The Use of Multimedia to Promote Safety and Disseminate New

Information in the OR

Boston University School of Medicine

May 5, 2005

Rafael Ortega, MDAssociate Professor of Anesthesiology

1st Annual Ellison Pierce Symposium

Positioning Your Anesthesia Practice for the Future

• Define “Multimedia”

• Summarize the history of multimedia

• Clarify copyright law and multimedia

• Compare multimedia to traditional teaching techniques

• Review the “academic merit” of publishing in multimedia

• Identify the equipment and software to create multimedia

• Learn how to evaluate multimedia applications

• To discuss multimedia and ARS use for education and training.

• To explain the advantages and disadvantages of ARS.

• Present our multimedia projects

Objectives

Instructional Approach

Teaching to the

TOP

of the class

(challenging the rest)

Teaching to the

BOTTOM

of the class

(safety issues)

Using, involving, or encompassing several media (also, an approach to learning)

Source: Merriam-Webster’s Collegiate Dictionary

The term first appeared 1962

Multimedia: Definition

PhotographyVideo

AnimationIllustration

Text

MusicSound Effects

Narration

Touch?

Media

Multimedia is effective because humans are multimedia communicators

words alone (verbal): 7 %

tone and inflection: 38 %

facial expressions/gestures 55 %

Impact of face-to-face communication

Source: University of Minnesota Digital Media Center

Why it is Effective

People recall:

20 % of what they see

40 % of what they see and hear,

70 % of what they see, hear, and do.

Multimedia allows for seeing, hearing, and doing.

Source: University of Minnesota Digital Media Center

Why it is Effective

People cannot easily retain specific steps in a process without text.

Text can be used to reinforce other media

For a group of experts, hypertext may dominant(they can process information faster and faster and more strategically than with audio or video)

Text Learning

Multimedia: Advantages

• Interactive: allows the consumer to “drive” the product

• Non-linear

• Combines play and information. Crucial for children

• Allows training: hazardous environments, simulations

• Mixing media allows for sensory immersion

• Uses each media for its own particular strengths

• The hard/software have not reached maturity: no standards

• Copyright still requires standardization.

• Multimedia requires skills in sound, images, text and programming.

• CD ROM multimedia is still relatively small

• Retail prices are considered high by many consumers.

• Production/marketing costs for are high making it difficult for a small developer to survive.

• Much multimedia has been 'shovelware’.

Multimedia: Disadvantages

Multimedia: “buzzword” in 1993

In 1993: 3.6 million multimedia PCs in USA

The buyer's average income was $39,000

Male-dominated market

In 1994: from 3.6 million to 11.4 million multimedia PCs .

Little profit for producers: Production costs are high!

Multimedia: History

Beliefs (among medical educators) re: multimedia

• It is as effective as traditional methods

• Makes problem based learning easier (less inhibiting)

• Personalizes instruction: learner-centered learner-paced

learner-controlled

Medical Education Application

The supplement: some or all of the learners use multimedia in addition to other resources.

The alternative: one set uses multimedia, the seconduses another resource. Neither has access to the other’s resource.

Research Problems

©

Copyright Law & Multimedia

1. Copyright law: protects original "works of authorship.“

2. Patent law: protects new, useful, and "nonobvious” inventions and processes.

3. Trademark law: protects words, names, and symbols used by manufacturers and businesses to identify their goods and services.

4. Trade secret law: protects valuable information not generally known that has been kept secret by its owner.

Intellectual Property: Laws

Literary works. Novels, nonfiction prose, poetry, newspaper articles and newspapers, magazine articles and magazines, computer software, software manuals, training manuals, manuals, catalogs, brochures, ads (text), and compilations such as business directories. Musical works. Songs, advertising jingles, and instrumentals. Dramatic works. Plays, operas, and skits. Pantomimes and choreographic works. Ballets, modern dance, jazz dance, and mime works. * Pictorial, graphic, and sculptural works. Photographs, posters, maps, paintings, drawings, graphic art, display ads, cartoon strips and cartoon characters, stuffed animals, statues, paintings, and works of fine art. Motion pictures and other audiovisual works. Movies, documentaries, travelogues, training films and videos, television shows, television ads, and interactive multimedia works. Sound recordings. Recordings of music, sounds, or words., Etc., Etc., Etc…………………………

Works Protected

Copyright protection arises automatically when an "original" work of authorship is "fixed" in a tangible

medium of expression.

Registration with the Copyright Office is optional!

(but you have to register before you file an infringement suit).

Copyright Protection

Original: if it owes its origin to the author and was not copied from some preexisting work.

Fixed: if it is made "sufficiently permanent or stable to permit it to be perceived, reproduced, or otherwise communicated for a period of more than transitory duration.

Copyright: Definitions

The life of the author plus 50 years

(for works created on and after January 1, 1978)

(For "works made for hire”: 75 years from the date of first "publication” or 100 years from the date of creation, whichever expires first).

How Long Does Copyright Last?

• “It doesn't have a copyright notice on it, so it's not copyrighted.”

• “I don't need a license. I'm using only a small amount of the copyrighted work.”

• “I'm planning to give credit to all authors, I don't need to get licenses.”

• “My work will be a showcase for the copyright owner's work. The owner will not object to my use of the work.”

• “I'm going to alter the work I copy. I don't need a license.”

• “If I find something on the Net, it s okay to copy it.”

Copyright: Myths

• Purpose and character of use (education, comment, critique)

• Nature of the copyrighted work (factual vs. creative)

• Amount and substantiality of the portion used

• Effect on the potential market value of the protected work

“Fair Use”

BUMC Anesthesia Computer-AssistedInstruction Evolution

• Multimedia Lab

• Available computers

• Digital Cameras

• Digital Video Cameras

• DVD Production

• Computer Network

…from simple text tutorials/quizzes to DVD and Internet

Materials Produced

• Medical Student Tutorials

• Interesting DVD Case Collection

• Audio CD (for instruction)

• Scientific Exhibits

• Peer Reviewed Publications

• Commercial Products (for industry)

Using Digital Media

The organization could not exist in its present form without the (digital) aid of:

• Internet based scheduling

• Alpha-numeric pagers/phones

• Audio CD (clinical updates)

• DVD (clinical / administrative procedures)

• Audience Response System

Audience Response System (ARS) Defined

A technology allowing participants to respond with an interactive keypad

to questions posed by the lecturer with immediate graphic feedback.

Audience Response Systems

• More common with game shows, debates and corporate conferences and training workshops.

• Increasingly common in universities and colleges.

• Body of literature on ARS beginning to grow (relatively new technology)

Main Components

centralized receiver individual transmitters

Infrared Wireless Keypads

• Compact, lightweight

• 2 way confirmation

• Continues to transmit until transmission received

• Can be used in multiple rooms if not connected by a visual open space

• No FCC or international licenses needed

Radio Frequency Wireless Keypads

• Reliable, barrier-free operation

• Uses license free frequencies

Software

• Key component

• Usually bundled with ARS

• Integrates easily with PowerPoint

• Records and stores responses

• Varies with different vendors

Basic Concept

Disclosure Policy

It is the policy of

Boston University School of Medicine

that faculty disclose to program participants

any real or apparent conflict of interest.

NO50%

YES50%

Have you ever used an Audience Response System before?

1. YES2. NO

Effectiveness = knowledge gained

Efficiency = knowledge gained / time unit

Effectiveness vs. Effectiveness

“Utilization of an Audience Response System”

• Increased attendance by 50% (sustained for 2+ years)

• Enhanced enthusiasm

• Survey results: educational, valuable and fun.

Homme J, Asay G, Morgensten B. Medical Education 2004; 38: 545

Mayo Clinic Pediatric residency program weekly board review voluntary conference

“Impact of an Audience Response System”

• Used in 15 conferences

• In 67% of conferences, audience opinion changed

• “The quality of the clinical question and the degree of

uncertainty among the audience can be instantly assessed

with the ARS.”

• Allows for evaluation of changing audience opinion after a

presentation

• Immediate feedback deeper discussion

Eggert CH, West CP, Thomas KG. Medical Education 2004; 38: 576(Mayo Clinic Internal Medicine Residency Program Decision Making Conference)

“Audience Response System: Effect on Learning in Family Medicine Residents”

• 24 Family Medicine residents

• Didactic lectures with and without ARS

• Audience interaction with ARS was associated with improved learning outcomes

Schackow TE, Chavez M, Loya L, Friedman M

Family Medicine 2004; 36(7): 496-504

(Department of Family Medicine University of Illinois at Chicago)

“Experiences of using an interactive audience response system in lectures.”

• Evaluated use in pediatric courses

• Usually ~6 questions per 45 minute lecture

Uhari M, Renko M, Soini H

BMC Medical Education 2003; 3:12

(Department of Pediatrics, University of Oulu, Finland)

Student Attendance & Activity

Uhari M, Renko M, Soini H. “Experiences of using an interactive audience response system in lectures.” BMC Medical Education 2003; 3:12

Student Opinion of Voting

Uhari M, Renko M, Soini H. “Experiences of using an interactive audience response system in lectures.” BMC Medical Education 2003; 3:12

“Touch-Pad Technology: Immediate feedback for resident educators in teenage reproductive health.”

• Allowed teens to respond “candidly and anonymously”.

• Guided educator’s lecture focus

• Activity provided a link between community and university

Winsor SHM, Case AM, Kwon JS, Reid RL

Obstetrics & Gynecology 1999; 93: 790-794

(Department of OBGYN, Queen’s University, Ontario, Canada)

“Using an audience response system to teach about physician-industry interactions”

• Aimed to “stimulate thought and self-reflection”

• “forced” participants to declare their positions on pertinent questions

• “enriches and improves” the discussion

• Good means to begin a process of attitude and behavior change where appropriate

Stellini M

Journal of General Internal Medicine 2004; 19: 99

(Wayne State University, Detroit)

Student Responses (n=43)

The use of the ARS in class was preferable to going through the lecture slides alone:

0

10

20

30

40

50

60

70

stronglyagree

agree neitheragree nordisagree

disagree stronglydisagree

noanswer

‘Learning by Remote Control’: Exploring the use of an audience response system as a vehicle for content delivery.

Williams, JB. Proceedings of the 20th Annual Conference of the Australian Society for Computers in Learning in Tertiary Education. Adelaide, 7-10 December 2003.

The quality of discussion which followed each ARS question deepened my learning in the class:

0

10

20

30

40

50

60

70

stronglyagree

agree neitheragree nordisagree

disagree stronglydisagree

noanswer

‘Learning by Remote Control’: Exploring the use of an audience response system as a vehicle for content delivery.

Student Responses (n=43)

Williams, JB. Proceedings of the 20th Annual Conference of the Australian Society for Computers in Learning in Tertiary Education. Adelaide, 7-10 December 2003.

I was more likely to respond/participate/engage with the context because of the anonymity:

0

10

20

30

40

50

60

70

stronglyagree

agree neitheragree nordisagree

disagree stronglydisagree

noanswer

‘Learning by Remote Control’: Exploring the use of an audience response system as a vehicle for content delivery.

Student Responses (n=43)

Williams, JB. Proceedings of the 20th Annual Conference of the Australian Society for Computers in Learning in Tertiary Education. Adelaide, 7-10 December 2003.

ARS Helps Instructor to Determine if Students:

• Have read before class?

• Are paying attention?

• Remember important facts?

• Are thinking?

• Recognize concepts?

• Comprehend the material?

• Work in a group?

• Do numerical exercises?

ARS: Advantages

• Students remain alert

• Increased participation

• Student answers may guide discussion

• Improved student satisfaction

• Reinforced lecture material

• Monitor student attendance, performance

• “Shy” students express their thoughts

ARS: Disadvantages

• Start-up costs (time, $)

• Usually cover less lecture material

• Initially burdens lecturer

• More work to prepare lectures

• Loss of equipment

ARS: Recommended Guidelines

• Keep questions simple clear & easy to understand

• < 5 alternative answers

• Plan to allow more time for discussion

ARS: Vendors

• Audience Response Systems, Inc. (www.audienceresponse.com)

• Classroom Performance System (www.einstruction.com)

• Communication Technology International (www.consensor.com)

• Conference Systems, Inc. (www.conferencesystems.com)

• CP Wireless Audience Response, Inc. (www.cpwireless.com)

• Fleetwood Reply Systems (www.replysystems.com)

• Group Response System (www.xtol.com)

• Interactive Horizons (www.inthorizons.com)

• Media Group Interactive Systems (www.mg-interactive.com)

• Meridia Interactive Information Services (www.meridia-interactive.com)

• Option Technologies, Inc. (www.optiontechnologies.com)

• Personal Response Systems (www.educue.com)

• Rsi Communications Group (www.rsicommunications.com)

• Quick Tally Audience Response System (www.quick-tally.com)

Topic Index

Main MenuMain Menu

Air Emboli

Amyloidosis

Arterial Line Complication

Bag-Valve Devices

Bladder Perforation

Bolusing Epidural Guidelines

Bradycardia

Broken Needle in Aorta

Bronchospasm

Cardiac Arrest After Alpha-Agonist

CO2 Chemical Test

CO2 Embolism

Common Pitfalls during Laryngoscopy

Continuous Noninvasive BP Monitoring

Continuous Spinal Anesthesia

Cough Reflex

Desiccation of Soda Lime

Epidural Blood Patch

Epiglottitis

Esophageal Intubation

ETT and LMA Cuff Pressure

Failed Facemask Ventilation

Hanging Drop Technique

Herpetic Whitlow

Hypocapnia

Impalement to the Brain

Infection After Radial Artery Catheterization

Interscalene Block Complication

IV Infiltration

Left-Sided Double Lumen Tube Position

Local Anesthetic CNS Toxicity

Loose Teeth

Major Leak after Induction

Mediastinoscopy

Nasogastric Tube Obstruction

Oculocardiac Reflex

Pediatric Laryngospasm

Preoxygenation

Pruritus After Intrathecal Morphine

Rapid Sequence Induction

Raynaud’s Disease

Reinke’s Edema

Retrobulbar Block Complication

Right IJ Hematoma Compression

Straight Laryngoscope Blade

Tec-6 Vaporizer Battery

Tracheostomy Under Local Anesthesia

Transtracheal Jet Ventilation

Transurethral Resection Syndrome

Venous Phlebitis after Anesthesia

Vocal Cord Polyp

20%

30%

20% 20%

10%

1 2 3 4 5

Immediately after intraabdominal CO2 insufflation for a laparoscopy, a patient develops bradycardia and the systolic blood pressure drops from 120 to 65mmHg. Which is the most likely cause?

1. CO2 venous embolism2. Paradoxical CO2 venous

embolism3. Vagally mediated reflex4. Anesthetic overdose5. Respiratory acidosis

Main Menu View Tutorial Next Question Reference

CO2 Embolism

Duration: 1:45

Main Menu Back to Question Next Question Reference

ARS: Other Possibilities

• Assigning keypads to students

• Preparing a classroom with assigned seating

• Conducting quizzes and storing data

• Maintain attendance record

The Guts of a Modern OR

3600 Panorama