# AI-Assisted Competency Assessment from Egocentric Video in Simulation-Based Nursing Education

arXiv: https://arxiv.org/abs/2605.20233 · HTML: https://mlsanity.com/paper/2605.20233/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 6 of its 33 references that are in the map.
- First posted on arXiv 16 May 2026.

## Builds on (most cited first, 6 of 6)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [DINOv2: Learning Robust Visual Features without Supervision](https://mlsanity.com/paper/2304.07193/) (2023)
- [Temporal Action Segmentation: An Analysis of Modern Techniques](https://mlsanity.com/paper/2210.10352/) (2022)
- [Video-based surgical skill assessment using 3D convolutional neural networks](https://mlsanity.com/paper/1903.02306/) (2019)
- [Multimodal Integration of Human-Like Attention in Visual Question Answering](https://mlsanity.com/paper/2109.13139/) (2021)

## Abstract (arXiv)

Assessing learner competency in clinical simulation requires expert observation that is time-intensive, difficult to scale, and subject to inter-rater variability. Vision-language models have emerged as a promising tool for understanding complex visual behavior. In this work, we investigate whether visual observations can provide educationally meaningful signals for competency assessment through a three-stage framework that (1) extracts action timelines from egocentric nursing simulation video using frozen visual encoders and few-shot learning, (2) derives sequence-level features and per-session recognition metrics, and (3) relates these to instructor-rated competency. Across 22 densely annotated sessions (3.8 hours, 493 actions), a frozen DINOv2 backbone with HMM Viterbi decoding achieves 57.4% MOF in leave-one-out 1-shot recognition. Surprisingly, we observe a negative trend between recognition accuracy and competency (rho = -0.524, p = 0.012 for mIoU), robust to six confound controls: more competent students produce diverse, harder-to-classify workflows, while simple sequence features show no such relationship. Per-item analysis identifies patient safety protocols and team communication as the expected behaviors most reflected in this pattern, and process model comparisons reveal that higher-competency students exhibit more protocol-consistent action transitions. These findings suggest that recognition accuracy may complement predicted action timelines as a pedagogically informative signal in automated competency assessment.