²INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris F-75005, France. ³AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris F-75013, France. ⁴Emergency Department, Hôpital Pitié-Salpêtrière and INSERM U956, Université Pierre et Marie Curie, Paris, France. ⁵Department of Medical ICU, Hôpital Saint Antoine and Université Pierre et Marie Curie, Paris, France. ⁶Department of Surgical ICU, Hôpital Pitié-Salpêtrière and Université Pierre et Marie Curie, Paris, France. ⁷Department of Medical and Surgical ICU, Hôpital Tenon and Université Pierre et Marie Curie, Paris, France. ⁸Emergency Department, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France.

Received: 8 May 2013 Accepted: 11 April 2014

Published: 22 May 2014

References

1. Spiegel DA, Smolen RC, Hopfensperger KA: Medical student stress and clerkship performance. *J Med Educ* 1986, 61:929-931.

2. Spiegel DA, Smolen RC, Jonas CK: An examination of the relationships among interpersonal stress, morale and academic performance in male and female medical students. *Soc Sci Med* 1986, 23:1157-1161.

3. Dyrbye LN, Thomas MR, Shanafelt TD: Medical student distress: causes, consequences, and proposed solutions. *Mayo Clin Proc* 2005, 80:1613-1622.

4. Wolf TM, Randall HM, von Almen K, Tynes LL: Perceived mistreatment and attitude change by graduating medical students: a retrospective study. *Med Educ* 1991, 25:182-190.

5. Wilkinson TJ, Gill DJ, Fitzjohn J, Palmer CL, Mulder RT: The impact on students of adverse experiences during medical school. *Med Teach* 2006, 28:129-135.

6. Benbassat J: Undesirable features of the medical learning environment: a narrative review of the literature. *Adv Health Sci Educ Theory Pract* 2013, 18(3):527-536.

7. Leonard M, Graham S, Bonacum D: The human factor: the critical importance of effective teamwork and communication in providing safe care. *Qual Saf Health Care* 2004, 13(Suppl 1):i85-i90.

8. Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, Bohnen J, Orser B, Doran D, Grober E: Communication failures in the operating room: an observational classification of recurrent types and effects. *Qual Saf Health Care* 2004, 13:330-334.

9. Williams RG, Silverman R, Schwind C, Fortune JB, Sutyak J, Horvath KD, Van Eaton EG, Azzie G, Potts JR 3rd, Boehler M, Dunnington GL: Surgeon information transfer and communication: factors affecting quality and efficiency of inpatient care. *Ann Surg* 2007, 245:159-169.

10. Lockyer J, Armson H, Chesluk B, Dornan T, Holmboe E, Loney E, Mann K, Sargeant J: Feedback data sources that inform physician self-assessment. *Med Teach* 2011, 33:e113-e120.

11. Allan CK, Thiagarajan RR, Beke D, Imprescia A, Kappus LJ, Garden A, Hayes G, Laussen PC, Bacha E, Weinstock PH: Simulation-based training delivered directly to the pediatric cardiac intensive care unit engenders preparedness, comfort, and decreased anxiety among multidisciplinary resuscitation teams. *J Thorac Cardiovasc Surg* 2010, 140:646-652.

12. Howe A: Detecting psychological distress: can general practitioners improve their own performance? *Br J Gen Pract* 1996, 46:407-410.

13. Li Q, Ma E-L, Liu J, Fang L-Q, Xia T: Pre-training evaluation and feedback improve medical students' skills in basic life support. *Med Teach* 2011, 33:e549-e555.

14. Snyder CW, Vandromme MJ, Tyra SL, Porterfield JR Jr, Clements RH, Hawn MT: Effects of virtual reality simulator training method and observational learning on surgical performance. *World J Surg* 2011, 35:245-252.

15. Solomon B, Bizekis C, Dellis SL, Donington JS, Oliker A, Balsam LB, Zervos M, Galloway AC, Pass H, Grossi EA: Simulating video-assisted thoracoscopic lobectomy: a virtual reality cognitive task simulation. *J Thorac Cardiovasc Surg* 2011, 141:249-255.

16. Joyce DL, Dhillon TS, Caffarelli AD, Joyce DD, Tsirigotis DN, Burdon TA, Fann JI: Simulation and skills training in mitral valve surgery. *J Thorac Cardiovasc Surg* 2011, 141:107-112.

17. Hamilton NA, Kieninger AN, Woodhouse J, Freeman BD, Murray D, Klingensmith ME: Video review using a reliable evaluation metric

improves team function in high-fidelity simulated trauma resuscitation. *J Surg Educ* 2012, 69:428-431.

18. Owen H, Sprick C: Simulation debriefing and quantitative analysis using video analysis software. *Stud Health Technol Inform* 2008, 132:345-347.

19. Gask L, Goldberg D, Lesser AL, Millar T: Improving the psychiatric skills of the general practice trainee: an evaluation of a group training course. *Med Educ* 1988, 22:132-138.

20. Spielberger C, Gorsuch R, Lushene R, Vagg P, Jacobs G: *Manuel de L'Inventaire d'anxiété État-Trait Forme Y (STAI-Y). Editions du Centre de Psychologie Appliquée.* Paris: (M. Bruchon-Schweitzer & I. Paulhan, Adapt. Française); 1993.

21. Spielberger C: *Manual for the State-Trait Anxiety Inventory*. Palo Alto, California: Consulting Psychologists Press; 1983.

22. Savoldelli GL, Naik VN, Park J, Joo HS, Chow R, Hamstra SJ: Value of debriefing during simulated crisis management: oral versus video-assisted oral feedback. *Anesthesiology* 2006, 105:279-285.

23. Fanning RM, Gaba DM: The role of debriefing in simulation-based learning. *Simul Healthc* 2007, 2:115-125.

24. Lempp H, Seale C: The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching. *BMJ* 2004, 329:770-773.

25. Morgan PJ, Kurrek MM, Bertram S, LeBlanc V, Przybyszewski T: Nontechnical skills assessment after simulation-based continuing medical education. *Simul Healthc* 2011, 6:255-259.

26. Hart D, McNeil MA, Griswold-Theodorson S, Bhatia K, Joing S: High fidelity case-based simulation debriefing: everything you need to know. *Acad Emerg Med* 2012, 19:E1084.

27. Hecimovich MD, Maire J-A, Losco B: Effect of Clinician Feedback Versus Video Self-Assessment in 5th-Year Chiropractic Students on an End-of-Year Communication Skills Examination. *J Chiropr Educ* 2010, 24:165-174.

28. Birnbach DJ, Santos AC, Bourlier RA, Meadows WE, Datta S, Stein DJ, Kuroda MM, Thys DM: The effectiveness of video technology as an adjunct to teach and evaluate epidural anesthesia performance skills. *Anesthesiology* 2002, 96:5-9.

29. Scherer LA, Chang MC, Meredith JW, Battistella FD: Videotape review leads to rapid and sustained learning. *Am J Surg* 2003, 185:516-520.

30. Sheehan KH, Sheehan DV, White K, Leibowitz A, Baldwin DC Jr: A pilot study of medical student "abuse". Student perceptions of mistreatment and misconduct in medical school. *JAMA* 1990, 263:533-537.

31. Vytal K, Cornwell B, Arkin N, Grillon C: Describing the interplay between anxiety and cognition: from impaired performance under low cognitive load to reduced anxiety under high load. *Psychophysiology* 2012, 49:842-852.

32. Choi JM, Padmala S, Pessoa L: Impact of state anxiety on the interaction between threat monitoring and cognition. *Neuroimage* 2012, 59:1912-1923.

33. Tennyson RD, Woolley FR: Interaction of anxiety with performance on two levels of task difficulty. *J Educ Psychol* 1971, 62:463-467.

34. Hsueh Y: The Hawthorne experiments and the introduction of Jean Piaget in American industrial psychology, 1929-1932. *Hist Psychol* 2002, 5:163-189.

doi:10.1186/1472-6920-14-103

Cite this article as: Schmidt et al.: Video-based feedback of oral clinical presentations reduces the anxiety of ICU medical students: a multicentre, prospective, randomized study. BMC Medical Education 2014 14:103.

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