Video Analysis Assessment Tool

BACKGROUND

Interactive video analysis assessment tools provide the opportunity to use video stimuli to assess learners’ comprehension, situational awareness, and the abilities to analyze and evaluate simulated or real situations as well as select alternative ways of responding to the situations demonstrated in the video. The integration of test questions into the video at selected points in time allows the learner to easily review the stimulus before responding, providing practice in observation and focused attention.

With the goal to assess student’s competency in all domains of Interprofessional Collaborative Practice (as outlined by IPEC expert panel), we developed a screenplay centered on the complex of issues associated with the treatment of a hospitalized elderly patient who, at the same time, participates in a clinical trial. The screenplay was conceived as 3 modules that might be utilized independently or together. Upon completing the screenplay, we selected and employed professional actors and shot a 3- part video entitled “The Patient or The Protocol”.

As a tool for interactive video assessment, we adopted Zaption application software developed by Jim Stigler, a Professor in the Department of Psychology at UCLA. The software allows integrating slides with text and images as well as test questions (such as free response, true-false, yes-no, numerical, drawing, and multiple choice) into the video, at selected points in time. It also allows jumping within the video from frame to frame and/or question to question, post comments after watching a certain period of the video, and use functions such as “replay”, “pause”, and “continue”. Finally, Zaption creates analytics that allow an instructor to monitor progress of an individual student or a class in understanding of the concepts of the assignment.

After uploading the produced video into the Zaption software environment we equipped it with a variety of test questions and pilot-tested Part II of the video (“The Medical Group Debates”) on 27 medical and nursing students attending interprofessional education course at UCLA.

The characters and the summary of each Part of the video as well as the test questions, their relations to the IPEC Competency Domains, and recommendations for the use of this video analysis assessment tool are outlined below.

Characters

Primary Care Physician (Internist), James Smith

Role: consults the medical group regarding the patient's medical history and life events. Has cared for the patient for 10 years; knows the patient and the patient’s family well. Responsible for coordinating overall care approaches. He will assume care for the patient when and if patient is discharged.

Hematology-Oncologist Physician, Stephen Brown

Role: has ultimate responsibility for supervision of the patient’s chemotherapy regimen and acute measures. Also, Dr. Brown is a principle investigator for the START-2 clinical trial.

Hematology-Oncologist Fellow, Erika Evans

Role: plans to have an academic research career and is working with Dr. Brown on the START-2 clinical trial; prescribes the chemotherapy regimen to the patient and evaluates the effects of the new drug therapy.

Hematology-Oncologist Nurse Practitioner, Sally Bowles

Role: participates in and monitors the development of policies, procedure, and standards of care in the department and assists in communicating these to the patient and relatives; collaborates with both Drs. Brown and Evans in the development of treatment plan for the patient; writes prescriptions for medications, lab tests, and post- discharge care; determines the patient’s eligibility for participating in clinical trials; requests consultations; administers therapeutic and diagnostic measures; evaluates the quality of care.

Clinical Social Worker, Susan Anderson

Role: Called in for crisis and grief counseling for family and patient by Dr. Smith, and to coordinate continuity of care and community resources, such as hospice, as required. She has met with patient and family several times over the last month. She also, assesses the patient’s mental status and advocates for the patient’s rights and well- being.

Summary

PART I – When Healing Hurts (from The Patient or the Protocol)

This 4.14-minute video module shows an elderly and frail patient in a monitored bed. The patient was hospitalized due to the worsening of her condition associated with acute myelogenous leukemia. The patient is in distress. Her platelets, white blood cells, and hematocrit counts are very low. However, because the patient is on experimental treatment – START-2 clinical trial, her other treatment options are limited. A nurse practitioner (NP) is taking care of the patient. Patient’s daughter and son are also at the bedside. The patient voices her desire to be left alone. The patient’s daughter tries to enthusiastically convince her about the positive outcomes of the clinical trial. The patient, the patient’s son, and the NP listen to the daughter’s speech with skepticism. The patient’s son forces his mother to take a dose of pain medicine.

PART II – The Medical Group Debates (from The Patient or the Protocol)

This 13-minute video module centers on the debates of the group of medical providers concerning the patient’s condition and the course of treatment. The medical group is split between the patient’s best interest and the interests of the clinical trial. Finding clearly shared goal for the group is further complicated by the differences in opinion on the patient treatment between the patient’s daughter and son. While the daughter persists in keeping her mother in the clinical trial program no matter what, the son, on the other hand, is having difficulty watching his mother suffer; he wants her to have quality of life and is ready to put her into hospice care. The nurse practitioner, as one of the medical group members, is concerned that the patient’s daughter coerced the patient into consenting to the treatment that she may not fully understand or want. Clinical Social Worker agrees with the Nurse Practitioner’s opinion. The patient’s Primary Care Physician acts as a moderator and the leader of the debates. He eventually guiding the medical group to accurate and humane evaluation of worthiness of keeping the patient in the clinical trial and under aggressive therapy and to subsequent realization of the necessity to listen to and consider the patient’s wishes.

PART III – Painful Decision (from The Patient or the Protocol)

This 6.16-minute video module presents the Primary Care Physician (PCP), Clinical Social Worker (CSW), Nurse Practitioner (NP), hematology-oncology physician and fellow, as well as the patient’s daughter and son at the patient’s bedside. Medical personnel act as a team now. With a clear goal and a consensus on the course of treatment, the team professionally shares their plan with the patient and the patient’s daughter and son. CSW convinces the patient’s daughter to listen to her mother’s wishes. The patient’s son expresses his concern with his mother’s suffering. Both Hematology – Oncology physicians and the NP honestly explain to the patient and the patient’s daughter and son the danger of continuing clinical trial for the patient’s condition. The patient’s daughter continue “fighting” for keeping her mother in the clinical trial referring to her incapacity for making decision, but CSW states otherwise. The patient’s PCP mediates this bedside discussion with humanity, care, and, professionalism. The patient expresses her wish to go home and be comfortable.