Designing demonstration for learning: Experimental evidence on demonstration format and camera perspective in psychomotor nursing skills education.

BACKGROUND: Demonstration is a core instructional strategy in psychomotor skills education. While video-based demonstration is increasingly used, evidence comparing its effectiveness with traditional live demonstration remains mixed, and the impact of camera perspective on skill performance remains unclear in nursing and midwifery education. AIM: This study aims to determine whether demonstration format and camera perspective influence initial performance among novice nursing and midwifery students. METHODS: Two experimental studies using post-test-only randomised controlled designs were conducted. Participants were first-year nursing and midwifery students with no prior experience in the target psychomotor skills. In Study 1, skills lab sessions were cluster-randomised to an instructor-led live or a self-paced, standardised video demonstration format for intramuscular injection and venepuncture. In Study 2, students were individually randomised to view a first-person or third-person video demonstration for wound care and hand disinfection. Students performed each skill individually after the demonstration and prior to deliberate practice. Performance was assessed using objective measures, and outcomes were analysed using linear mixed-effects models (Study 1) and analysis of covariance (Study 2), adjusting for relevant student and procedural characteristics. RESULTS: Across both studies, analyses included 518 individual student performances. In Study 1, students who observed self-paced, standardised video demonstrations achieved higher initial performance scores than those who observed instructor-led live demonstrations for intramuscular injection (n = 118) and venepuncture (n = 145). In Study 2, no statistically significant performance differences were detected between first-person and third-person video perspectives for wound care (n = 77) and hand disinfection (n = 178). These findings should be interpreted cautiously given limited statistical sensitivity for wound care and ceiling effects in hand disinfection outcomes. Exploratory analyses suggested variability across skills and cohorts, while associations with student and procedural characteristics differed across outcomes. CONCLUSION: The self-paced, standardised video demonstration format was associated with higher initial psychomotor nursing skill performance than the instructor-led live demonstration format. This advantage likely reflects differences in instructional features, including learner control, repeatability, and standardisation, rather than the video medium itself. No statistically detectable effects of camera perspective were observed, although findings should be interpreted cautiously given the limited sensitivity to detect small effects. These findings suggest that instructional characteristics embedded within demonstration formats play a meaningful role in early psychomotor skill acquisition, particularly when it affords learner control, repeatability, and standardisation. The instructional value of camera perspective may depend on the cognitive and visuospatial demands of the task.