Introduction
The ePrePP resource is a student centred electronic platform to enhance the transition from student to practitioner in medicine, nursing and pharmacy. University of Limerick, one of the collaborator institutions on the ePrePP project, has developed resources in videoconferencing (VC) and remote teaching (RT).
Clinical teaching at the University of Limerick Graduate Entry Medical School (GEMS) occurs at multiple sites, in general practice and acute hospitals, distributed among three of Ireland’s Health Service Executive (HSE) regions. Formal teaching sessions, such as grand rounds take place in University Hospital Limerick (UHL) and at the GEMS on a regular basis. An effective system of communication between these two learning sites and the multiple regional hubs is essential, therefore, for teaching and learning.
The ULGEMS technical team has developed an efficient VC system to enable multidirectional communication between learners and teachers in the various sites. The VC system is in use for a variety of educational sessions several times each day to link with the following sites: University Maternity Hospital, University Hospital Limerick, University Hospital Ennis, University Hospital Nenagh, Milford Hospice Limerick, St John’s Hospital Limerick, St Luke’s Hospital Kilkenny, South Tipperary General Hospital Clonmel, Midlands Regional Hospital Tullamore, Midlands Regional Hospital Portlaoise, Portiuncula Hospital Ballinasloe, St Fintan’s Psychiatric Hospital Portlaoise, Farranfore Medical Centre, Farranfore and Ayrfield Medical Practice Kilkenny.
Background
VC has become an integral part of educational delivery in the western world with almost 30,000 video conferencing systems in U.S. schools, service centres, district offices, and departments of education (www.mashable.com). In health science education, students are now learning in more remote sites with reports of similar educational and acceptability levels to those in University hospital centres. VC equipment is a key part of this approach to teaching. The effective use of synchronous VC technology to convey didactic and interactive lectures to multiple sites has been documented (Markova, 2002).
When used appropriately, distance learning may be an efficient and effective approach to address the many barriers to education faced by the health workforce, including budget constraints, overloaded schedules, the need for on-the-job learning opportunities, and lack of access (Varikojis, 2011). Students can complete learning objectives as well as they do in the traditional classroom setting (Bertsch, 2009)
Early difficulties with VC included: slow-speed connection, the requirement for digital materials, and the need for residents and faculty to adjust to a new learning method (Markova, 2002). There was also a need for increased coordination at the sites and heavy reliance on electronic communication (Markova, 2005). With advances in technology, these challenges have now been overcome.
VC is a recognised means of providing a uniform and equivalent educational experience to learners at distant sites (Jeun, 2008). Studies have shown that the use of recorded seminars followed by live interaction through videoconferencing is an acceptable and effective method of providing continuing education with the benefit of reducing time and travel expenses (Klein, 2011).
A wide variety of disciplines have reported early benefits of VI. Surgeons in rural areas have benefitted from expertise delivered through VC systems (Augestad, 2009). Studies in psychotherapy trainees showed that readily accessible, inexpensive Web-conferencing applications facilitates distance supervision and interactive peer learning (Chic, 2011). The reliability and acceptability of V-C in delivering education to pharmacy students has been described. Key components to its success include careful planning, involving all the stakeholders from the planning stage to implementation and ongoing use (Fox, 2011).
In less well-off countries VC has greatly enhanced learning of students and residents through facilitating the virtual proximity of experts (Pereira, 2012). If VC modalities are well planned and supported they are a feasible, acceptable and cost-effective method of supporting learners (Chipps, 2012). VC also enhanced the networking opportunities between practitioners, providing an avenue of ongoing professional support necessary for maintaining the health workforce in rural and remote areas (BMC Health Serv Res. 2014).
Reese at al (2009) found that VC use was not only acceptable to students but had similar outcomes to the more traditional face to face learning. However it was recommended that some face to face interaction would happen to maintain the mentor-mentee relationship. Many of the more recent studies have highlighted the importance of involving the students in distant sites. Facilitating interaction between learners in different sites is important in order to promote problem-solving skills and retention of information and strategies specific to VC learning have been developed (Ertmer, 2007).
Uses for health sciences education:
1. Didactic and interactive teaching: connecting with experts
2. Virtual tours e.g. operating theatre
3. Peer learning- collaboration between groups of students e.g. journal club
4. Continuing Professional Development (CPD): teaching the teachers
Setting up
Setting up a video conference system for 3rd level education in health sciences
The last ten years has seen a dramatic increase in the number of video conference options on the market. These range from personal systems such as skype, google hangouts, apple face-time, adobe connect to corporate systems provided by polycom, cisco, vidyo etc.
In an Irish educational context Heanet, Ireland’s National Education and Research Network (www.heanet.ie ) have a dedicated multi-media team that provide advice and direction on video conferencing http://www.heanet.ie/services/multimedia. They have recently partnered with “Janet” (https://heanet.vscene.jisc.ac.uk/jsp/li/home.jsp) their UK equivalents to provide a one stop video conference service “V-Scene” to third level institutes in Ireland. Using this system it is possible to setup your own “virtual meeting rooms” which can be used to host your video conference calls. Up to 40 individual sites can dial into a virtual meeting room. The janet “V-Scene” video conference system allows for the scheduling, automatic dialling of remote video conference units, recording and streaming of video conference calls. During a normal video conference call it is possible to view both the presenter, any material he is sharing from his pc/tablet as well as all the other participants in the meeting.
Using this system eliminates the need for an individual institute to purchase their own multipoint control unit (MCU) which was until recently perhaps the most expensive part of setting up a video conference network. The mcu is the key piece of the video conference infrastructure as the mcu serves as a bridge which allows all the individual video conference systems to dial into the one meeting room. As described previously it does this by setting up virtual meeting rooms which individual endpoints can connect to when they wish to join a meeting.
The next issue to consider is how the participants will connect to the meeting. In video conferencing parlance these devices are called endpoint systems.
Obviously which system you choose to use will depend on the purpose of the videoconference and the numbers of participants and layout of the room in which the video conference will take place. For example, video-conferencing a lecture from a lecture hall or classroom will most likely require the purchase of a video conference room system. There are a number of different suppliers of video conference rooms systems on the marked however one of the largest suppliers to Irish educational institutes is Polycom, www.polycom.com. They have a range of different system to suit the needs of 3rd level education in health sciences and a tender process is already setup on heanet for institutes who are considering purchasing these systems.
For smaller groups or individuals, a number of software solutions have also come onto the market which allows a participant to dial into the video conference meeting from their own pc/laptop/tablet. In the case of the University of Limerick Graduate Entry Medical School, a mixed infrastructure is used with room systems setup in the larger lecture spaces and software systems in place in some of the smaller rooms. One popular software applications is Realpresence desktop which is available for a small fee for windows and apple machines and is downloadable free of charge from the apple app store and on google play. This low-cost solution can be used in situations when a video conference room system is not required. V-scene itself also provides a free desktop client which can be downloaded and used by individual participants. Full multi-media instructions in setting up and using v-scene are available online at https://community.jisc.ac.uk/library/janet-services-documentation/vscene?state=hidden.
In order to ensure a high quality call, it is important that each participant has access to a fast internet connection. For third level institutes this is not an issue but if you are setting up a link in a remote site it is advisable to check that the site has a good internet service. The minimum speed necessary for video conferencing is 512mb down /512mb up but higher speeds are preferable for a better quality of service.
The next aspect to consider is room layout and managing the human factor involved in video conferencing. As is often the case managing the human factors involved with video-conferencing is perhaps the most difficult aspect to manage. The key points to consider are as follows:
- Managing room layout. For a successful video conference, it is crucial that all users are visible to the presenter during a conference call. Ideally the VC camera should be in such a location that the presenter can see all the other users in the remote sites and that the remote users can clearly see the presenter as well. The standard VC lecture setup will allow each user to see the presenter as well as his slides.
- User and presenter training. Teaching using video conference technology adds an extra layer of complexity so it is important that all users receive training in its use and that protocols are put in place to manage interactions during the call.
- Support system. It is also important that a support system is put in place to manage any technical problems that could arise during a call. Backup procedures should be put in place to manage different scenarios that may arise.
A full checklist regarding successfully video conferencing is provided below.
Tips for effective video conferencing
The following are based on Lynne Coventry’s report on Video Conferencing in higher education (Heriott Watt University, Edinburgh):
• Preparation- content, student briefing, IT support meeting
• Logistics- number, layout and technical issues with the sites involved
• IT- optimise use of microphone, camera, multimedia equipment available
• Learning environment- creating a culture of participation with respect and clear instruction
• During the lecture- engage students at various sites, use a variety of teaching modalities
• Moderator- a second teacher to ensure the smooth running of the session
• Training- for students and presenters on use of the equipment
Factors for the presenter to consider:
• Camera and sound checks
• Appearance including that of the presenter, the backdrop and the visual aids
• Content – meangingful and memorable
When organising a video conference:
• Book VC room and all learning sites well in advance
• Involve the IT team at the planning stage and during the session if possible
• Practice with and pre-set camera(s)
• Pay attention to light and sound
Pitfalls when video conferencing:
• Do not discuss personal issues while microphone is turned on
• Resist moving the microphone
• Avoid frequent adjustments to the camera
It is also important to provide advice for using for their video conference session.
VC etiquette for facilitator and learner
• Arrive 10 minutes early
• Make sure everyone in room is visible on screen
• Place microphone on table in easy reach of all participants
• Mute microphone unless speaking
• Be mindful that you are visible on screen, limit side conversations/emails/twitter!
• Participate
Technical issues
Common technical problems
Helpdesk support is available Monday to Friday from 8:00 to 21:00 from v-scene. Local issue and possible solutions are listed below.
Dialled in can’t see slides
– Dial in and dial out
– Use display or click Far button and then left/right buttons to change content layout.
– Check internet connection
Can’t dial in “no network connection”
– Check internet working
– Check rooter switched on
– Check network cable connected
– Reboot
References
Abbass A, Arthey S, Elliott J, Fedak T, Nowoweiski D, Markovski J, Nowoweiski S. Web-conference supervision for advanced psychotherapy training: a practical guide.Psychotherapy (Chic). 2011 Jun;48(2):109-18.
Augestad KM, Lindsetmo RO. Overcoming distance: video-conferencing as a clinical and educational tool among surgeons. World J Surg. 2009 Jul;33(7):1356-65
Bertsch TF, Callas PW, Rubin A, Caputo MP, Ricci MA. Effectiveness of lectures attended via interactive video conferencing versus in-person in preparing third-year internal medicine clerkship students for Clinical Practice Examinations (CPX). Teach Learn Med. 2007 Winter;19(1):4-8.
Fox B, Pharm D, McDonough S, McConatha BJ, Marlowe KF, Establishing and Maintaining a Satellite Campus Connected by Synchronous Video Conferencing.
Chipps J, Ramlall S, Mars M. Videoconference-based education for psychiatry registrars at the University of KwaZulu-Natal, South Africa. Afr J Psychiatry (Johannesbg). 2012 Jul;15(4):248-54. doi: http://dx.doi.org/10.4314/ajpsy.v15i4.32
Ertmer PA, Nour AY. Teaching basic medical sciences at a distance: strategies for effective teaching and learning in internet-based courses. J Vet Med Educ. 2007 Summer;34(3):316-24.
Jeun BS, Javan R, Gay SB, Olazagasti JM, Bassignani MJ. An inexpensive distance learning solution for delivering high-quality live broadcasts. Radiographics. 2008 Sep-Oct;28(5):1251-8.
Klein KP, Miller KT, Brown MW, Proffit WR. In-office distance learning for practitioners. Am J Orthod Dentofacial Orthop. 2011 Jul;140(1):126-32.
Markova T, Roth LM. E-conferencing for delivery of residency didactics. Acad Med. 2002 Jul;77(7):748-9.
Markova T, Roth LM, Monsur, J. Synchronous distance learning as an effective and feasible method for delivering residency didactics. Family Medicine, 2005, Volume 37, Issue 8
Pereira BM, Calderan TR, Silva MT, Silva AC, Marttos AC Jr, Fraga GP. Initial experience at a university teaching hospital from using telemedicine to promote education through videoconferencing Sao Paulo Med J. 2012;130(1):32-6.
Ray RA, Fried O, Lindsay D. Palliative care professional education via video conference builds confidence to deliver palliative care in rural and remote locations. BMC Health Serv Res. 2014 Jun 19;14:272.
Reese, R. J., Aldarondo, F., Anderson, C. R., Lee, S. J., Miller, T. W., & Burton, D. (2009). Telehealth in clinical supervision: A comparison of supervision formats. Journal of Telemedicine and Telecare, 15, 356–361.
Varekojis SM, Sergakis GG, Dunlevy CL, Foote E, Clutter J. Distance learning and the internet in respiratory therapy education. Respir Care. 2011 Nov;56(11):1808-11.
Website references:
http://mashable.com/2010/04/21/classroom-video-conferencing/
https://media.heanet.ie/page/ffc64c6ee4564a7fa1bb81bc6f55f594
https://media.heanet.ie/page/ffc64c6ee4564a7fa1bb81bc6f55f594
Appendices
Appendix 1: Video conference setup in GEMS-LRC
Please read the instructions below to find out how to use the system.
Figure 1 AV Controller LRC MWRH
Option 1: Steps to setting up video conferencing using the Podium PC
- Turn on the podium pc. Login using Username: /localuser and Password Medschool2012
- Press the power button on the vc remote control to switch it on.
- Press “Video C PC” button. This will turn on both projectors. Projector 1 will display the near camera/content and projector 2 will display the remote sites
To Place a Call
- Using the video conference remote control select either “UL GEMS Meeting Room 1” or “UL GEMS Meeting Room 2” to dial into either of these meeting rooms.
- If you are not dialling into UL’s meeting room, select Option 3 “Place a Call” and enter the ip address of the vc unit that you wish to dial
- Press “Green Call” button on the remote control to start call
To show the content from the podium pc on the projector during a video conference call
- Press the “Silver Content” button on the vc remote control to display your slides on screen
To use the microphone during a video conference call
Press button to mute/unmute microphone
Green Light = On
Red Light = Off
The microphone is located on the podium. Please make sure the microphone is on when you are speaking. You may have to mute your microphone if a participant from an external site is speaking.
To move the camera
- Press the near button and then use the left/right, up/down, zoom in/out buttons on the remote control to move the camera. Please ensure that you are visible to the remotes site during a vc call
Using camera Presets
Simply press on the number listed below to move the camera to the location defined.
- Press 1 show the audience
- Press 0 to return to default view (Presenter top of room)
To change how the far sites are displayed on screen.
- Press the far button on the remote control and use the left/right, up/down to cycle through the various layouts until you find the layout you desire.
To end Call
- Press the red “End Call” button on remote control to end the vc call
Option 2: Steps to setting up video conferencing using your own laptop
- Turn on your laptop
- Connect the vga cable on the desk to your laptop
- Press the power button on the vc unit to turn it on. When the video conference unit is switched on there is a blue light on the front of the unit.
- Press “Video C Laptop” button. This will turn on both projectors. Projector 1 will display the near camera/content and projector 2 will display the remote sites
To Place a Call
- Using the video conference remote control select either “UL GEMS Meeting Room 1” or “UL GEMS Meeting Room 2” to dial into either of these meeting rooms.
- If you are not dialling into UL’s meeting room, select Option 3 “Place a Call” and enter the ip address of the vc unit that you wish to dial
- Press “Green Call” button on the remote control to start call
To show content
- Connect your laptop to the vga cable provided
- Press the “Silver” content button and select the laptop icon. Scroll to it by using right arrow button and select it using by pressing the enter button (circular button with a dot).
Note if you get an error message please press the same keys you would use when displaying your laptop througha projector, usually one of the following combinations: Fn+F4 (or) Fn+F7 (or) Fn+F8.
- To stop showing content simply press the “Silver content button again”
All additional instructions are the same as described under the heading “Steps to setting up a video conference session using the podium pc”
Note: please turn off projector at the end of you session using the “System Off” button
Appendix 2: Essential equipment
Appendix 3- instructions for lecturer use
