Open Access Research article

A prospective, blinded evaluation of a video-assisted ‘4-stage approach’ during undergraduate student practical skills training

Katrin Schwerdtfeger1, Saskia Wand1, Oliver Schmid1, Markus Roessler1, Michael Quintel1, Kay B Leissner2 and Sebastian G Russo1*

Author Affiliations

1 Department of Anaesthesiology, University Hospital Göttingen, Göttingen 37075, Germany

2 VA Boston Healthcare System, Boston, MA, USA

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BMC Medical Education 2014, 14:104  doi:10.1186/1472-6920-14-104

Published: 22 May 2014



The 4-stage approach (4-SA) is used as a didactic method for teaching practical skills in international courses on resuscitation and the structured care of trauma patients. The aim of this study was to evaluate objective and subjective learning success of a video-assisted 4-SA in teaching undergraduate medical students.


The participants were medical students learning the principles of the acute treatment of trauma patients in their multidiscipline course on emergency and intensive care medicine. The participants were quasi- randomly divided into two groups. The 4-SA was used in both groups. In the control group, all four steps were presented by an instructor. In the study group, the first two steps were presented as a video. At the end of the course a 5-minute objective, structured clinical examination (OSCE) of a simulated trauma patient was conducted. The test results were divided into objective results obtained through a checklist with 9 dichotomous items and the assessment of the global performance rated subjectively by the examiner on a Likert scale from 1 to 6.


313 students were recruited; the results of 256 were suitable for analysis. The OSCE results were excellent in both groups and did not differ significantly (control group: median 9, interquantil range (IQR) 8–9, study group: median 9, IQR 8–9; p = 0.29). The global performance was rated significantly better for the study group (median 1, IQR 1–2 vs. median 2, IQR 1–3; p < 0.01). The relative knowledge increase, stated by the students in their evaluation after the course, was greater in the study group (85% vs. 80%).


It is possible to employ video assistance in the classical 4-SA with comparable objective test results in an OSCE. The global performance was significantly improved with use of video assistance.

Teaching methods; Medical students; Trauma care