AUC Academic Conference 'From Virtual to Reality' The University of
Queensland 1996AUC Academic Conference 'From Virtual to Reality' The University of
Queensland 1996
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Paper Title:
Design and Implementation of Internet-based Multimedia Tutorials for Medical Teaching
Presenter:
Associate Professor Zoltan H Endre, The University of Queensland
Authors
Associate Professor Zoltan H Endre,
Department of Medicine, The University of Queensland
George K F Pang,
Prentice Computer Centre, The University of Queensland
Keywords: WWW-Teaching, Medical-PBL
Faculty area: Deputy Dean (Graduate Medical Curriculum)
Introduction: the development of PBL tutorials
The new medical curriculum at the University of Queensland (UQ GMC) has taken several bold inititives. Most dramatic was the choice of the Medical Faculty to embrace a hybrid curriculum embodying problem based learning in addition to the integrated incorporation of traditional lectures, tutorial and practical classes. In the final development of the process, it was decided to deliver the problem-based tutorials over a high speed WWW-based medical intranet and to use videoconferencing to facilitate delivery of some of the expert tutorials to multiple groups simultaneously.
Problem based learning tutorials involve a progressive and controlled release of information about a medical problem. This information must be digested and the students must form their own learning objectives depending on their own perceived knowledge base. The students are presented with material, which uses real medical presentations. The learning objectives are triggered by any combination of textual description, static or dynamic medical quality images (high resolution & high colour) and auditory stimuli. Fundamentally, the material to be "learnt " is highlighted by obvious examples which allow the students to identify their lack of knowledge about some fundamental aspect of the problem. Most simplistically, the normal is emphasised by the abnormal, function by its absence. The students then go and research and learn material driven by the need to understand the learning objctives they have defined themselves. Lab practicals and lectures and expert tutorials complement this process by delivering material which is relevant but doesn't necessarily solve the problem for the students. This requires careful integration and often limitation of the traditional "expert-centred" teaching so that learning becomes "student-centred". A concrete example is summarised below.
For example, to develop an interest in understanding renal function, the course of a patient suffering major trauma is followed from the time of admission to hospital, and emergency surgical treatment through a phase of reduced urine output and abnormal serum biochemistry which reflect the sudden loss of kidney function (acute renal failure) which has resulted from severe blood loss sustained during the initial trauma. To implement this flow of knowledge requires text describing the patient's clinical course in hospital, images of X Rays showing fractured bones and pulmonary oedema, tables showing the abnormal blood and urine biochemistry which highlight reduced renal tubular function, a video clip illustrating haemodialysis and examples of the renal histology obtained by renal biopsy performed because of delayed recovery of renal function.
The Medical Intranet for PBL tutorial delivery
The cross platform and mutiuser character of the internet has provided the ideal model for delivery of PBL tutorials to mutiple sites. The advent of the high speed intranet has overcome the shortcomings of internet/wide area networks (security, speed, stability, flexibility). This has revolutionised the delivery of teaching resources in the UQ GMC from the traditional paper and lecture-based model. The ability to distribute information that is both media rich and dynamic is a feature unique to this model. By using a WEB-based model there is simplified and cost effective access to a broad range of media otherwise expensive to reproduce or difficult to disseminate. For example, consider the cost of creating XRAYs or colour prints of histological material or patient photographs and providing one for each student (240 copies) or one per tutorial room (14 copies) or one per student group (18 copies) per year compared with the cost of a single copy of each on the WEBSite. Almost more compelling is the difficulty and cost when one of these fixed resources needs to be edited or replaced. Even if cost of editing and replacement were not a consideration (does this senario exist?) there is strong inertia acting as an impediment to a complex editing process which may include many steps starting with the identification of the problem to its ultimate correction, reproduction and dissemination. This is especially true if the media are distributed via CD. CD Rom was considered for this task and rejected for its long and costly edit-dissemination cycle.
For these reasons, the WEB-based high speed intranet was the medium of choice for the UQ GMC. The network was designed for high bandwidth applications such as multimedia and videoconferencing (Fig. 1) . The structure is based on local intranets coupled together with ATM. The intranets localise network traffic and minimise the resources required for implementation.
The core of the WEBSite is centred around a dynamic WEB-page building server. This allows HTML documents to be created on the fly from a medical case database (Fig. 2). A strength of this arrangement is that direct edits, additions and deletions are immediately reflected in the WEBSite, all associated links being instantaneously updated as appropriate. Such editing can be performed remotely and easily through a WEB browser. Editors are guide through the editing process with prompts. Web-based information sources can be distributed and updated immediately from local or remote sites - empowering the author of the material in the process of dissemination itself. Timeliness is also added, so that teaching materials may increase their educational value by being able to quickly intergrate current issues into the course (eg. a E.Coli food poisoning case could be integrated into the course when there is a food poisoning issue in the news). Another great strength of this configuration is the ability to index all the teaching material. For the purposes of teaching, this will allow constant monitoring of case content. For example it possible to search all the cases for related to renal pathology, etc..
The basis of PBL delivery is the controlled flow of information. In PBL mode, students are not allowed to progress before they have brainstormed a trigger sufficiently (ie identified the problem, formulated a hypothesis, and synthesised the problem and identified the learning objectives which need to be researched): the traditional PBL tutorial relies on paper text, XRAYS etc which the tutor hands out when these steps have been covered. In the intranet implementation, permission to progress in our delivery is carried out at the server/database level after authorisation by the tutor (ie. even if the student has the URL and the adequate student level permissions, the information will not be accessible until the tutor has granted tutor level permissions).
A suite of resources were implemented to the wide range of Faculty resources. The elements required included bulletin boards. The digital nature of these allow for prioritisation, and sorting to allow students to focus on the issue in question. One bulletin board is provided for students allowing for discussion of student issues and events, another for staff for a similar purpose and yet another, a joint board, for sending questions from the students to the staff and for having qualified answers viewable to all. Having this service will allow a compilation of frequently asked questions, which will in future reduce the question load. Both groups require Help facilities, and the students also need timetables, questions for formative assessment, access to student support services and to have access to reviewed and approved WEBSites, expanding on the available quality teaching material. Questions for evaluation of the tutorials also need inclusion for selective Problem evaluation and review.
Multimedia has become the buzz word of the nineties, but has been traditionally hard to intergrate rapidly into teaching materials. The database model allows for painless integration, as the database knows of the possible properties of each multimedia object, and if not specified, its default settings (Fig. 3). Apple's Quicktime Media Layer (QTML), including Quicktime and Quicktime VR, facilitate the inclusion of videoclips showing media which cannot be done in any other way, eg the clinical examination and important clinical signs. Sunsoft's Java will allow implementation of almost an infinitely flexible or as complex an interactive experience as could be desired. This allows the inherent advantages of a dynamic system like the web, to be applied directly to educational practices - allowing the flexibility of a client/server system into the classroom and lecture theatre.
Quicktime Conferencing was chosen to provide video conferencing for expert tutorials. Additionally, interaction betweeen staff and students as well as with other staff will be facilitated through this technology, which should substantially reduce travelling time for staff between multiple campuses.Videoconferencing is becoming more of everyday reality in medicine and especially in the field of medical imaging. The ability for remote expert diagnosis and in UQ GMC's case, tutorials has meant a far greater coverage from otherwise overstretched staff, allowing tutorials to not only a larger number of students but maintain the interactions consistent of smaller work groups. A shared white board allows multiple parties to view a medical quality picture (be it histology, X-Ray, etc) or a movie highlighting clinical features or assessment of individual skills within groups by a remote tutor. Video conferencing is not limited to our intranet, or for that matter even the internet. Several machines will also have ISDN capability allowing interaction with industry standard H.320 video conferencing systems (especially important in this setting since local department of health has opted for a H.320 system in all its hospitals - this will facilitate access of health care professionals to Faculty teaching staff for continuing medical education or enhancement of student teaching and supervision). The package thus provides for an information technology highway from the undergraduate to the level of the health care provider and beyond.
The implementation of PBL tutorials on a dynamic WEB-site serving multiple tutorial rooms simutaneously, with 30 out of 134 problems already developed for the new UQ GMC has provided an excellent solution.
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Associate Professor Zoltan H Endre,
Department of Medicine,
George K F Pang,
Prentice Computer Centre,
Royal Brisbane Hospital,
The University of Queensland
St Lucia
Queensland 4072Ph: +61 7 3365 5217
Fax : +61 7 3365 5462
Email: endre@medicine.herston.uq.edu.auBack to Home Page ...... by Presenter ...... by Paper Title ...... by Keyword
