Coming to a medical school near you: full motion video medical education
2005; Wiley; Volume: 39; Issue: 11 Linguagem: Inglês
10.1111/j.1365-2929.2005.02311.x
ISSN1365-2923
Autores Tópico(s)Empathy and Medical Education
ResumoMedical EducationVolume 39, Issue 11 p. 1081-1082 Free Access Coming to a medical school near you: full motion video medical education Mark Albanese, Mark AlbaneseSearch for more papers by this author Mark Albanese, Mark AlbaneseSearch for more papers by this author First published: 27 October 2005 https://doi.org/10.1111/j.1365-2929.2005.02311.xCitations: 9AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat If the adage is correct that a picture is worth a thousand words, what is a full motion video worth − an Encyclopaedia Britannica, perhaps, or less than a picture? The answer (if there is a 'correct' answer) is not straightforward. Balslev et al.1 conducted a small trial of the use of video versus a paper case in graduate medical education. While one's immediate response to this type of intervention might be 'of course a video has to be better than a paper case', the results offer some cautions. In analysing the interactions among resident learner groups, what Balslev and colleagues found was that those who viewed the video engaged in more data exploration, theory building and theory evaluation. They also engaged in less meta-reasoning and took more time at the task; 5 minutes more, to be exact (28 minutes versus 23 minutes). This increased time of analysis following viewing of a video is similar to results found in a paediatric clerkship by Kamin and colleagues.2 If using video results in more time being spent and spent in different ways, is this a better use of time than working through about 20% more paper cases (with the extra time)? To address this issue, it will be helpful to analyse the tasks being asked of students in the two different instructional modes and discuss the role that full motion video might play in medical education. Beginning with a paper case, we usually have a well-defined problem that we wish to present. We describe the conditions under which the situation arises and then the presenting medical condition. We have to make choices about how technical to be in describing the medical condition. If we say that the patient has a haematoma, we are either expecting that the learner knows what a haematoma is or we are willing to let them look it up. If we do not want to give them the clue of the technical name for the malady, we have to resort to providing a still picture of the haematoma, or describing it in words (invoking the 1000-word problem). In a total paper case, the learners either have to take some time to learn what the words mean in terms of what a patient would look like, or they need to be able to operate directly on the words alone. The latter assumes that if they can do this then they would know what a haematoma looks like, but there is no guarantee that that is the case. A second feature of a paper case is that, with few exceptions, only relevant information is included. Adding irrelevant information is usually considered bad construction for a paper case. One major advantage of the paper case is that as long as medical charts are primarily in a paper-type format (even electronic charts), the paper case will reflect that reality of patient care. If videos start to become standard adjuncts to the medical record, this advantage will begin to be lost. A video case presents the learner with the image of a patient with a problem. The first task of the learner is to work out what the problem is. If it is a haematoma, he or she must know what one looks like in order to work out what to do about it. The learner must also sort out what is relevant from what is not. Patients come with what they are: a combination of active health problems, health problems in the making and mental and physical bumps and bruises from living. Teaching videos are often created with the aim of keeping the distractions to a minimum, but they are there just the same. For novices, in particular, determining what the relevant features are of the problem can be a daunting task, because every cut and bruise is a potential contributor to lymphoma or measles for them. This probably contributed to the increase in time that the video group learners spent in data exploration and theory considerations in Balslev et al.1 Thus, unlike the paper case that is both focused and uses carefully selected language, the video presents learners with the images and sounds of disease/injury/life. The learner must translate these into the language of medicine in order to function. This is a more complex and realistic task than the paper case presents. For new learners, it may be too complex and a paper case may be the best method to use to introduce them to clinical applications. Its focus and clarity help them to begin to apply their rudimentary knowledge to clinical cases. As learners gain clinical expertise, they need to make the transition to more lifelike cases. Video cases offer a splendid transitional mechanism. In a real clinical experience, patient problems come at the speed of life and not at the speed needed for learners to learn. A full motion video enables us to still-frame life, or we can slow it down to a speed learners can absorb, and we can repeat it over and over again. We can doctor images so that irrelevant bumps and bruises do not distract the learner. There is also the potential for animation to demonstrate mechanisms of action of underlying cells and pathogens. The possibilities are limited only by our own creativity. There is a cautionary note that seems necessary. Humans have certain limits to their capacities to incorporate information and they seem to take certain shortcuts. For example, Garg and colleagues3 investigated the ability to rotate an object (in this case it was a wrist and hand) in all dimensions to determine to what extent this improves learning. They found that seeing all angles had a small benefit for learners with good spatial ability, but that it substantially handicapped learners with poor spatial abilities. They also found that learners generally memorise several key viewpoints (best visualised and least obscured) and then use these standard positions to develop their 360-degree perspective. Considering time as a fourth dimension, there may be analogous challenges we will face as full-motion video becomes used increasingly in medical education. References 1 Balslev T, De Grave D, Muijtjens A, Scherpbier A. Comparison of text and video cases in a postgraduate PBL format with respect to the cognitive and metacognitive processes induced. Med Educ 2005; 39: 1086– 1092. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 2 Kamin CS, O'Sullivan PS, Younger M, Deterding R. Measuring critical thinking in problem-based learning discourse. Teach Learn Med 2001; 13: 27– 35. CrossrefCASPubMedWeb of Science®Google Scholar 3 Garg AX, Norman GR, Eva KW, Spero L, Sharan S. Is there any real virtue of virtual reality? The minor role of multiple orientations in learning anatomy from computers. Acad Med 2002; 77(10): S97– 99. CrossrefPubMedWeb of Science®Google Scholar Citing Literature Volume39, Issue11November 2005Pages 1081-1082 ReferencesRelatedInformation
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