Comparison of Self Versus Expert-assisted Feedback for Cricothyroidotomy Training

Comparison of Self Versus Expert-assisted Feedback for Cricothyroidotomy Training | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Self Versus Expert-assisted Feedback for Cricothyroidotomy Training Hasan Aldinc, Cem Gun, Serpil Yaylaci, Cigdem Ozkaya Senuren, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-959406/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract The self-video feedback method may have the potential to provide a low-cost alternative to physician-driven simulation-based training. This study aimed to assess the utility of video feedback by comparing the improvement in procedural performance when trainees received self-video feedback (trainees review their performance alone) and expert-assısted video feedback (trainees review their performance while an emergency physician provides additional feedback). This study was performed at a university simulation center with 89 final-year medical students and used a cricothyroidotomy simulation model. Following the educational presentation and the best practice video, trainees were randomized into two groups (self video-feedback and expert assisted video-feedback). They performed the cricothyroidotomy before and after the feedback, The procedures were recorded and scored. Scoring were made using a pre-defıned checklist. Mann Whitney U test and Wilcoxon test were used to analyze non-normally distributed data. For the analysis of normally distributed data, Student t-test and Paired Samples t-test were used. Results demonstrated significant improvement in cricothyroidotomy performance with both types of video feedback. The improvement was significantly greater in the expert-assisted video feedback group. We think that simulation-based training is effective with self video feedback. Educational Philosophy and Theory Internal Medicine Medical education research simulation feedback Figures Figure 1 Introduction In medical education, simulation-based training (SBT) is a rapidly expanding field due to advances in technology. Simulation-based medical training improves patient safety and eliminates human factors through developed technical competency in a risk-free environment ( 1 ). Simulation-based medical training aims to create real lifelike situations using specially designed structured activities. With this realistic simulated environment, students would enhance their skills, knowledge, and attitudes ( 2 ). Feedback in simulation-based training is defined as “specific information that compare a trainee’s performance to the preset standard, aiming to improve the trainee’s performance” ( 3 ). It is a crucial process that follows the practice and induces the trainee to reflect on their performance ( 3 ). Despite the importance of feedback in academic literature, effective feedback remains hard to achieve within the clinical training context. Coping with barriers to meaningful feedback requires both institutional and individual efforts ( 4 ). Failures at providing effective feedback to medical students have been discussed many times in recent years ( 5 ). Overly complex, delayed, and overly brief feedbacks were some of the common complaints of the students ( 5 , 6 ). The instructor’s disappointment arises when trainees ignore their feedback and continue with the uncorrected practice ( 5 ). As an alternative way to performative evaluation, video feedback (viewing the video recording of one’s own performance) may improve the debriefing quality and maximize learning ( 7 ). Also, self-assessment has been long known as an important procedure in the development of learning skills ( 8 ). A randomized trial study revealed that expert feedback provided no significant additional advantages. A similar improvement can be achieved when students are allowed to assess their performance by video recording ( 9 ). Besides that, Vnuk reports that students viewing the video recording of their performance did not improve the agreement of trainees’ self-assessment with the objective assessment by the expert ( 10 ). In light of these findings, the self-video feedback method is expected to reduce the need for an expert in SBT. This self-assessment may have the potential to provide a low-cost alternative to physician-driven SBT. This study aimed to assess the utility of video feedback by comparing the development in procedural performance when trainees received video feedback in isolation (trainees review their performance alone) and video feedback with an expert (trainees review their performance while an emergency physician provides additional feedback). Emergency cricothyroidotomy is a potentially life-saving procedure performed to provide oxygenation if neither intubation nor a mask or mouth-to-mouth ventilation is possible ( 11 ). However, these airway procedures may not always be employed successfully ( 12 ). This procedure’s life-saving potential necessitates training and experience for clinicians ( 13 ). The majority of student training on this procedure is simulation-focused ( 14 ). We used “Emergency Cricothyroidotomy Simulation” as surgical training on a realistic mannequin model. Material And Method The study was performed between September 2019 – November 2019 at the Acibadem Mehmet Ali Aydınlar University Simulation Center, Turkey. On a volunteer basis, the study included 89 final-year medical students studying at the Acıbadem Mehmet Ali Aydınlar University. The study protocol was approved by the Acıbadem Mehmet Ali Aydinlar University Medical Research Ethical Committee (ATADEK-2019/14). We used an effective and low-cost simulation model, which was done, using styrofoam, a sheep trachea, and a double-layer of chicken skin. Sterile gloves, a scalpel, a scalpel handle, a hook, an endotracheal tube, and a syringe were used in carrying out the procedure. The sheep trachea was placed in the cavity made in the styrofoam, and two layers of chicken skin were then fixed over the trachea (Figure 1 ). Skins were replaced after every 3 or 4 cricothyroidotomy applications. Two emergency medicine assistant professors and an emergency medicine resident recorded a best practice video of the cricothyroidotomy procedure ( 15 ). The video was shown three times to trainees following a PowerPoint presentation regarding the cricothyroidotomy procedure. During the presentation, trainees were informed about cricothyroidotomy indications, complications, and how the procedure should be performed. Trainees were randomized into two groups after the presentation and the best practice video. One was self video-feedback group (SVFG); trainees review their performance alone for 15 minutes with a checklist of procedure steps (Appendix A). And the other was expert assisted video-feedback group (EVFG); trainees review their performance while an emergency physician provides additional feedback. Nine of the trainees were quitted before the practical session of the study. 80 trainees subsequently performed the cricothyroidotomy procedure and all performances were recorded using a dome camera (2 Megapixel, 4.8 - 120 mm) positioned to record an optimal view of the application site. Trainees received no instruction or feedback during the procedure. An emergency physician evaluated students’ live performance skills and assessed them based on the cricothyroidotomy steps checklist (Appendix A). Each step on the checklist was scored separately. Any step that was applied incorrectly or missed was scored as “1”. Steps including a pause after the previous step but performed properly and at the correct time, scored as “2". In contrast, those performed at the proper way and time, and without hesitation, scored as “3”. The last step was about total procedure time. We used a threshold of 40 seconds to define success as Wong et al. ( 16 ). Failure and success were scored “1,2” respectively. After the feedback (SVFG or EVFG), trainees performed the procedure, recorded it onto video, and scored again. Scores gained for each step were added, and the total score was obtained. On the other hand, video recordings of pre- and post- feedback performances were also watched and scored by another emergency physician based on the same checklist. The mean total score was calculated from the assessment results of the two physicians. Also, trainees’ age, sex, and the duration of applications were recorded. We additionally evaluated the mean scores of the 1st and the 4th steps because they are the most critical. Statistical analysis was performed using the MedCalc Statistical Software version 12.7.7 (MedCalc Software bvba, Ostend, Belgium; http://www.medcalc.org ; 2013). Descriptive statistics were presented using mean, standard deviation, median, minimum, maximum scale variables. For comparison of two non-normally distributed independent groups, Mann Whitney U test was used. For comparison of two normally distributed independent groups, Student t-test was used. For comparison of two non-normally distributed dependent groups, the Wilcoxon test was used. For comparison of two normally distributed dependent groups, Paired Samples t-test was used. Statistical significance was accepted when the two-sided p-value was lower than 0.05. Results The study was performed with 80 final-year medical students. The average age of the trainees was 25. Forty-four students (55%) were men, and 36 (45%) were women. There was a statistically significant difference between PreFAss. (Pre Feedback Assessment) and PostFAss. (Post Feedback Assessment) measurements in terms of L Ass./ V Ass._Mean ( Live Assessment Score/Video Assessment Score) and Time in SVFG (Self Video Feedback Group) and EVFG (Expert Assisted Video Feedback Group) (p<0.05). The average of PostFAss. was higher in both SVFG and EVFG for L Ass./ V Ass._Mean . The average of PreFAss. was higher in both SVFG and EVFG for Time (Table 1 ). Table 1 COMPARISONS ACCORDING TO GROUPS AND MEASUREMENTS PreFAss. PostFAss. p SVFG/EVFG Mean ± Std.Dev. Med. (Min.-Max.) Mean ± Std.Dev. Med. (Min.-Max.) L Ass.-V Ass._ MEAN SVFG 19.2 ± 3.1 19 (10-25.5) 22.5 ± 3.6 23.5 (15-28.5) <0.001 1 EVFG 19.5 ± 3.8 20.0 (12-28.5) 24.3 ± 2.9 25 (17-29) <0.001 2 p 0.634 3 0.027 4 TIME SVFG 86 ± 27 85 (40-150) 68 ± 22 62 (33-125) <0.001 1 EVFG 88 ± 37 78 (40-210) 53 ± 14 52 (28-90) <0.001 1 p 0.762 3 0.001 3 Paired Samples t test 1 , Wilcoxon test 2 , Student t test 3 , Mann-Whitney U test 4 PreFAss . : Pre Feedback Assessment PostFAss : Post Feedback Assessment SVFG : Self Video Feedback Group EVFG : Expert Assissted Video Feedback Group L Ass . : Live Assessment Score V Ass. : Video Assessment Score There was a statistically significant difference between SVFG and EVFG in terms of L Ass./ V Ass._Mean and Time for PostFAss. measurements (p<0.05). The average of EVFG was higher for L Ass./ V Ass._Mean , and the average of SVFG was found higher for Time (Table 1 ). When we additionally evaluated the critical steps, we noticed a statistically significant difference between PreFAss. and PostFAss. measurements in terms of Step1Step4_Mean in SVFG and EVFG groups (p<0.05). The average of PostFAss. was higher in both SVFG and EVFG for Step1Step4_Mean (Table 2 ). Table 2 COMPARISONS ACCORDING TO GROUPS (Step1Step4_Mean Differences) PreFAss. PostFAss. p Mean ± Std.Dev. Med. (Min.-Max.) Mean ± Std.Dev. Med. (Min.-Max.) Step1Step4_Mean SVFG 1.98 ± 0.41 2 (1-2.75) 2.35 ± 0.55 2.5 (1-3) <0.001 1 EVFG 1.97 ± 0.43 2 (1-2.75) 2.59 ± 0.41 2.75 (1.5-3) <0.001 1 p 0.920 2 0.047 2 Wilcoxon test 1 , Mann-Whitney U test 2 We also found a significant difference between SVFG and EVFG in terms of Step1Step4_Mean for PostFAss. measurements (p<0.05). The average of EVFG was higher for Step1Step4_Mean (Table 2 ). Discussion The traditional model for simulation-based training includes post-simulation feedback in which students’ experiences are explored and reflected upon to improve future performance ( 17 ). A better understanding of the role of feedback in competency-based education could result in a more efficient student learning process ( 18 ). But this traditional model needs an expert in the post-simulation feedback session. Shifting the degree of primary learning responsibility from the expert to the learner through self-guided learning has received more attention in reducing resource intensity ( 17 ). This study set out with the aim of assessing the probability of low cost simulation-based practical education method. Results demonstrated significant progress in cricothyroidotomy performance with both types of video feedback. This finding agrees with Hawkins’s findings, which showed progress with video self-assessment ( including video recorded ‘benchmark performance’ ) and expert assessor groups ( 8 ). This also accords with the study of Nesbitt ( 19 ), Backstein ( 20 ), and Phillips ( 9 ), who demonstrated a significant improvement in practical performance for participants receiving self video feedback with an expert or alone. In these three studies, no significant additional benefit was demonstrated from EVFG, and a similar improvement can be obtained using a best practice expert video and allowing attendees to assess their performances. Our results demonstrated significant enhancement with expert-assisted video feedback group and self-video feedback group, suggesting that the opportunity to review trainee’s performance using video feedback plays an important role in improving the learning experience. However, the progress was significantly greater with the expert-assisted video feedback group. When considered from this point of view, we can see there was an expert effect. However, it does not mean “expert need” is essential. In 2003, Wong designed a study to determine the minimum practical training need for successful cricothyroidotomy with a self video feedback alone. This study showed that by the fifth attempt, 96% of the attendees could perform the cricothyroidotomy successfully ( 16 ). According to this information, it can be thought that expert assistance saves time, and more practice time is required if we use the self video assessment method. According to our sub-group evaluation on two critical steps, we demonstrated similar results with overall findings. Again, we found significant improvement with the expert-assisted and the self video-feedback groups when two steps were taken into account. Also, the progress was significantly greater with the expert-assisted video-feedback group. The main limitation of this study was that students performed the procedure only once. The literature indicates that at least five trials must be done to perform the procedure successfully. The other limitation is that the study design neglected control groups that received no feedback (to define the baseline of how much learning occurs by recurrent practice). The lack of a power analysis calculation to plan the sample size is another limitation of this study. Conclusion This study demonstrates significant progress in cricothyroidotomy performance with both types of video feedback. This combination of findings may help us to understand what the most appropriate simulation-based training model is. It is clear that video feedback enables trainees to understand the process and progress of clinical procedures. They can visualize the actions involved in the task in a stepwise manner. The real question is about the necessity of an expert in low-cost, effective simulation-based training. With self video feedback without an expert, simulation-based training is effective. However, more practice time seems to be necessary. Declarations Ethics approval and consent to participate : The study protocol was approved by the Acıbadem Mehmet Ali Aydinlar University Medical Research Ethical Committee (ATADEK-2019/14). The study was performed in accordance with the Declaration of Helsinki and Ethics Committee of the Chamber of Physicians approval. The written informed consent was obtained from the participants before the practice. All of the participants were more than 16 years old; therefore, parental consent was not required. Consent for Publication : Not Applicable Availability of data and materials : All the data, written documents, materials are available. Competing interests: The authors declare that they have no competing interests. Funding: No funding was obtained for this study. Authors' contributions: H.A. ve S.Y. designed the study. H.A. and C.O.S. wrote the main manuscript. S.Y. and C.G. conducted the statistical analysis. F.G. and M.S. prepared tables and figures. K.K. and S.T. reviewed the manuscript. All authors read and approved the final manuscript. Acknowledgements: We thank Emre Aldinc MD and Ela Ahmad MD for editorial support. References Sakakushev BE, Marinov BI, Stefanova PP, Kostianev SS, Georgiou EK. Striving for Better Medical Education: the Simulation Approach. Folia Med (Plovdiv). 2017 Jun 1;59(2):123-131. doi: 10.1515/folmed-2017-0039 . PMID: 28704187. Aksoy, M. E., Guven, F., Sayali, M. E., & Kitapcıoglu, D. The effect of web-based learning in pediatric basic life support (P-BLS) training. Computers in Human Behavior. 2019; 94, 56–61. doi: 10.1016/j.chb.2018.12.032 Van de Ridder JM, Stokking KM, McGaghie WC, ten Cate OT. What is feedback in clinical education? Med Educ. 2008 Feb;42(2):189-97. doi: 10.1111/j.1365-2923.2007.02973.x . PMID: 18230092. Lefroy J, Watling C, Teunissen PW, Brand P. Guidelines: the do's, don'ts and don't knows of feedback for clinical education. Perspect Med Educ. 2015 Dec;4(6):284–99. doi: 10.1007/s40037-015-0231-7 . PMID: 26621488; PMCID: PMC4673072. Boud, David; Falchikov, Nancy (ed.). Rethinking assessment in higher education: Learning for the longer term. Routledge, 2007. Bloxham, Sue, and Pete Boyd. Developing Effective Assessment In Higher Education: A Practical Guide: A Practical Guide. McGraw-Hill Education (UK), 2007. Wittler M, Hartman N, Manthey D, Hiestand B, Askew K. Video-augmented feedback for procedural performance. Med Teach. 2016 Jun;38(6):607–12. doi: 10.3109/0142159X.2015.1075650 . Epub 2015 Sep 18. PMID: 26383586. Hawkins SC, Osborne A, Schofield SJ, Pournaras DJ, Chester JF. Improving the accuracy of self-assessment of practical clinical skills using video feedback--the importance of including benchmarks. Med Teach. 2012;34(4):279-84. doi: 10.3109/0142159X.2012.658897 . PMID: 22455696. Phillips AW, Matthan J, Bookless LR, Whitehead IJ, Madhavan A, Rodham P, Porter ALR, Nesbitt CI, Stansby G. Individualised Expert Feedback is Not Essential for Improving Basic Clinical Skills Performance in Novice Learners: A Randomized Trial. J Surg Educ. 2017 Jul-Aug;74(4):612–620. doi: 10.1016/j.jsurg.2016.12.003. Epub 2016 Dec 29. PMID: 28041770. Vnuk A, Owen H, Plummer J. Assessing proficiency in adult basic life support: student and expert assessment and the impact of video recording. Med Teach. 2006 Aug;28(5):429-34. doi: 10.1080/01421590600625205 . PMID: 16973455. Braun C, Kisser U, Huber A, Stelter K. Bystander cricothyroidotomy with household devices - A fresh cadaveric feasibility study. Resuscitation. 2017 Jan;110:37–41. doi: 10.1016/j.resuscitation.2016.10.015 . Epub 2016 Nov 1. PMID: 27810460. Ozkaya Senuren C, Yaylaci S, Kayayurt K, Aldinc H, Gun C, Şimşek P, Tatli O, Turkmen S. Developing Cricothyroidotomy Skills Using a Biomaterial-Covered Model. Wilderness Environ Med. 2020 Sep;31(3):291–297. doi: 10.1016/j.wem.2020.05.003 . Epub 2020 Aug 24. PMID: 32855020. Coughlin RF, Chandler I, Binford JC, Bonz JW, Hile DC. Enhancement of Cricothyroidotomy Education Using a Novel Technique: Cadaver Autografting. J Emerg Med. 2017 Dec;53(6):885–889. doi: 10.1016/j.jemermed.2017.08.071 . Epub 2017 Oct 21. PMID: 29066133. Gustafson ML, Hensley B, Dotson M, Broce M, Tager A. Comparison of Manikin Versus Porcine Trachea Models When Teaching Emergent Cricothyroidotomy Among Emergency Medicine Residents. AEM Educ Train. 2019 Apr 7;3(3):280-285. doi: 10.1002/aet2.10333 . PMID: 31360821; PMCID: PMC6637022. Krikotiroidotomi: maket ile uygulama. [Cricothyroidotomy: A Practice with Mannequin] 2019. [Accessed December 20, 2019]. https:// www.acilci.net/krikotiroidotomi-maket-uygulama/ . Wong DT, Prabhu AJ, Coloma M, Imasogie N, Chung FF. What is the minimum training required for successful cricothyroidotomy?: a study in mannequins. Anesthesiology. 2003 Feb;98(2):349-53. doi: 10.1097/00000542-200302000-00013 . PMID: 12552192. Tudor GJ, Podolej GS, Willemsen-Dunlap A, Lau V, Svendsen JD, McGarvey J, Vozenilek JA, Barker LT. The Equivalence of Video Self-review Versus Debriefing After Simulation: Can Faculty Resources Be Reallocated? AEM Educ Train. 2019 Aug 12;4(1):36-42. doi: 10.1002/aet2.10372 . PMID: 31989069; PMCID: PMC6965677. Tekian A, Watling CJ, Roberts TE, Steinert Y, Norcini J. Qualitative and quantitative feedback in the context of competency-based education. Med Teach. 2017 Dec;39(12):1245–1249. doi: 10.1080/0142159X.2017.1372564. Epub 2017 Sep 19. PMID: 28927332. Nesbitt CI, Phillips AW, Searle RF, Stansby G. Randomized trial to assess the effect of supervised and unsupervised video feedback on teaching practical skills. J Surg Educ. 2015 Jul-Aug;72(4):697–703. doi: 10.1016/j.jsurg.2014.12.013 . Epub 2015 Feb 18. PMID: 25703737. Backstein D, Agnidis Z, Regehr G, Reznick R. The effectiveness of video feedback in the acquisition of orthopedic technical skills. Am J Surg. 2004 Mar;187(3):427-32. doi: 10.1016/j.amjsurg.2003.12.011 . PMID: 15006577. Additional Declarations No competing interests reported. Supplementary Files database.xls Appendix.docx Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-959406","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":56741464,"identity":"7b2735dd-d8e3-4632-99c6-884ce62e04c7","order_by":0,"name":"Hasan 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15:56:02","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":12294,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-959406/v2/5698875b8bcca6afb1fd841e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eComparison of Self Versus Expert-assisted Feedback for Cricothyroidotomy Training\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn medical education, simulation-based training (SBT) is a rapidly expanding field due to advances in technology. Simulation-based medical training improves patient safety and eliminates human factors through developed technical competency in a risk-free environment (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Simulation-based medical training aims to create real lifelike situations using specially designed structured activities. With this realistic simulated environment, students would enhance their skills, knowledge, and attitudes (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFeedback in simulation-based training is defined as \u0026ldquo;specific information that compare a trainee\u0026rsquo;s performance to the preset standard, aiming to improve the trainee\u0026rsquo;s performance\u0026rdquo; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It is a crucial process that follows the practice and induces the trainee to reflect on their performance (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Despite the importance of feedback in academic literature, effective feedback remains hard to achieve within the clinical training context. Coping with barriers to meaningful feedback requires both institutional and individual efforts (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Failures at providing effective feedback to medical students have been discussed many times in recent years (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Overly complex, delayed, and overly brief feedbacks were some of the common complaints of the students (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The instructor\u0026rsquo;s disappointment arises when trainees ignore their feedback and continue with the uncorrected practice (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs an alternative way to performative evaluation, video feedback (viewing the video recording of one\u0026rsquo;s own performance) may improve the debriefing quality and maximize learning (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Also, self-assessment has been long known as an important procedure in the development of learning skills (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A randomized trial study revealed that expert feedback provided no significant additional advantages. A similar improvement can be achieved when students are allowed to assess their performance by video recording (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Besides that, Vnuk reports that students viewing the video recording of their performance did not improve the agreement of trainees\u0026rsquo; self-assessment with the objective assessment by the expert (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In light of these findings, the self-video feedback method is expected to reduce the need for an expert in SBT. This self-assessment may have the potential to provide a low-cost alternative to physician-driven SBT.\u003c/p\u003e \u003cp\u003eThis study aimed to assess the utility of video feedback by comparing the development in procedural performance when trainees received video feedback in isolation (trainees review their performance alone) and video feedback with an expert (trainees review their performance while an emergency physician provides additional feedback).\u003c/p\u003e \u003cp\u003e \u003cem\u003eEmergency cricothyroidotomy\u003c/em\u003e is a potentially life-saving procedure performed to provide oxygenation if neither intubation nor a mask or mouth-to-mouth ventilation is possible (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, these airway procedures may not always be employed successfully (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This procedure\u0026rsquo;s life-saving potential necessitates training and experience for clinicians (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The majority of student training on this procedure is simulation-focused (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). We used \u0026ldquo;Emergency Cricothyroidotomy Simulation\u0026rdquo; as surgical training on a realistic mannequin model.\u003c/p\u003e"},{"header":"Material And Method","content":"\u003cp\u003eThe study was performed between September 2019 \u0026ndash; November 2019 at the Acibadem Mehmet Ali Aydınlar University Simulation Center, Turkey. On a volunteer basis, the study included 89 final-year medical students studying at the Acıbadem Mehmet Ali Aydınlar University. The study protocol was approved by the Acıbadem Mehmet Ali Aydinlar University Medical Research Ethical Committee (ATADEK-2019/14).\u003c/p\u003e \u003cp\u003eWe used an effective and low-cost simulation model, which was done, using styrofoam, a sheep trachea, and a double-layer of chicken skin. Sterile gloves, a scalpel, a scalpel handle, a hook, an endotracheal tube, and a syringe were used in carrying out the procedure. The sheep trachea was placed in the cavity made in the styrofoam, and two layers of chicken skin were then fixed over the trachea (Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Skins were replaced after every 3 or 4 cricothyroidotomy applications.\u003c/p\u003e\u003cp\u003eTwo emergency medicine assistant professors and an emergency medicine resident recorded a best practice video of the cricothyroidotomy procedure (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The video was shown three times to trainees following a PowerPoint presentation regarding the cricothyroidotomy procedure. During the presentation, trainees were informed about cricothyroidotomy indications, complications, and how the procedure should be performed.\u003c/p\u003e \u003cp\u003eTrainees were randomized into two groups after the presentation and the best practice video. One was self video-feedback group (SVFG); trainees review their performance alone for 15 minutes with a checklist of procedure steps (Appendix A). And the other was expert assisted video-feedback group (EVFG); trainees review their performance while an emergency physician provides additional feedback.\u003c/p\u003e \u003cp\u003eNine of the trainees were quitted before the practical session of the study. 80 trainees subsequently performed the cricothyroidotomy procedure and all performances were recorded using a dome camera (2 Megapixel, 4.8 - 120 mm) positioned to record an optimal view of the application site. Trainees received no instruction or feedback during the procedure. An emergency physician evaluated students\u0026rsquo; live performance skills and assessed them based on the cricothyroidotomy steps checklist (Appendix A). Each step on the checklist was scored separately. Any step that was applied incorrectly or missed was scored as \u0026ldquo;1\u0026rdquo;. Steps including a pause after the previous step but performed properly and at the correct time, scored as \u0026ldquo;2\". In contrast, those performed at the proper way and time, and without hesitation, scored as \u0026ldquo;3\u0026rdquo;. The last step was about total procedure time. We used a threshold of 40 seconds to define success as Wong et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Failure and success were scored \u0026ldquo;1,2\u0026rdquo; respectively. After the feedback (SVFG or EVFG), trainees performed the procedure, recorded it onto video, and scored again. Scores gained for each step were added, and the total score was obtained.\u003c/p\u003e \u003cp\u003eOn the other hand, video recordings of pre- and post- feedback performances were also watched and scored by another emergency physician based on the same checklist. The mean total score was calculated from the assessment results of the two physicians. Also, trainees\u0026rsquo; age, sex, and the duration of applications were recorded.\u003c/p\u003e \u003cp\u003eWe additionally evaluated the mean scores of the 1st and the 4th steps because they are the most critical.\u003c/p\u003e \u003cp\u003eStatistical analysis was performed using the MedCalc Statistical Software version 12.7.7 (MedCalc Software bvba, Ostend, Belgium; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.medcalc.org\u003c/span\u003e\u003c/span\u003e; 2013). Descriptive statistics were presented using mean, standard deviation, median, minimum, maximum scale variables. For comparison of two non-normally distributed independent groups, Mann Whitney U test was used. For comparison of two normally distributed independent groups, Student t-test was used. For comparison of two non-normally distributed dependent groups, the Wilcoxon test was used. For comparison of two normally distributed dependent groups, Paired Samples t-test was used. Statistical significance was accepted when the two-sided p-value was lower than 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study was performed with 80 final-year medical students. The average age of the trainees was 25. Forty-four students (55%) were men, and 36 (45%) were women.\u003c/p\u003e\n\u003cp\u003eThere was a statistically significant difference between \u003cstrong\u003ePreFAss.\u003c/strong\u003e (Pre Feedback Assessment) and \u003cstrong\u003ePostFAss.\u003c/strong\u003e (Post Feedback Assessment) measurements in terms of \u003cstrong\u003eL Ass./ V Ass._Mean (\u003c/strong\u003eLive Assessment Score/Video Assessment Score) and \u003cstrong\u003eTime\u003c/strong\u003e in \u003cstrong\u003eSVFG\u003c/strong\u003e (Self Video Feedback Group) and \u003cstrong\u003eEVFG\u003c/strong\u003e (Expert Assisted Video Feedback Group) (p\u0026lt;0.05). The average of \u003cstrong\u003ePostFAss.\u003c/strong\u003e was higher in both \u003cstrong\u003eSVFG\u003c/strong\u003e and \u003cstrong\u003eEVFG\u003c/strong\u003e for \u003cstrong\u003eL Ass./ V Ass._Mean\u003c/strong\u003e. The average of \u003cstrong\u003ePreFAss.\u003c/strong\u003e was higher in both \u003cstrong\u003eSVFG\u003c/strong\u003e and \u003cstrong\u003eEVFG\u003c/strong\u003e for \u003cstrong\u003eTime\u003c/strong\u003e (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCOMPARISONS ACCORDING TO GROUPS AND MEASUREMENTS\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePreFAss.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePostFAss.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSVFG/EVFG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cspan class=\"BoldUnderline\" name=\"Emphasis\" type=\"BoldUnderline\"\u003e\u0026plusmn;\u003c/span\u003e\u003cstrong\u003eStd.Dev.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMed. (Min.-Max.)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cspan class=\"BoldUnderline\" name=\"Emphasis\" type=\"BoldUnderline\"\u003e\u0026plusmn;\u003c/span\u003e\u003cstrong\u003eStd.Dev.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMed. (Min.-Max.)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eL Ass.-V Ass._ MEAN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSVFG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.2\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e3.1\u003c/p\u003e\n \u003cp\u003e19 (10-25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.5\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e3.6\u003c/p\u003e\n \u003cp\u003e23.5 (15-28.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEVFG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.5\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e3.8\u003c/p\u003e\n \u003cp\u003e20.0 (12-28.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.3\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e2.9\u003c/p\u003e\n \u003cp\u003e25 (17-29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.634\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.027\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTIME\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSVFG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e27\u003c/p\u003e\n \u003cp\u003e85 (40-150)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e22\u003c/p\u003e\n \u003cp\u003e62 (33-125)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEVFG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e37\u003c/p\u003e\n \u003cp\u003e78 (40-210)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e14\u003c/p\u003e\n \u003cp\u003e52 (28-90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.762\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cem\u003ePaired Samples t test\u003c/em\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e,\u003cem\u003eWilcoxon test\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e,\u003cem\u003eStudent t test\u003c/em\u003e\u003csup\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sup\u003e,\u003cem\u003eMann-Whitney U test\u003c/em\u003e\u003csup\u003e\u003cem\u003e4\u003c/em\u003e\u003c/sup\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003ePreFAss\u003c/span\u003e. : Pre Feedback Assessment \u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003ePostFAss\u003c/span\u003e : Post Feedback Assessment \u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003eSVFG\u003c/span\u003e : Self Video Feedback Group \u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003eEVFG\u003c/span\u003e : Expert Assissted Video Feedback Group \u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003eL Ass\u003c/span\u003e. : Live Assessment Score \u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003eV Ass.\u003c/span\u003e : Video Assessment Score\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eThere was a statistically significant difference between \u003cstrong\u003eSVFG\u003c/strong\u003e and \u003cstrong\u003eEVFG\u003c/strong\u003e in terms of \u003cstrong\u003eL Ass./ V Ass._Mean\u003c/strong\u003e and \u003cstrong\u003eTime\u003c/strong\u003e for \u003cstrong\u003ePostFAss.\u003c/strong\u003e measurements (p\u0026lt;0.05). The average of \u003cstrong\u003eEVFG\u003c/strong\u003e was higher for \u003cstrong\u003eL Ass./ V Ass._Mean\u003c/strong\u003e, and the average of \u003cstrong\u003eSVFG\u003c/strong\u003e was found higher for \u003cstrong\u003eTime\u003c/strong\u003e (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eWhen we additionally evaluated the critical steps, we noticed a statistically significant difference between \u003cstrong\u003ePreFAss.\u003c/strong\u003e and \u003cstrong\u003ePostFAss.\u003c/strong\u003e measurements in terms of \u003cstrong\u003eStep1Step4_Mean\u003c/strong\u003e in \u003cstrong\u003eSVFG\u003c/strong\u003e and \u003cstrong\u003eEVFG\u003c/strong\u003e groups (p\u0026lt;0.05). The average of \u003cstrong\u003ePostFAss.\u003c/strong\u003e was higher in both \u003cstrong\u003eSVFG\u003c/strong\u003e and \u003cstrong\u003eEVFG\u003c/strong\u003e for \u003cstrong\u003eStep1Step4_Mean\u003c/strong\u003e (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCOMPARISONS ACCORDING TO GROUPS (Step1Step4_Mean Differences)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePreFAss.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePostFAss.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cspan class=\"BoldUnderline\" name=\"Emphasis\" type=\"BoldUnderline\"\u003e\u0026plusmn;\u003c/span\u003e\u003cstrong\u003eStd.Dev.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMed. (Min.-Max.)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cspan class=\"BoldUnderline\" name=\"Emphasis\" type=\"BoldUnderline\"\u003e\u0026plusmn;\u003c/span\u003e\u003cstrong\u003eStd.Dev.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMed. (Min.-Max.)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStep1Step4_Mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSVFG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.98\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e0.41\u003c/p\u003e\n \u003cp\u003e2 (1-2.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.35\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e0.55\u003c/p\u003e\n \u003cp\u003e2.5 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEVFG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.97\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e0.43\u003c/p\u003e\n \u003cp\u003e2 (1-2.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.59\u003cspan class=\"Underline\" name=\"Emphasis\" type=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e0.41\u003c/p\u003e\n \u003cp\u003e2.75 (1.5-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.920\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cem\u003eWilcoxon test\u003c/em\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e, \u003cem\u003eMann-Whitney U test\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eWe also found a significant difference between \u003cstrong\u003eSVFG\u003c/strong\u003e and \u003cstrong\u003eEVFG\u003c/strong\u003e in terms of \u003cstrong\u003eStep1Step4_Mean\u003c/strong\u003e for \u003cstrong\u003ePostFAss.\u003c/strong\u003e measurements (p\u0026lt;0.05). The average of \u003cstrong\u003eEVFG\u003c/strong\u003e was higher for \u003cstrong\u003eStep1Step4_Mean\u003c/strong\u003e (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe traditional model for simulation-based training includes post-simulation feedback in which students\u0026rsquo; experiences are explored and reflected upon to improve future performance (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). A better understanding of the role of feedback in competency-based education could result in a more efficient student learning process (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). But this traditional model needs an expert in the post-simulation feedback session. Shifting the degree of primary learning responsibility from the expert to the learner through self-guided learning has received more attention in reducing resource intensity (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study set out with the aim of assessing the probability of low cost simulation-based practical education method. Results demonstrated significant progress in cricothyroidotomy performance with both types of video feedback. This finding agrees with Hawkins\u0026rsquo;s findings, which showed progress with video self-assessment ( including video recorded \u0026lsquo;benchmark performance\u0026rsquo; ) and expert assessor groups (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis also accords with the study of Nesbitt (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), Backstein (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), and Phillips (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), who demonstrated a significant improvement in practical performance for participants receiving self video feedback with an expert or alone. In these three studies, no significant additional benefit was demonstrated from EVFG, and a similar improvement can be obtained using a best practice expert video and allowing attendees to assess their performances.\u003c/p\u003e \u003cp\u003eOur results demonstrated significant enhancement with expert-assisted video feedback group and self-video feedback group, suggesting that the opportunity to review trainee\u0026rsquo;s performance using video feedback plays an important role in improving the learning experience. However, the progress was significantly greater with the expert-assisted video feedback group. When considered from this point of view, we can see there was an expert effect. However, it does not mean \u0026ldquo;expert need\u0026rdquo; is essential. In 2003, Wong designed a study to determine the minimum practical training need for successful cricothyroidotomy with a self video feedback alone. This study showed that by the fifth attempt, 96% of the attendees could perform the cricothyroidotomy successfully (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). According to this information, it can be thought that expert assistance saves time, and more practice time is required if we use the self video assessment method.\u003c/p\u003e \u003cp\u003eAccording to our sub-group evaluation on two critical steps, we demonstrated similar results with overall findings. Again, we found significant improvement with the expert-assisted and the self video-feedback groups when two steps were taken into account. Also, the progress was significantly greater with the expert-assisted video-feedback group.\u003c/p\u003e \u003cp\u003eThe main limitation of this study was that students performed the procedure only once. The literature indicates that at least five trials must be done to perform the procedure successfully. The other limitation is that the study design neglected control groups that received no feedback (to define the baseline of how much learning occurs by recurrent practice). The lack of a power analysis calculation to plan the sample size is another limitation of this study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates significant progress in cricothyroidotomy performance with both types of video feedback. This combination of findings may help us to understand what the most appropriate simulation-based training model is. It is clear that video feedback enables trainees to understand the process and progress of clinical procedures. They can visualize the actions involved in the task in a stepwise manner. The real question is about the necessity of an expert in low-cost, effective simulation-based training. With self video feedback without an expert, simulation-based training is effective. However, more practice time seems to be necessary.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate :\u003c/strong\u003e The study protocol was approved by the Acıbadem Mehmet Ali Aydinlar University Medical Research Ethical Committee (ATADEK-2019/14). The study was performed in accordance with the Declaration of Helsinki and Ethics Committee of the Chamber of Physicians approval. The written informed consent was obtained from the participants before the practice. All of the participants were more than 16\u0026thinsp;years old; therefore, parental consent was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication :\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials :\u0026nbsp;\u003c/strong\u003eAll the data, written documents, materials are available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eH.A. ve S.Y. designed the study. H.A. and C.O.S. wrote the main manuscript. S.Y. and C.G. conducted the statistical analysis. F.G. and M.S. prepared tables and figures. K.K. and S.T. reviewed the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe thank Emre Aldinc MD and Ela Ahmad MD for editorial support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSakakushev BE, Marinov BI, Stefanova PP, Kostianev SS, Georgiou EK. Striving for Better Medical Education: the Simulation Approach. Folia Med (Plovdiv). 2017 Jun 1;59(2):123-131. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1515/folmed-2017-0039\u003c/span\u003e\u003c/span\u003e. PMID: 28704187.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAksoy, M. E., Guven, F., Sayali, M. E., \u0026amp; Kitapcıoglu, D. The effect of web-based learning in pediatric basic life support (P-BLS) training. Computers in Human Behavior. 2019; 94, 56\u0026ndash;61. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.chb.2018.12.032\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan de Ridder JM, Stokking KM, McGaghie WC, ten Cate OT. What is feedback in clinical education? Med Educ. 2008 Feb;42(2):189-97. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1365-2923.2007.02973.x\u003c/span\u003e\u003c/span\u003e. PMID: 18230092.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLefroy J, Watling C, Teunissen PW, Brand P. Guidelines: the do's, don'ts and don't knows of feedback for clinical education. Perspect Med Educ. 2015 Dec;4(6):284\u0026ndash;99. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40037-015-0231-7\u003c/span\u003e\u003c/span\u003e. PMID: 26621488; PMCID: PMC4673072.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoud, David; Falchikov, Nancy (ed.). Rethinking assessment in higher education: Learning for the longer term. Routledge, 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBloxham, Sue, and Pete Boyd. Developing Effective Assessment In Higher Education: A Practical Guide: A Practical Guide. McGraw-Hill Education (UK), 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWittler M, Hartman N, Manthey D, Hiestand B, Askew K. Video-augmented feedback for procedural performance. Med Teach. 2016 Jun;38(6):607\u0026ndash;12. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3109/0142159X.2015.1075650\u003c/span\u003e\u003c/span\u003e. Epub 2015 Sep 18. PMID: 26383586.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHawkins SC, Osborne A, Schofield SJ, Pournaras DJ, Chester JF. Improving the accuracy of self-assessment of practical clinical skills using video feedback--the importance of including benchmarks. Med Teach. 2012;34(4):279-84. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3109/0142159X.2012.658897\u003c/span\u003e\u003c/span\u003e. PMID: 22455696.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhillips AW, Matthan J, Bookless LR, Whitehead IJ, Madhavan A, Rodham P, Porter ALR, Nesbitt CI, Stansby G. Individualised Expert Feedback is Not Essential for Improving Basic Clinical Skills Performance in Novice Learners: A Randomized Trial. J Surg Educ. 2017 Jul-Aug;74(4):612\u0026ndash;620. doi: 10.1016/j.jsurg.2016.12.003. Epub 2016 Dec 29. PMID: 28041770.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVnuk A, Owen H, Plummer J. Assessing proficiency in adult basic life support: student and expert assessment and the impact of video recording. Med Teach. 2006 Aug;28(5):429-34. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/01421590600625205\u003c/span\u003e\u003c/span\u003e. PMID: 16973455.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun C, Kisser U, Huber A, Stelter K. Bystander cricothyroidotomy with household devices - A fresh cadaveric feasibility study. Resuscitation. 2017 Jan;110:37\u0026ndash;41. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.resuscitation.2016.10.015\u003c/span\u003e\u003c/span\u003e. Epub 2016 Nov 1. PMID: 27810460.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzkaya Senuren C, Yaylaci S, Kayayurt K, Aldinc H, Gun C, Şimşek P, Tatli O, Turkmen S. Developing Cricothyroidotomy Skills Using a Biomaterial-Covered Model. Wilderness Environ Med. 2020 Sep;31(3):291\u0026ndash;297. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.wem.2020.05.003\u003c/span\u003e\u003c/span\u003e. Epub 2020 Aug 24. PMID: 32855020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoughlin RF, Chandler I, Binford JC, Bonz JW, Hile DC. Enhancement of Cricothyroidotomy Education Using a Novel Technique: Cadaver Autografting. J Emerg Med. 2017 Dec;53(6):885\u0026ndash;889. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jemermed.2017.08.071\u003c/span\u003e\u003c/span\u003e. Epub 2017 Oct 21. PMID: 29066133.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGustafson ML, Hensley B, Dotson M, Broce M, Tager A. Comparison of Manikin Versus Porcine Trachea Models When Teaching Emergent Cricothyroidotomy Among Emergency Medicine Residents. AEM Educ Train. 2019 Apr 7;3(3):280-285. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/aet2.10333\u003c/span\u003e\u003c/span\u003e. PMID: 31360821; PMCID: PMC6637022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrikotiroidotomi: maket ile uygulama. [Cricothyroidotomy: A Practice with Mannequin] 2019. [Accessed December 20, 2019]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps:// www.acilci.net/krikotiroidotomi-maket-uygulama/\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong DT, Prabhu AJ, Coloma M, Imasogie N, Chung FF. What is the minimum training required for successful cricothyroidotomy?: a study in mannequins. Anesthesiology. 2003 Feb;98(2):349-53. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00000542-200302000-00013\u003c/span\u003e\u003c/span\u003e. PMID: 12552192.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTudor GJ, Podolej GS, Willemsen-Dunlap A, Lau V, Svendsen JD, McGarvey J, Vozenilek JA, Barker LT. The Equivalence of Video Self-review Versus Debriefing After Simulation: Can Faculty Resources Be Reallocated? AEM Educ Train. 2019 Aug 12;4(1):36-42. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/aet2.10372\u003c/span\u003e\u003c/span\u003e. PMID: 31989069; PMCID: PMC6965677.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTekian A, Watling CJ, Roberts TE, Steinert Y, Norcini J. Qualitative and quantitative feedback in the context of competency-based education. Med Teach. 2017 Dec;39(12):1245\u0026ndash;1249. doi: 10.1080/0142159X.2017.1372564. Epub 2017 Sep 19. PMID: 28927332.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNesbitt CI, Phillips AW, Searle RF, Stansby G. Randomized trial to assess the effect of supervised and unsupervised video feedback on teaching practical skills. J Surg Educ. 2015 Jul-Aug;72(4):697\u0026ndash;703. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jsurg.2014.12.013\u003c/span\u003e\u003c/span\u003e. Epub 2015 Feb 18. PMID: 25703737.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBackstein D, Agnidis Z, Regehr G, Reznick R. The effectiveness of video feedback in the acquisition of orthopedic technical skills. Am J Surg. 2004 Mar;187(3):427-32. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.amjsurg.2003.12.011\u003c/span\u003e\u003c/span\u003e. PMID: 15006577.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Medical education research, simulation, feedback","lastPublishedDoi":"10.21203/rs.3.rs-959406/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-959406/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe self-video feedback method may have the potential to provide a low-cost alternative to physician-driven simulation-based training. This study aimed to assess the utility of video feedback by comparing the improvement in procedural performance when trainees received self-video feedback (trainees review their performance alone) and expert-assısted video feedback (trainees review their performance while an emergency physician provides additional feedback). This study was performed at a university simulation center with 89 final-year medical students and used a cricothyroidotomy simulation model. Following the educational presentation and the best practice video, trainees were randomized into two groups (self video-feedback and expert assisted video-feedback). They performed the cricothyroidotomy before and after the feedback, The procedures were recorded and scored. Scoring were made using a pre-defıned checklist. Mann Whitney U test and Wilcoxon test were used to analyze non-normally distributed data. For the analysis of normally distributed data, Student t-test and Paired Samples t-test were used. Results demonstrated significant improvement in cricothyroidotomy performance with both types of video feedback. The improvement was significantly greater in the expert-assisted video feedback group. We think that simulation-based training is effective with self video feedback.\u003c/p\u003e","manuscriptTitle":"Comparison of Self Versus Expert-assisted Feedback for Cricothyroidotomy Training","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2022-04-25 15:51:00","doi":"10.21203/rs.3.rs-959406/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2021-10-15 14:47:29","doi":"10.21203/rs.3.rs-959406/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e0acb3f8-4c53-4138-b347-425242ed3989","owner":[],"postedDate":"April 25th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":7890487,"name":"Educational Philosophy and Theory"},{"id":7890488,"name":"Internal Medicine"}],"tags":[],"updatedAt":"2021-10-26T04:29:10+00:00","versionOfRecord":[],"versionCreatedAt":"2022-04-25 15:51:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-959406","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-959406","identity":"rs-959406","version":["v2"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}