Practical Efficacy of the Mobile Video Feedback Method in Teaching Clinical Abscess Incision and Drainage Skills

Abstract

Objective

Although video feedback is incorporated into medical education research, its broad implementation in the practical teaching of procedural skills remains challenging. Thus, we aimed to investigate the practical effects of the mobile video feedback teaching method in clinical skills training for abscess incision and drainage.

Methods

A total of 72 second-year medical students majoring in a 5-year clinical medicine program were randomly allocated (1:1) to either the traditional teaching (TT) group or the mobile video feedback teaching (MVFT) group. All students received the same foundational theoretical knowledge, followed by distinct practical training sessions corresponding to their group allocation. The final procedural assessment on a simulation manikin was conducted by 2 examiners simultaneously, and each student's final score was calculated as the average of both examiners’ scores. Effects were further assessed using the Mini-Clinical Evaluation Exercise (Mini-CEX), in addition to evaluations of teaching performance and self-perception.

Results

Students in the MVFT group achieved a significantly higher average final score than those in the TT group (78.67 ± 6.72 vs 75.00 ± 7.95, P = .038). Additionally, 4 initially lower-performing students in the MVFT group scored significantly higher than 4 comparable students in the TT group (67.50 ± 1.29 vs 63.00 ± 3.16, P = .039). The MVFT group achieved significantly higher scores in clinical judgment, physical examination, organizational skills, and overall performance (P = .000, P = .000, P = .037, P = .040, respectively). Furthermore, students in the MVFT group reported significantly greater satisfaction across several domains, including their perception of the teaching methodology, comprehension of learning materials, and ability to perform self-directed learning with tools (P = .042, P = .032, P = .041, respectively).

Conclusion

This study demonstrates that the mobile video feedback method enhances comprehension and procedural proficiency in clinical skills, particularly for initially lower-performing students, supporting its integration into the curriculum to improve educational outcomes. The method's accessibility and low cost further facilitate its adoption as a scalable tool for self-directed learning and targeted remediation.

Keywords

mobile video feedback teaching method clinical skills training incision and drainage of an abscess mini-clinical evaluation exercise

Introduction

Clinical skills serve as critical indicators of clinical practitioners’ practical competence and represent indispensable core competencies for medical students worldwide.^1,2 Consequently, simulation-based clinical skills training has become a fundamental component of modern medical education across diverse educational systems, accelerated by rapid technological advancements.^3–5 However, undergraduate students initially exposed to clinical skills courses often lack clinical awareness and practical experience. The short duration of these courses also poses learning challenges, potentially leading to rote memorization that could compromise future clinical practice and examination performance. Therefore, enhancing student efficiency and proactivity in simulation training is paramount.

The mobile video feedback approach is theoretically anchored in established educational frameworks. Mayer's multimedia learning theory posits that dual-channel processing (visual and auditory) enhances knowledge retention and transfer.⁶ Video feedback directly addresses these limitations by enabling structured self-assessment through Kolb's experiential learning cycle, which further supports this method: students engage in concrete experience (performing a procedure), reflective observation (reviewing their video), abstract conceptualization (identifying errors), and active experimentation (repeating corrected actions).⁷ This process is further reinforced by the principles of deliberate practice, which emphasizes focused, repetitive performance refinement against defined benchmarks,⁸ and self-directed learning coupled with reflective practice, empowering learners to independently identify and correct errors.^9,10 The act of reviewing one's own performance also engages metacognition, enabling students to monitor and regulate their own learning processes. Moreover, social and observational learning is facilitated when videos of peer or expert performances are incorporated, allowing students to learn through modeling.^11,12 The foundational role of feedback for learning (Hattie & Timperley) is central, as video provides tangible evidence that closes the gap between current and desired performance.¹³ Finally, the video feedback environment creates a form of cognitive apprenticeship, where instructors can make their expert thinking and maneuvers visible, guiding students through the stages of skill acquisition.^14,15

Video feedback teaching uses recording devices to document students’ procedural procedures, facilitating systematic review and constructive feedback.^16,17 This method enables learners to compare their performance against standardized videos, identify errors, and refine skills through iterative correction.¹⁸ Learners can compare their performance against standardized videos to identify and correct errors iteratively. Although used in foundational training, institutional equipment disparities limit broader adoption in hands-on clinical instruction.¹⁹ Currently, most institutions apply video feedback primarily in research rather than practical skills teaching. Given the ubiquity of smartphones, low-cost, scalable implementation is now feasible.^20,21 This study therefore leveraged the convenience of mobile phone video recording within a clinical skills feedback framework to assess the outcomes of this method compared to traditional teaching methodologies.

Methods

Study Participants

A cohort of 72 second-year students from the Department of Clinical Medicine at Chongqing Medical University undertook a course on abscess incision and drainage during 2023, within the framework of their foundational clinical skills training. All participants were inexperienced with the procedure, having neither observed nor performed it previously. Informed consent was obtained from all participants prior to the study; those who declined were excluded. Both instructors were board-certified attending physicians with over 8 years of experience in general surgery and more than 5 years of teaching experience. Before the study, they completed a 1-week intensive training program on video feedback instructional methodology.

Ethics Statement

This study was approved by the Ethics Committee of Chongqing Medical University (No. 2022-346). Written informed consent was obtained from all participants. The study reporting adheres to the DOCTRINE Guidelines and the EQUATOR Network guidelines.²²

Randomization and Grouping

Randomization was performed using a stratified random sampling method. Students were ranked in descending order based on their average scores from the previous semester and divided into 9, each comprising 8 students. From each stratum, students were randomly assigned in a 1:1 ratio to either the traditional teaching (TT) group or the mobile video feedback teaching (MVFT) group, resulting in 2 groups of 36 students each.

Teaching Content and Implementation

Both groups covered the content on abscess incision and drainage from the “Clinical Skills Simulation Training and Evaluation” (Chen Hongyan, Science Press) as the theoretical foundation for their 4-h instruction. The associated scoring rubric served as a standardized assessment instrument for practical skills examination. The theoretical content was delivered alternately by 2 instructors following the established teaching syllabus. The instructors for both groups were members of the research team. To mitigate potential bias, the procedural assessments were evaluated independently by 2 examiners blinded to group allocation, and the final scores were averaged. The standardized procedural video materials were sourced from the “Clinical Skills Training Course” video series developed by Chongqing Medical University. All instructional materials represented standard curriculum content for second-year medical students. Figure 1 presents the instructional procedures for both groups. All instruction and practice utilized simulation manikins.

Figure 1.

The schematic diagram illustrating the instructional procedures for the TT and MVFT groups.

Instructional Curriculum for the TT Group

The instructional curriculum for the TT group followed a traditional teacher-centered approach:

Theory instruction: Theoretical sessions covered the rationale for surgical incision and drainage, including indications, contraindications, and established treatment modalities.

Standardized video viewing: Students viewed standardized operation videos with instructor guidance on critical precautions and procedural steps.

Teacher demonstration: The instructor performed a comprehensive live demonstration on a simulation manikin. Students were then invited to pose questions and handle the surgical instruments.

Supervised practice: Students practiced using an Abscess Identification and Incision Procedure Module (Model ZH/LV3, Shanghai Zhonghong Science and Education Equipment Co., Ltd) under instructor supervision. The instructor identified and corrected errors, provided constructive feedback, and addressed questions.

In-class assessment: Students completed in-class assessments, which were evaluated by instructors using the established marking criteria, with results recorded.

Pre-final exam practice: Before the final examination, students had an additional unsupervised practice session. They were encouraged to self-assess using the evaluation rubric without formal scoring.

Instructional Curriculum for the MVFT Group

The MVFT group curriculum included:

Theory instruction, video viewing, and teacher demonstration: Identical to the TT group.

Video-recorded practice: During practice, students worked in pairs, recording their performance using mobile devices and conducting immediate self-review against standard operation videos, with instructor feedback.

In-class assessment with video recording: During assessments, instructors scored performances while students recorded each other for subsequent comparison with standard videos to enable self-correction.

Pre-final exam video feedback practice: Before the final examination, students again worked in pairs, recording their procedures and comparing them with standard videos to identify and correct discrepancies. This video feedback process aligns with Kolb's experiential learning cycle, encompassing concrete experience, reflective observation, abstract conceptualization, and active experimentation. All sessions used simulation manikins.

Teaching Evaluation

After the course, students from both groups were evaluated on their ability to perform the procedure using a simulation manikin. Performance was scored on a 100-point scale using the established criteria (see Supplemental Teaching Evaluation Scale).

Comprehensive Procedural Assessment and Teaching Quality Evaluation

The mini-clinical evaluation exercise (mini-CEX) assessed students’ procedural processes across 7 domains: clinical judgement, interviewing skills, humanistic care, physical examination, communication skills, organizational skills, and overall performance.²³ Teaching quality was assessed via anonymous questionnaires evaluating 6 dimensions: teacher recognition, perceptions of teaching methodologies, course interest, comprehension of learning materials, self-directed learning with tools, and problem-solving skills. The survey used a satisfaction/dissatisfaction format. All 72 questionnaires were returned (100% response rate).

Statistical Analysis

Data were analyzed using SPSS 18.0 (SPSS Inc., Chicago, IL, USA). Continuous data are presented as mean ± standard deviation or median, and compared using 1-way ANOVA or independent samples t-test. Categorical data were analyzed using chi-square tests. Statistical significance was set at P < .05.

Results

Results of the Procedural Examination

The average age of the students in the TT group was 19.83 ± 0.50 years, with a median age of 20 years. The group consisted of 17 male and 19 female students. Across all semesters, the mean score was 74.50 ± 9.24, with a median score of 74.35. The average age of the students in the MVFT group was 19.97 ± 0.50 years, with a median age of 20 years. The cohort comprised 16 male and 20 female students. Across all semesters, the mean score was 74.07 ± 8.93, with a median score of 73.87. There were no statistically significant differences between the 2 groups of students with respect to age, gender distribution, or average grades from the previous semester.

The mean final operation test scores for the TT group and the MVFT group were 75.00 ± 7.95 and 78.67 ± 6.72, respectively, with median scores of 73.50 and 79.50. Compared with the TT group, the MVFT group achieved a significantly higher mean operation score (t = 2.85, P = .038) (Table 1). In particular, within the MVFT group, students who initially performed poorly achieved a significantly higher average score (67.50 ± 1.29, n = 4) than did their counterparts in the TT group (63.00 ± 3.16, n = 4). This difference was statistically significant (t = 0.078, P = .039), as shown in Table 1.

Table 1.

Examination Results.

	TT group	MVFT group	t-value	P-value
Mean scores of total students	75.00 ± 7.95	78.67 ± 6.72	0.285	.038*
Mean scores of 4 students initially performed poorly	63.00 ± 3.16	67.50 ± 1.29	0.078	.039*

The practice examination scores of students in the mobile video feedback teaching (MVFT) group were significantly higher than those in the traditional teaching (TT) group; The practice examination scores of students with previous poor performance in the MVFT group were significantly higher than those in the TT group.

* Statistically significant difference.

Results of the Procedural Evaluation

The results of the mini-clinical exercise evaluation indicated that students in the MVFT group achieved significantly higher scores than those in the TT group across 4 key areas: clinical judgement, physical examination, organizational ability, and overall performance (Table 2). Specifically, the mean scores for the MVFT group were 5.83 ± 1.34, 5.44 ± 1.18, 4.75 ± 1.31, and 5.57 ± 1.28, respectively. The corresponding scores for the TT group were 4.31 ± 1.12, 4.44 ± 1.18, 5.57 ± 1.28, and 5.14 ± 1.07, respectively. Statistical analysis revealed significant differences (Table 2).

Table 2.

The Results of mini-CEX.

	TT group	MVFT group	t-value	P-value
Clinical judgment	4.31 ± 1.12	5.83 ± 1.34	0.272	.000*
Interviewing skills	5.64 ± 1.29	5.14 ± 1.15	0.342	.087
Humanistic care	5.22 ± 1.17	5.57 ± 1.46	0.111	.096
Physical examination	4.06 ± 0.72	5.44 ± 1.18	0.000	.000*
Communication skills	5.19 ± 1.28	5.58 ± 1.42	0.305	.224
Organizational skills	4.28 ± 0.70	4.75 ± 1.31	0.000	.037*
Overall performance	5.14 ± 1.07	5.57 ± 1.28	0.209	.040*

The scores of students in the mobile video feedback teaching (MVFT) group are significantly higher than those in the traditional teaching (TT) group in terms of clinical judgement, physical examination, organizational ability and overall performance.

* Statistically significant difference.

Results of the Teaching and Self-Recognition Questionnaire

The results of the questionnaire survey indicated that students in the MVFT group demonstrated a significantly greater level of recognition of the teaching method, a deeper understanding of the learning content, and a more pronounced ability to engage in tool-assisted self-study than those in the TT group (Table 3).

Table 3.

Results of the Satisfaction Survey.

	TT group	MVFT group	χ² value	P-value
Teacher recognition	28/36	29/36	0.84	.772
Perception of teaching methodologies	25/36	32/36	4.126	.042*
Level of course interest	31/36	30/36	0.107	.743
Comprehension of learning materials	26/36	33/36	4.600	.032*
Self-directed learning with tools	28/36	34/36	4.181	.041*
Autonomous problem-solving skills	22/36	28/36	2.356	.125

Student satisfaction in the mobile video feedback teaching (MVFT) group is significantly greater than that in the traditional teaching (TT) group in terms of recognition of teaching methods, understanding of the learning content and the ability to self-learn with tools.

* Statistically significant difference.

Discussion

Key Results

This study demonstrated that the MVFT method significantly improved practical examination scores and mini-CEX performance in clinical judgment, physical examination, organizational ability, and overall competence compared to TT, particularly benefiting initially lower-performing students. Students also reported higher satisfaction with the teaching methodology, content comprehension, and self-directed learning.

Limitations

This study has several limitations. The use of mobile phones for video recording presents challenges, including variable recording quality that may obscure essential procedural details and the potential for handling devices to interrupt procedural workflow and induce performance anxiety. Although randomization based on prior academic performance was employed to minimize selection bias, unmeasured confounders such as differences in manual dexterity or prior experience with video self-assessment could have influenced outcomes. The use of the mini-CEX, rather than a Direct Observation of Procedural Skills (DOPS) tool, may have reduced the precision of technical skill evaluation. Furthermore, the absence of self-reported confidence data limits understanding of the method's psychological impact, and the study-specific teaching satisfaction questionnaire lacks formal validation, potentially affecting result interpretation. Finally, the findings are primarily generalizable to second-year medical students in comparable curricula, warranting future studies involving diverse cohorts, including senior students and residents, to identify the most suitable learner groups for this approach.

Interpretation

Clinical skills training constitutes a fundamental component of preclinical medical education, serving as a crucial link between theoretical knowledge and clinical practice.²⁴ In China, it is integral to both the medical licensing examination and standardized residency training assessments.²⁵ However, variable curricula and scheduling across institutions often limit students’ opportunities for standardized practice. Combined with time constraints and examination pressure, this leads to underperformance and difficulty in self-identifying errors during assessments. These challenges necessitate innovative teaching methods.²⁶ Instructor-guided feedback models that emphasize self-directed learning and self-assessment can holistically develop students’ technical, cognitive, and emotional competencies, fostering independent learning more effectively than traditional approaches.²⁷

Our results are consistent with existing literature on video-assisted procedural training. Previous studies indicate that video feedback enhances both technical proficiency and psychological readiness for assessments, aligning with the MVFT group's superior examination and mini-CEX performance.^28–31 Similar benefits in technical and communication skills have been reported with segmented video demonstrations, echoing our findings regarding clinical judgment and organizational efficiency.³² Video feedback has been widely documented to shorten learning curves and improve skill retention, consistent with our abscess training outcomes.^30,31 While specialized video feedback systems with annotation functions enable structured self- and peer-assessment,³³ our mobile method offers greater accessibility despite lacking advanced features like shared annotated feedback.

Theoretical foundations from Kolb's experiential learning, Bandura's social learning theory, and the cognitive apprenticeship model are operationalized through mobile video feedback.^7,19,34 Specifically, students engage in observational learning by comparing their recordings with expert videos, facilitating attentional retention and motor reproduction—key mechanisms in Bandura's theory. Repeated review of procedural segments also aligns with cognitive load theory,³⁵ supporting learning through managed cognitive processing.

Compared to immersive technologies like virtual reality (VR), augmented reality (AR), and 3D models—which require costly hardware and software-mobile video feedback is more accessible and cost-effective.^36,37 Although VR/AR excel in standardized, high-risk procedural training, mobile video is better suited for real-world skills like abscess drainage, as it captures actual performance for self-reflection. Unlike 3D models, it provides personalized feedback based on real attempts.

Empirical evidence confirms that this approach improves both procedural competence and assessment readiness. Our study corroborates these findings, demonstrating that MVFT enhanced practical examination scores and clinical performance ratings, especially among initially lower-performing students. The method's portability supports flexible learning, extending the online learning trend to hands-on training.³⁸ Unlike prolonged VR/AR use, mobile video causes minimal workflow disruption. However, institutional resource disparities remain a barrier to broader implementation. Future studies could explore hybrid models combining mobile feedback with AR/3D tools to balance accessibility and technological sophistication.

Challenges for Integration into Medical Education

Despite its cost-effectiveness and scalability advantages over technologies like VR/AR, the integration of mobile video feedback into medical education faces several challenges. These include variable recording quality from personal devices, potential operational disruption during practice, and the need for dedicated faculty training in methodology and feedback. Furthermore, embedding this approach requires careful curriculum adaptation and must address significant privacy and data security concerns regarding the recording of procedures. Successful implementation thus depends on overcoming these logistical and ethical hurdles through comprehensive faculty development, thoughtful curricular planning, and clear institutional governance.

Generalizability

During the COVID-19 pandemic, mobile devices were extensively utilized for their portability and immediacy. Students engaged in online classes and micro-lessons from home or dormitories, an approach recognized as an innovative teaching method.³⁸ Recent studies indicate that students respond positively to online courses and micro-lessons.^39,40 The portability of mobile devices was effectively leveraged in online skill instruction, significantly enhancing teaching efficacy. However, the potential of mobile devices remains underutilized in traditional clinical skills training. In our study, we utilized smartphone portability and video-recording capabilities to encourage students to document their own skill performances. Students were then guided to systematically review their recordings against standard procedural videos. This approach enhances procedural memory and facilitates error self-correction,^7,19 particularly improving learning efficiency among previously underperforming students.^19,29 Furthermore, it cultivates habits of self-reflection and self-correction in clinical practice, promoting a culture of continuous self-improvement.

Conclusion

Compared with traditional instruction, the mobile video feedback method demonstrates significant advantages in abscess incision and drainage training. Students receiving mobile video feedback achieved higher procedural assessment scores on simulation manikins, with particularly substantial improvements observed among initially low-performing students. Mini-CEX evaluations further confirmed superior performance in essential clinical domains including clinical judgment, physical examination, organizational ability, and overall clinical competence. Additionally, this approach yielded significantly higher student satisfaction ratings, particularly regarding acceptance of the teaching methodology, comprehension of learning content, and capacity for tool-supported self-directed learning. These findings indicate that the mobile video feedback method effectively enhances understanding, procedural proficiency, and self-correction capabilities in clinical skills training, with particular benefit for students experiencing initial performance challenges. Therefore, implementation of mobile video feedback in clinical skills instruction is recommended to achieve more favorable educational outcomes.

Supplemental Material

sj-xls-1-mde-10.1177_23821205251408676 - Supplemental material for Practical Efficacy of the Mobile Video Feedback Method in Teaching Clinical Abscess Incision and Drainage Skills

Supplemental material, sj-xls-1-mde-10.1177_23821205251408676 for Practical Efficacy of the Mobile Video Feedback Method in Teaching Clinical Abscess Incision and Drainage Skills by Chunmu Miao, Feng Li, Daiwen Su and Wenfeng Zhang in Journal of Medical Education and Curricular Development

Supplemental Material

sj-docx-2-mde-10.1177_23821205251408676 - Supplemental material for Practical Efficacy of the Mobile Video Feedback Method in Teaching Clinical Abscess Incision and Drainage Skills

Supplemental material, sj-docx-2-mde-10.1177_23821205251408676 for Practical Efficacy of the Mobile Video Feedback Method in Teaching Clinical Abscess Incision and Drainage Skills by Chunmu Miao, Feng Li, Daiwen Su and Wenfeng Zhang in Journal of Medical Education and Curricular Development

Supplemental Material

sj-docx-4-mde-10.1177_23821205251408676 - Supplemental material for Practical Efficacy of the Mobile Video Feedback Method in Teaching Clinical Abscess Incision and Drainage Skills

Supplemental material, sj-docx-4-mde-10.1177_23821205251408676 for Practical Efficacy of the Mobile Video Feedback Method in Teaching Clinical Abscess Incision and Drainage Skills by Chunmu Miao, Feng Li, Daiwen Su and Wenfeng Zhang in Journal of Medical Education and Curricular Development

Footnotes

Acknowledgments

The authors express their appreciation to the Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University and the Surgical Training Center and Clinical Skills Training Center at the Second Affiliated Hospital of Chongqing Medical University.

ORCID iD

Wenfeng Zhang

Ethics Approval and Consent to Participate

This study was approved by the Ethics Committee of Chongqing Medical University. Written consent was obtained from all the participating students.

Author Contributions

Wenfeng Zhang designed this experiment. Chunmu Miao, Feng Li, and Daiwen Su collected and analyzed the data. Wenfeng Zhang and Chunmu Miao completed the manuscript and authorized the publication of the manuscript.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Natural Science Foundation of China, Natural Science Foundation of Chongqing Municipality, the Nanan District Health Commission and the Nanan District Science and Technology Bureau of Chongqing Municipality and Kuanren Talents Program of the Second Affiliated Hospital of Chongqing Medical University (grant numbers 82272203, CSTB2023NSCQ-MSX0214, CSTB2024NSCQ-MSX0203, 2024-01 and kryc-yq-2209).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Supplemental Material

Supplemental material for this article is available online.

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