1. Improving Clinical Observation Skills through the use of Digital Photography and Photo Rounds Did we achieve what we set out to do? Thea Ballinger, MA Richard Usatine, MD James Tysinger, PhD Sandra Burge, PhD Dept. Family & Community Medicine University of Texas Health Science Center – San Antonio

2. Agenda Stimulate you to think creatively about using digital photography & Photo Rounds to teach & learn medicine. Present evaluation data from students on the use of digital cameras & participation in a Photo Rounds program. Share information about costs, benefits & lessons learned in setting up Photo Rounds

3. Photo Rounds Concept A picture IS worth a thousand words! Concept of using digital images to learn & teach medicine. –Increase variety of exposure to conditions. –Improve observation skills. –Enhance long term memory. Issue cameras to students to document clinical cases.

4. Clerkship Photo Rounds Started September 2004 Currently have a database of over 2037 images taken by students. Voluntary Program, 1 point added to final clerkship grade for participation. Required to upload 1 case per week with a max of 2 pictures to online photo album. Participate in the weekly Photo Rounds sessions every Friday at the start of didactics.

5. Clerkship Orientation Interested students are issued a camera to use during the clerkship. 30 minute session on basic features and operating the camera. Includes: –Use of the macro feature for close up shots. –Flash vs. No Flash –Removing memory card, using card reader. Students are encouraged to practice using the camera by taking pictures of friends, family, pets, etc. Asking for Permission –ALWAYS ASK –Use Consent Forms for the face or recognizable areas (Spanish/English) Tour of the online photo album. –Uploading photos –Naming conventions Hand out “how-to” guide & tour photo rounds website. –Technical Support Contacts –Step by Step instructions

6. Photo Rounds Website

7. Program Evaluation Sample – 249 students over 9 rotations (January 2005-March 2006) Administered online through end of clerkship evaluation. 185 students used the cameras 64 students did not use the cameras NOTE: The non-camera users were still required to participate in the weekly Photo Rounds.

8. Reasons for non-use  Unable to find visually interesting clinical material. Uncomfortable asking permission. Didn’t feel there was enough time during clinic. Not supported at clinical site. Lost extra credit possibility, so gave up.  Didn’t see much dermatology.  RELATED: lack of understanding that program focus was not just dermatology.

9. How students rated their digital photography skills…

10. Did the clerkship experience influence students perception of digital cameras?

11. Did the clerkship experience influence students perception of digital cameras? Users vs. Non-Users

12. Did we accomplish what we set out to do?

15. Overall Educational Value

16. Best Aspects of the Program Sharing cases & learning with classmates Learning during Photo Rounds Having a camera to use Increasing observation skills Improving long term memory of cases seen Having visual images for the future Learning Dermatology Learning more about photography Seeing a wide variety of cases

17. Most difficult aspects: Focusing, taking clear pictures Using the website, uploading pictures Asking permission to take a picture Remembering to bring the camera & to take pictures Taking good quality photographs Carrying the camera Taking good close up pictures, Macro feature Finding subjects to photograph Finding the time during clinic Operating the camera

18. Student comments on what could be done to make using the camera a better experience? More hands-on instruction/practice during orientation, especially on use of the macro function Make it easier to obtain extra credit for photos Cover all the submitted photos during Photo Rounds Make sure all sites are aware of and approve the use of cameras (issue that was solved over time) Devote more time to Photo Rounds sessions

19. Establishing a Photo Rounds Program Before you start: Investigate your institutions policy on patient confidentiality, consent forms. Survey faculty and all clinical sites to gauge their willingness to participate & their own policies. (separate consent forms?) Setting up the program: Choosing the right camera & accessories Finding a the right online photo album or electronic scrapbook Integrate Photo Rounds into curricula Make basic technical support available. A KEY TO SUCCESS! Educate and make faculty aware of the program. Their support can make or break the program!

20. Our choices Camera: Nikon CoolPix 3700 –Small, Compact, Rechargeable Battery, User-friendly, Good Macro Feature, Durable. –Price: $170.00 each with $100 rebate. Currently priced: $220-370 online. Online Album: www.Fotki.com –Unlimited storage, Ease of use, Password Protected. –Price: $30 /year

21. How much to get started? Cameras 25 x $220 = $5500 128 SD Memory Cards 25 x $15 = $375 Camera Bags 25 x $15 = $375 Jump Drives 25 x $15 = $375 Online Album (unlimited storage) $30 yr of service = $30 Total: $6655

22. Resources Comparison of online albums http://www.andromeda.com/people/ddyer/photo/ albums.html UTHSCSA Family & Community Medicine Photo Rounds Website http://familymed.uthscsa.edu/education/clerkship/ photorounds.htm Family Medicine Digital Resource Library (FMDLR) *presentation posted there. http://www.fmdrl.org/ http://www.fmdrl.org/

23. SUMMARY A Photo Rounds program can be implemented at a reasonable cost. Students quickly learn to use the cameras and online albums with minimal guidance. Students feel that it helps to increase clinical observation skills and enhances development of good mental pictures of various conditions for future recognition. Now, let’s take a tour of some of the student photographs.

24. Tour Photos from Online Album

25. Discussion Are you currently running a similar program? What are potential barriers to starting this type of program at your institution? Do you currently use digital photography in any of your clinical teaching? WHEN ARE YOU GOING TO START YOUR PHOTO ROUNDS PROGRAM?

26. Contact information Richard Usatine, MD usatine@uthscsa.edu usatine@uthscsa.edu Thea Ballinger, MA ballinger@uthscsa.edu University of Texas Health Science Center – San Antonio Dept. of Family & Community Medicine 7703 Floyd Curl Drive, San Antonio, TX 78229 http://familymed.uthscsa.edu