The more authentic the case, the better it triggers learning, at least that is one of the popular mantras in medical education today. But how to apply this wisdom and achieve authenticity in preclinical education where real patients are at a premium? Video cases have been suggested as a potential solution. But are they?
Studies have said about video cases:
- they can present a holistic picture of patients;
- they allow students to make observations unfiltered through a professional's perspective;
- they convey emotion and non-verbal cues;
- they are more congenial to the MTV generation student, who is typically hooked on visual images.
But what if we apply the real litmus test to video cases? Do students really learn from them, better than from less authentic, paper cases? Does all the hard work put into producing and delivering them pay off? This is what Bas de Leng and his colleagues set out to investigate. They conducted a focus group study to pinpoint the additional value, if any, of video cases as experienced by second-year undergraduate medical students and they picked the students' brains on what promotes the productive use of video cases. The students had been exposed to text-based cases and some fifteen video cases (3 to 20 minutes), including a patient in pain making a strong emotional appeal to the doctor, advanced trauma life support, 3 patients with chest pain and differing pathophysiology. The key messages from the students on the additional value of video cases and their productive use are listed below with illustrative quotations.
Additional value
Video cases:
- are more authentic: "A physician uses his eyes first … He sees signs and symptoms and detects certain clinical pictures. We read about them in books and sometimes have little idea of how to visualise them …."
- present a comprehensive picture: "In a video on shock. We had to compare 3 patients … What was good was that we started to pay attention to details. What is pale skin, what is red skin? In a text you just read red skin, it is a given."
- are motivating and challenging: "A video on behavioural disorders showed a child just sitting there crying … and you did not know what was going on. You want to know what is wrong with that child. The image is challenging of itself; it really moves you."
- are better retained in memory: "Yes, the image, like that epileptic patient, I can still picture it in my mind."
Productive use
- The contents should not be too complete or directive: "… things were explained and the video did not engage your curiosity, it raised no questions"
- The degree of difficulty should be appropriate: "Seeing an endoscopy … after having learned about the anatomy of the bowel and then being asked what do you see here … now that would be really interesting …."
- Cases should be watched in a structured fashion: "… we had to compare and describe 3 patients with similar symptoms. Next we had to figure out who had had an infarction. That was a different way of watching a video … Your are motivated and made to think."
- The cases should be brief and unique: "With the arthrosis cases, the second video was structured in exactly the same way, only with the questions about the hip instead of the knee. That video we just did not watch at all."
The students' messages appear to confirm advantages described in the literature, i.e. a holistic picture and emotion, visualisation of disorders to help students connect mental representations to the real world and thereby make them stick in memory. The importance of directions and structure supports that it is mistaken to assume that video cases require little effort. Because visual information is ambiguous, directions are needed to preclude too little attention for important elements or too much attention for extraneous elements. Cases should be tailored to students' current knowledge, match curricular objectives and offer cues, but not too many, because the aim is to stimulate elaboration not stifle it.
Finally, the authors propose observational studies and studies of specific attributes of video as a medium. For now, the conclusion seems to be that, provided certain conditions are met, video can actually increase authenticity and help students learn and remember.
Bas de Leng, Diana Dolmans, Margje van de Wiel, Arno Muijtjens.
Medical Education 2007; 41; 181-188.
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Graduate School of Health Professions Education (SHE) 
