Assessing clinical skills through the examiner's eyes

Assessing the clinical skills of medical students before they enter real-world patient care is a critical component of medical education. While medical training provides students with essential knowledge, it is equally important to ensure they can apply that knowledge safely and effectively in clinical settings. To evaluate this readiness, medical schools widely use the Objective Structured Clinical Examination (OSCE), a competency-based assessment that measures practical skills, communication, professionalism, and clinical decision-making through standardized clinical scenarios.

Despite its value, the OSCE is resource intensive, requiring trained evaluators, support staff, and substantial logistical coordination to maintain assessment quality. Video recording is often used to support documentation and post-examination review, but conventional fixed cameras can struggle to capture fine procedural details because of limited viewing angles, distance from the examinee, and visual obstructions. To address these challenges, researchers in Japan investigated whether an examiner-worn, neck-mounted camera (THINKLET) could supplement the observation and review of clinical skills during OSCE assessments. Assistant Professor Miwa Sekine explains, “We investigated whether this camera could help evaluators confirm fine procedural skills in OSCE assessments and facilitate post-examination review.” The study was published in JMIR Medical Education on May 27, 2026.

The researchers evaluated the technology in a simulated OSCE focused on 12-lead electrocardiogram (ECG) electrode placement, a procedure that requires accurate identification of anatomical landmarks and precise hand movements. A fifth-year medical student served as the examinee, while nine experienced medical educators acted as evaluators. During the live assessment, evaluators scored performance using a 26-item checklist while both a neck-mounted camera and fixed cameras recorded the examination. After a one-month washout period, the evaluators reassessed performance using the wearable-camera footage. The researchers then compared live and video-based scores, examined how many checklist items could be reliably evaluated from each camera type, and gathered feedback on the device’s usability.

The results showed moderate to strong agreement between live and video-based assessments, with Cohen’s kappa values ranging from 0.258 to 0.913 (mean 0.67), indicating varying but generally favorable agreement between live and video-based assessments. Most checklist items achieved agreement rates of 75%–100%. Notably, the neck-mounted camera enabled more observations to be evaluated than the fixed camera, producing 206 evaluable observations compared with 185. This advantage was most apparent for tasks requiring close visualization of hand movements and ECG electrode placement. Evaluators also expressed overall support for incorporating video-based assessments into future OSCE practice. However, they identified several practical challenges, including audio limitations, occasional obstruction of the field of view, device slippage, heat generation, and difficulties handling evaluation forms while wearing the camera.

Overall, the findings suggest that examiner-worn, neck-mounted cameras could serve as a valuable complement to conventional recording methods in the OSCE. Dr. Sekine noted, “Combining a neck-mounted wearable camera with a fixed camera may help supplement the observation of detailed procedural steps, supporting the documentation of OSCE assessments and post-examination review.” She adds, “Such an approach could provide an additional option for supporting documentation and review of OSCE assessments, particularly in settings where evaluator resources are limited.”

Although larger studies involving multiple institutions and a broader range of clinical scenarios are needed, this pilot study highlights the potential of wearable recording technology to enhance the evaluation of procedural skills. As medical education continues to emphasize competency-based assessment, examiner-worn cameras may offer a promising approach for supporting OSCE review and improving documentation of procedural skills, although further validation is needed.

About Assistant Professor Miwa Sekine
Dr. Miwa Sekine is a researcher in the Division of Medical Education at Juntendo University. She holds a Ph.D. and has interdisciplinary expertise spanning medical education, public health, epidemiology, and clinical research.  Dr. Sekine has made notable contributions to advancing clinical research education, postgraduate medical training, and innovative methods for assessing clinical skills. Her work has helped strengthen healthcare education and physician training practices, supporting the development of more effective medical education programs across Japan.

About Professor Yuji Nishizaki

Dr. Yuji Nishizaki, MD, MPH, PhD, is a Professor at Juntendo University, Japan, with expertise in medical education, physician training, and clinical research education. He has made significant contributions to competency-based assessment, residency training programs, and innovative approaches to evaluating clinical skills. He has also mentored numerous researchers in the fields of medical education and clinical research.

About Professor Yuichi Tomiki
Dr. Yuichi Tomiki, MD, PhD, is a Professor of Medical Education and Coloproctological Surgery at Juntendo University, Japan. His academic and clinical expertise spans competency-based medical education, Objective Structured Clinical Examinations (OSCEs), assessment methodologies, and clinical skills training. He has made significant contributions to the advancement and implementation of structured medical education frameworks and clinical competency assessment systems at Juntendo University, strengthening both undergraduate and postgraduate medical training.

Reference
Authors: Miwa Sekine¹, Yuji Nishizaki¹, Amane Endo¹, Takasuke Ogawa¹, Yoshihide Takeshita¹, Motomi Nasu¹, Hiroo Wada¹, Chizuko Miyamoto², Michiko Oguro³, Chie Otake², Yasuhiko Konishi¹, and Yuichi Tomiki¹
DOI: https://doi.org/10.2196/87483
Affiliations:
¹Division of Medical Education, Faculty of Medicine, Juntendo University, Japan
²Chiba Faculty of Nursing, Tokyo Healthcare University, Japan
³Graduate School of Nursing Science, St. Luke's International University, Japan

History of Juntendo University
Juntendo was originally founded in 1838 as a Dutch School of Medicine at a time when Western medical education was not yet embedded as a normal part of Japanese society. With the creation of Juntendo, the founders hoped to create a place where people could come together with the shared goal of helping society through the powers of medical education and practices. Their aspirations led to the establishment of Juntendo Hospital, the first private hospital in Japan. Through the years the institution's experience and perspective as an institution of higher education and a place of clinical practice has enabled Juntendo University to play an integral role in the shaping of Japanese medical education and practices. Along the way the focus of the institution has also expanded, now consisting of nine undergraduate programs and six graduate programs, the university specializes in the fields of health science, health and sports science, nursing health care and sciences, and international liberal arts, as well as medicine. Today, Juntendo University continues to pursue innovative approaches to international level education and research with the goal of applying the results to society.

Mission Statement
The mission of Juntendo University is to strive for advances in society through education, research, and healthcare, guided by the motto “Jin – I exist as you exist” and the principle of “Fudan Zenshin - Continuously Moving Forward”. The spirit of “Jin”, which is the ideal of all those who gather at Juntendo University, entails being kind and considerate of others. The principle of “Fudan Zenshin” conveys the belief of the founders that education and research activities will only flourish in an environment of free competition. Our academic environment enables us to educate outstanding students to become healthcare professionals patients can believe in, scientists capable of innovative discoveries and inventions, and global citizens ready to serve society.