This study confirms that oral presentation is a major source of anxiety for medical students. Video-based feedback 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 sufficiently severe to impair their performance.
To our knowledge, this is the first study to evaluate the benefit of VBF on anxiety generated by oral presentation 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 identify failures, and can suggest corrective actions to remedy mistakes made during the presentation. The immediate effect of debriefing immediately after the oral presentation in the presence of other students who can make constructive criticisms is to reduce the accumulated pressure and stress experienced by the student who is being appraised. 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
Feedback now appears to be an essential part of medical simulations and education
[22, 25, 26]. Some authors suggest that the addition of video review does not provide any advantages over oral feedback alone
[22, 27]. However, we believe that VBF increases the didactic impact of the feedback
[28, 29]. Previous studies in the field of medical education demonstrate that VBF improves efficiency 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 students in the VBF group.
Public oral presentation is difficult and causes high levels of distress to many students. The STAI-S score before 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, respectively) or before a surgical operation (41 ± 9 and 45 ± 8)
. 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
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
, 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.