Physical and biophysical markers of assessment in medical training: A scoping review of the literature

Abstract

Purpose

Assessment in medical education has changed over time to measure the evolving skills required of current medical practice. Physical and biophysical markers of assessment attempt to use technology to gain insight into medical trainees’ knowledge, skills, and attitudes. The authors conducted a scoping review to map the literature on the use of physical and biophysical markers of assessment in medical training.

Materials and methods

The authors searched seven databases on 1 August 2022, for publications that utilized physical or biophysical markers in the assessment of medical trainees (medical students, residents, fellows, and synonymous terms used in other countries). Physical or biophysical markers included: heart rate and heart rate variability, visual tracking and attention, pupillometry, hand motion analysis, skin conductivity, salivary cortisol, functional magnetic resonance imaging (fMRI), and functional near-infrared spectroscopy (fNIRS). The authors mapped the relevant literature using Bloom’s taxonomy of knowledge, skills, and attitudes and extracted additional data including study design, study environment, and novice vs. expert differentiation from February to June 2023.

Results

Of 6,069 unique articles, 443 met inclusion criteria. The majority of studies assessed trainees using heart rate variability (n = 160, 36%) followed by visual attention (n = 143, 32%), hand motion analysis (n = 67, 15%), salivary cortisol (n = 67, 15%), fMRI (n = 29, 7%), skin conductivity (n = 26, 6%), fNIRs (n = 19, 4%), and pupillometry (n = 16, 4%). The majority of studies (n = 167, 38%) analyzed non-technical skills, followed by studies that analyzed technical skills (n = 155, 35%), knowledge (n = 114, 26%), and attitudinal skills (n = 61, 14%). 169 studies (38%) attempted to use physical or biophysical markers to differentiate between novice and expert.

Conclusion

This review provides a comprehensive description of the current use of physical and biophysical markers in medical education training, including the current technology and skills assessed. Additionally, while physical and biophysical markers have the potential to augment current assessment in medical education, there remains significant gaps in research surrounding reliability, validity, cost, practicality, and educational impact of implementing these markers of assessment.

Keywords:

• Assessment
• competency-based medical education
• technology
• scoping review

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Danielle T. Miller: Study concept and design, abstract and text review, charting and analyzing the data, drafting the manuscript, critical review and final approval of the manuscript. Sarah Michael: Study concept and design, abstract and text review, charting and analyzing the data, drafting the manuscript, critical review and final approval of the manuscript. Colin Bell: Study concept and design, abstract and text review, charting and analyzing the data, critical review and final approval of the manuscript. Cody H. Brevik: Study concept and design, abstract and text review, charting and analyzing the data, critical review and final approval of the manuscript. Bonnie Kaplan: study concept and design, abstract and text review, charting and analyzing the data, critical review and final approval of the manuscript. Ellie Svoboda: Development of search protocol, drafting the manuscript, critical review and final approval of the manuscript. John Kendall: Study concept and design, abstract and text review, charting and analyzing the data, critical review and final approval of the manuscript.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Danielle T. Miller

Danielle T. Miller is an Assistant Professor, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States. Dr. Miller is a grant-funded medical education researcher with multiple publications in competency-based medical education and assessment. She received her masters in Medical Education from University of Cincinnati. Her current research is in the integration of technology into assessment.

Sarah Michael

Sarah Michael is an Assistant Professor, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States. She is the director of the Medical Education Fellowship and has multiple publications in program assessment and development of non-technical skills curricula.

Colin Bell

Colin Bell is an Assistant Professor, Department of Emergency Medicine, University of Calgary, Canada.

Cody H. Brevik

Cody H. Brevik is a Clinical Instructor, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States with research interests in technology and education.

Bonnie Kaplan

Bonnie Kaplan is an Associate professor, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States. She served as residency program director for many years and currently is co-director of the school of medicine’s LCME accreditation process.

Ellie Svoboda

Ellie Svodoba is an Education Informationist, Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.

John Kendall

John Kendall is a Professor, Department of Emergency Medicine, Stanford School of Medicine, Palo Alto, California, United States. Dr. Kendall is a leader in ultrasound education and serves as a board member for the American Board of Emergency (ABEM).