Live video streaming and webcasting in dermatology education Maria Gonzalez Sonia Maurer Nan Zhang

Definitions Live video streaming or video- conferencing –Synchronous method of communicating between dispersed groups Webcasting –Broadcast of video, live or on-demand, using streaming technology across the world wide web

The Project Dermatology Surgical Skills Projects I and II Project I –Video Linkage of surgical theatre to seminar room Project II –Use of video capture software (Mediasite) to stream surgical sessions and lectures online and store them for on-demand viewing

Context Teaching and learning of surgical skills in dermatology is important Historical standard for this is apprenticeship model with direct participation in the Operating theatre “See one, do one, teach one”

Context Limited access – rationing of training in certain skills Use of live video/webcasting democratises this process Enhanced opportunity to “see one” Previously undergraduates did not have access to surgical theatres in dermatology Limited number of postgraduates had access in an ad hoc fashion

Format of live surgical sessions A work in progress Surgeon wears microphone to allow communication with seminar room Speakers on wall of theatre allows all in theatre to hear comments from students Moderator in the seminar room Surgeon discusses case and puts questions to the group as procedure is carried out Group also allowed to ask questions or comment

Main challenges Getting co-operation of NHS staff Having access to a technician who understands the technology and can be available for all sessions Must have patient consent and co- operation Ensuring audience remembers that all comments can be heard by patient

Main challenges Keeping students engaged –Skill and interactivity of surgeon –Facilitation skills of moderator –Always having new and interesting cases –Keeping session at the correct length Keeping surgeon engaged

Critical success factors Well trained / reliable IT staff Skilled and confident demonstrator Good facilitator – avoid television response Developmental approach to sessions – cases should not be ad hoc

Webcasting of lectures All lecturers speaking the department of dermatology are asked for permission to video their lecture Creation of a database of expert lectures

Key challenges Because of use of patient images doctors are often very unwilling to have their lecture videoed

Main benefits of project Anywhere, anytime access Videos can be paused, rewound etc allowing difficult aspects of surgical procedures to be viewed until viewer is happy they have understood – not possible in live observation Students less anxious about having to take notes

Main benefit Democratisation of access to knowledge –Groups benefiting: Undergraduates Post graduates in full time courses All dermatology trainees and consultants in Wales Alumnus – Dermatology Continuing Professional Development Society Distance learners

The future DOH funded project to bring surgical teaching to trainees throughout UK Linking up with other universities e.g. in developing countries CPD for dermatologists – licence to practice Assessment of registrars – DOPs (Direct observation of procedures)

Live video streaming and webcasting in Dermatology education: a case study Sonia Maurer Learning Technologist

Requirements Live video link from operating theatre to seminar room, with 2-way audio Software to stream sessions live to Internet Software management system for later on-demand access to recordings Rarely been done before

Where to start… Simple operating theatre video links are not new Contacted Dr Neil Warren –VideoSouth Medical Television –Touchvision –Starkstrom –Drake AV

In addition to video link: Live streaming Content management system User management system – control access to recorded content Record seminar room lectures (PowerPoint slides and video of lecturer) Flexible screen template

Identified Mediasite and Echo 360 –Mediasite sent links to USA surgery video –Echo 360 seemed put off by project Sent requirements to AV firms (incl. Mediasite links) –Site visits arranged by VideoSouth, Touchvision and Drake

VideoSouth Operating Theatre –One high quality camera on moveable arm –Radio mic –Preview monitor Seminar Room –Wall mounted camera, microphone –Mediasite on separate computer, hardwired into system –Integration into touch panel

Made contact with Mediasite –Become “reseller” –Agreed to oversee and guarantee Mediasite integration VideoSouth

Touchvision Operating Theatre –Two cameras (one ceiling-mounted CCTV-type, one overview of room) –Radio mics –Preview monitor, equipment rack Seminar room –4-way screen splitter £3000 yearly service contract Excluding webstreaming

Starkstrom Vague about exact equipment needed… Recommended Encoded Media Drake quote

Decision Time pressures looming VideoSouth / Mediasite combination was only system to inspire confidence –Mediasite offered us a joint-purchase deal with PGMDE Mediasite hosted on our dedicated server (shared with PGMDE)

Seminar Room – lecture recording

To record lectures In advance: LT logs into Mediasite management system and enters details of recording At time of lecture: administrator calls up the session on Mediasite computer, checks camera position, pins on mic and clicks Record Recordings automatically available on system

Surgery Recording

To record surgery LT schedules presentation in Mediasite (specify template) LT checks camera and mic in operating theatre Seminar room: open presentation in Mediasite, moderator mic, click record Live streaming to office PC

Integration Options How to integrate with existing environments? Mediasite user management – which username and password?

Integration Options VLE users already have username and password Mediasite can be integrated with Active Directory Complicated to implement (Desire2Learn / Moodle) AD doesn’t automatically give Single Sign On

Simulated Single Sign On –Send generic username and password from HTML page within VLE, using hidden fields One generic log-in for each group of users –Gives access to videos they are allowed to see –Accessed from VLE, with username and password given on page Integration Solutions

Student Feedback “It is a good introduction to dermatological surgery” “Very useful as different surgical skills like local anaesthetic injections, excision technique and suturing technique can be learnt.” “It was very nice that the surgeon was communicating with us, asking us questions and explaining the procedure as well.” “It is useful because it allows one to understand what is happening during the procedure and why things were being done.”

Demos 23:30

Sonia Maurer Learning Technologist