How to Establish an Interactive eConference and eJournal Club
2013; Elsevier BV; Volume: 39; Issue: 1 Linguagem: Inglês
10.1016/j.jhsa.2013.10.004
ISSN1531-6564
Autores Tópico(s)Innovations in Educational Methods
ResumoWith our hand team scattered across several different locations, it is difficult to find a time to get together for our weekly didactic hand conference and monthly hand journal club. In addition, traffic and tight clinical schedules sometimes force conferences to start late or be canceled. Our solution was to set up an on-line conference. Using TeamViewer to host our conference and Skype to host our journal clubs, we experienced increased attendance by both faculty and residents in our meetings. In this article, we establish a method of hosting effective on-line videoconferences to facilitate nearly universal participation of our hand team, and we hope to assist others who wish to establish similar setups in their communities. With our hand team scattered across several different locations, it is difficult to find a time to get together for our weekly didactic hand conference and monthly hand journal club. In addition, traffic and tight clinical schedules sometimes force conferences to start late or be canceled. Our solution was to set up an on-line conference. Using TeamViewer to host our conference and Skype to host our journal clubs, we experienced increased attendance by both faculty and residents in our meetings. In this article, we establish a method of hosting effective on-line videoconferences to facilitate nearly universal participation of our hand team, and we hope to assist others who wish to establish similar setups in their communities. Journal clubs and weekly didactics are a crucial component of graduate medical education. In 1 study surveying hand surgery fellows and fellowship program directors, most participants thought that journal club was successful and was an important part of their training.1Melchior J.A. Meals R.A. The journal club and its role in hand surgery education.J Hand Surg Am. 1998; 23: 972-976Abstract Full Text PDF PubMed Scopus (28) Google Scholar The most frequently suggested improvement was increased faculty participation. At many institutions as well as our own, the faculty and trainees are scattered among several different locations and it is difficult for everyone to physically attend these weekly teaching conferences and our monthly hand journal club. In addition, traffic and tight clinical schedules frequently force conferences to start late or be canceled. Fortunately, with the advances of modern technology, such concerns can be overcome. Videoconferencing has been around for some time and has gained popularity in the past decade. Several institutions are adopting this technology from on-line radiology teaching sessions to virtual grand rounds.2Ruskin K.J. Palmer T.E. Hagenouw R.R. et al.Internet teleconferencing as a clinical tool for anesthesiologists.J Clin Monit Comput. 1998; 14: 183-189Crossref PubMed Google Scholar, 3Richardson M.L. Petscavage J.M. Hunter J.C. et al.Running an online radiology teaching conference: why it's a great idea and how to do it successfully.Acad Radiol. 2012; 19: 746-751Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar In our article, we share our experiences in setting up a successful and interactive videoconference for our local, monthly hand journal club and our weekly hand didactic conference. Our conferences are run using TeamViewer 8 (TeamViewer, Inc., Tampa, FL), which is software capable of on-line meetings. It operates on all of the leading platforms including Windows, Mac, and Linux. The software supports Mac OS X 10.5 and later, including Mountain Lion (Apple Computer, Cupertino, CA) and Windows 8, 7, Vista, XP, 2000, and Server (Microsoft Corporation, Redmond, WA). The software also has its own app called TeamViewer for Meetings, which works on mobile devices such as the iPhone, iPad (Apple Computer), and Android (Google, Mountain View, CA). TeamViewer is Health Insurance Portability and Accountability Act compliant because it offers full encryption based on 1,024-bit RSA private/public key exchange and 256-bit AES encoding of each session, which ensures security and privacy. The software license is free for all noncommercial users. Although most presentations are made using PowerPoint (Microsoft Corporation) or Keynote (Apple Computer), any media presented on the computer can be seen by all users connecting remotely. For journal club, which is hosted in a faculty member's home, we use Skype (Microsoft Corporation), because it provides better audio and video optimization on a slower residential broadband connection. Aside from the improved audio and video, Skype was a better fit for journal club because the goal was not to present slides but to encourage participant discussion. However, slide presentation is possible and runs smoothly when using the screen sharing feature of Skype. A premium subscription that starts from $4.99/mo is required for group video chat functionality within Skype. Only the host computer needs to have a premium account, and it can support up to 10 people on the same video call. The software is compatible with Mac, Windows, and Linux. All participants will need to install Skype and create a free account to connect to the journal club. With the TeamViewer software installed, the host computer can be either a laptop or a desktop. We used a laptop for ease of portability. The laptop is connected to a liquid-crystal display projector for presentation to local attendees, and those who join remotely will also see everything that is projected as all media displayed on the computer screen are shared with the participants. Connected to the host computer via Universal Serial Bus is a ClearOne Chat160 group speakerphone (ClearOne, Inc., Salt Lake City, UT). The speakerphone features 3 built-in microphones array with 360° audio pickup up to 3.7 m (12 ft). It has the ability for full-duplex audio as well as advanced noise and echo cancellation algorithms. This is critical because using a standard speaker and microphone will cause annoying audio feedback loops. During our monthly journal club, we do not use a projector; instead, we use a Logitech HD Pro WebCam C920 (Logitech International S.A., Morges, Switzerland) that supports full high-definition 1080p video calls on Skype. The webcam is mounted on a video tripod that allows a journal club participant to pan toward the active speaker. We use the same ClearOne speakerphone at our journal club to minimize audio feedback as well as filter out background noise. For the participants, the type of microphone, soundcard, speaker, and webcam is of less importance. Most have been able to join with their existing setup and peripheral devices. To eliminate excessive background noise and feedback, an audio headset is preferred. Users also have the option to mute their audio within the TeamViewer program. Almost all users have a broadband Internet connection, and those on the go are able to connect via 3G or LTE wireless technologies. Weekly hand conferences are held every Tuesday, and at the appointed time, interested participants access the meeting remotely from their office, laptop, or mobile device. Local participants gather in a conference room equipped with the computer, projector, and speakerphone. Journal club is held monthly in a similar fashion. The meeting takes place at the residence of a faculty member, and local participants sit around the living room. The host laptop, speakerphone, and webcam are set up as previously described. Attendees joining remotely may do so from home, office, or hospital, and can be fully engaged with the help of group video chat. Shortly before each meeting, an e-mail message containing the conference hyperlink is sent to participants to connect remotely. TeamViewer automatically generates this message, which can be easily copied and pasted into an e-mail. Although there are several ways to join a meeting, the easiest and quickest is to use the link from the invitation e-mail. No additional data have to be entered, and one is connected directly to the meeting. Clicking that link will take conference participants to a Web page that downloads and installs TeamViewer QuickJoin. It already contains the Meeting ID and will connect automatically to the meeting. Over a span of 8 months, we have found an effective way to host successful weekly didactic conferences and monthly journal clubs, with participants signing in remotely from as far away as San Francisco. Faculty and resident participation have increased because those who were unable to attend before now regularly join remotely. Conferences hosted with TeamViewer produced excellent results especially with the high bandwidth of an institutional Internet connection. Audio and video quality is outstanding. Although audio feedback was an issue in other setups, we have eliminated the problem with the dedicated ClearOne speakerphone with built-in echo cancellation.3Richardson M.L. Petscavage J.M. Hunter J.C. et al.Running an online radiology teaching conference: why it's a great idea and how to do it successfully.Acad Radiol. 2012; 19: 746-751Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar Users report that they are able to follow the presentation as if they were physically present. Attending the conference on the go via iPhone, with 3G or faster, also produced excellent results. Slides are clearly visible on the phone screen and can be enlarged. The use of a headset may be necessary to reduce traffic noise and feedback. In addition to being able to host live meetings, TeamViewer also has the ability to record meetings. This is useful when participants are unable to attend but still wish to review the presentation at a later time. Although TeamViewer could certainly be used for hosting our monthly journal club, we found that it did not perform as well. Audio and video quality suffered slightly owing to a slower residential Internet connection. Internet speed tests from Speedtest.net recorded 25 Mbps download and 2 Mbps upload at the residence, whereas speeds in the conference room were 140 Mbps download and 60 Mbps upload. As a result, we found that the group video chat feature in Skype Premium worked well for our purposes. Skype handles audio and video better by optimizing them for the amount of bandwidth detected. Journal club hosted with Skype was also a success. Audio and video quality is excellent, with remote participants reporting that they were able to follow over 95% of the discussion that was being held locally. Remote participants were also able to present journal articles clearly and effectively. In a post–journal club survey, they appreciated the interactive nature of the journal club and mentioned that panning the camera made them feel as if they were actually there. Problems with consistent attendance have always been a barrier to successful conferences and journal clubs. Although a physical presence is ideal, it may not always be possible. By making our meetings accessible on-line, we have eliminated that barrier. Others have encountered similar frustrations and have taken their journal clubs on-line.4Lizarondo L. Kumar S. Grimmer-Somers K. Online journal clubs: an innovative approach to achieving evidence-based practice.J Allied Health. 2010; 39: e17-e22PubMed Google Scholar, 5McLeod R.S. MacRae H.M. McKenzie M.E. et al.A moderated journal club is more effective than an Internet journal club in teaching critical appraisal skills: results of a multicenter randomized controlled trial.J Am Coll Surg. 2010; 211: 769-776Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar However, they have had varying success because their discussions take place on a Web site and not in real time, as with our setup. Several other software options exist for on-line meetings that are currently being used in business and education: for example, WebEx (Cisco Systems, Inc., Santa Clara, CA) and GoToMeeting (Citrix Systems, Inc., Santa Barbara, CA). Before choosing our Web meeting software, we tested each of the programs and evaluated them based on what we wanted to accomplish. Because we have no commercial conflicts of interest, we sought to find the product that best fit our needs. Each product had different strengths and weaknesses (Table 1). Although they generally all have the same functionality, we found TeamViewer to be superior in that it had an intuitive control panel (Fig. 1) and participants were able to click on the slide remotely and display a pointer cursor for all to see (Fig. 2). This is useful when discussing an item on a presentation slide, such as a radiograph.Table 1Comparison of Web Meeting ClientsTeamViewerGoToMeetingWebExSkypeCostFree∗Free for noncommercial use.$49/mo$49/mo$4.99/moMeeting capacity25252510Ease of use+++++++++++Audio/video quality†Audio/video quality dependent on strength of Internet connection.++++++++++++Features Browser version✔✔✔ Change presenters✔✔✔ Chat✔✔✔✔ Conference calling✔✔✔✔ File sharing✔✔✔✔ Meeting recording✔✔✔ Mobile device apps✔✔✔✔ Participant pointer✔ Scheduling✔✔✔ Screen sharing✔✔✔✔ Whiteboard✔✔✔∗ Free for noncommercial use.† Audio/video quality dependent on strength of Internet connection. Open table in a new tab Figure 2Ability of remote user to point (blue arrow) in TeamViewer, thus providing greater interactivity.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The ClearOne Chat160 group speakerphone is a key component to making conference and journal club run smoothly. Before using the Chat160, we had a standard conference microphone and external speaker setup. Although the conference microphone was excellent, audio from the external speakers would feedback into the microphone, and participants connecting remotely would hear an annoying echo of themselves. The difference with the Chat160 is that it has hardware echo and noise cancellation algorithms built in. Although many computers have echo cancellation capabilities, they does not apply to an external microphone. There are several other considerations to take into account when looking for a conference microphone. The microphone should have adequate range of audio pickup. If hosting in a large conference room, daisy chaining of more than 1 microphone may be necessary. Full-duplex audio will also help with voice transmission and prevents cutting in and out. To maximize attendance and usefulness of the conference and journal club, we aim to offer continuing education credits through our institution, which may offer incentive to those interested in joining remotely. In addition to hosting weekly meetings and journal clubs, this technology can be used during residency and fellowship interviews. It would be just as easy to host on-line meetings or videoconferences with faculty and prospective applicants. An interactive on-line conference and journal club can be successfully implemented with the proper setup and a little patience. Modern technology has allowed us to connect and collaborate as never before. In time, videoconferences and virtual meetings will become the norm and medical education will benefit from such advances.
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