HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tello, R. Articles by Blickman, J. G. Search for Related Content PubMed PubMed Citation Articles by Tello, R. Articles by Blickman, J. G. Social Bookmarking                      What's this?

The Virtual Course

Delivery of Live and Recorded Continuing Medical Education Material over the Internet

¹ All authors: Department of Radiology, Boston Medical Center, 88 E. Newton St., Boston MA 02118.

Received October 13, 1999; accepted after revision November 19, 1999.

 
Supported in part by unrestricted educational grants from Berlex, Inc., and Medrad, Inc.

Address correspondence to R. Tello.

Abstract

Top Abstract Introduction Materials and Methods Results Discussion References

 
OBJECTIVE. Our objective was to deliver live and recorded lectures from a continuing medical education course, including the representations of original slides, over the Internet, using streaming audio media.

CONCLUSION. The streaming audio media, an emerging technology, not only delivers large lectures over the Internet using commercially available PCs and modems, but also allows review at any time by individuals with access to the Web. An interactive conference of continuing medical education curriculum can thus be delivered and continuing medical education credit earned without leaving home.

Introduction

Top Abstract Introduction Materials and Methods Results Discussion References

 
With the continued emergence of the Internet as a means to deliver educational material, new and innovative approaches to use this technology for education have been actively researched. As shown by the Inforad demonstration at the Radiological Society of North America annual meetings and in the Computers in Radiology section of the American Journal of Roentgenology, the Internet is emerging as a viable means to deliver educational material. For some time, radiologists have been using the Internet for interactive textbooks and on-line representation of radiologic images, so that work on automating this function is receiving attention [1]. The technique of streaming media with audio and video allows delivery on the Internet of material in a visual and audio format that mimics the lecture hall. We present our experience in the delivery of material using streaming media and minimum hardware. We discuss the delivery of a continuing medical education course over the Internet, the evaluation of its acceptance by the Internet audience, and the future possibilities for continuing medical education on the Internet.

Materials and Methods

Top Abstract Introduction Materials and Methods Results Discussion References

 
Live Presentations
A series of 18 hr of lectures dealing with topics in vascular imaging, CT angiography, MR angiography, and conventional angiography was coordinated and organized at a remote site over a 3-day period using an international faculty (Table 1). The lecture material consisted of slides and text outlines. The text slides were prepared using Power-Point (version 4.0; Microsoft, Bothell, WA), which was the software of choice by most of the faculty. Lecture or educational images were converted into standard graphic interchange file format (GIFF) for Internet hypertext markup language transmission, using the PowerPoint version 7.0 converter option on a Macintosh PowerPC 8500 (Apple Computer, Sunnyvale, CA). The text and images were then uploaded to a commercial server (Interland, Atlanta, GA) using a Windows NT Server network (version 4.0, Microsoft), and a syllabus resulted.

Although audio serving via commercial compression software was possible, we chose to use standard wave (.wav) file formats for audio transmission because playback drivers for this format were available for both Windows 95 (Microsoft) and MacOS 7.5 or greater (Apple). The lecturers were recorded using a dual-channel stereo cassette deck (KX-W421; Yamaha, Buena Park, CA) that was digitized at 11.5 kHz with 4:1 audio compression on a Macintosh PowerPC 8500 using video version 3.0 software (Avid, Tewksbury, MA). The audio track was linked to the appropriate image and Web pages of the respective authors' PowerPoint presentations. Images that were not readily available in PowerPoint format were digitized using a Dimage slide scanner (Minolta, Ramsey, NJ) and were then uploaded to the Web server (www.burad.net), as indicated in the flow chart in Figure 1.

View larger version (22K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1. —Flow chart shows process of preparing an Internet lecture. PowerPoint is a product of Microsoft, Bothell, WA. GIFF = graphic interchange file format, HTML = hypertext markup language.

Test Configuration
A combination of computers—a Macintosh PowerPC 8500 (Apple) with MacOS 7.5.3, a Deskpro (Compaq, Houston, TX) using Windows 98 and Windows NT—was tested for download times using AOL 3.0 (America Online, Dulles, VA) with its own driver, Netscape 3.0 (Netscape Communications, Mountainview, CA) using either the Netscape Navigator version 3.0 (Netscape) or Internet Explorer version 3.01 (Microsoft) on direct Internet connections and over 56K modem lines. No plug-ins or downloaded software was necessary because the wave format is a standard audio format on either Windows or Macintosh platforms. The authors judged the quality of the images, sound, and user friendliness of the data by consensus to be either satisfactory or unsatisfactory.

Results

Top Abstract Introduction Materials and Methods Results Discussion References

 
A total of 18 hr of lecture material that included more than 12,000 slides was created. The slides included images of CT, angiography, sonography, and conventional radiography. Embedded video was created using QuickTime compression for one speaker who presented video information. All teaching points were easily discernible at each lecture, with the average image file size being approximately 50K. The total audio file information for a 45-min lecture averaged approximately 2 MB. All lectures all had rapid image download time, and audio download time was shown to be comparable for different combinations of viewers (Table 2).

Delivery of the lecture was evaluated over a 56K modem. The evaluators graded the audio playback as satisfactory, with the commentary easily understood in the context of the accompanying images. There was no instance in which both audio and video were judged unsatisfactory. Internet polling showed more than 400 inquiries to the site during the first week of its availability. The queuing of the speaker to the slides was done by using sequentially linked hypertext markup language pages that allowed clear association of an audio and video segment. The most often noted disadvantage in about half the recorded lectures was pauses or global inflections ("mmm," "ah,"), but these could easily be edited and modified after processing.

Discussion

Top Abstract Introduction Materials and Methods Results Discussion References

 
We present a natural extension of the original work of Tamm et al. [2]. The ability to deliver a complete course over the Internet with simultaneous images and audio in real time, regardless of receiving techniques, makes it possible to obtain continuing medical education credits without having to travel long distances. In these days of cost containment for travel, less time for travel, and increasing demands by accrediting organizations for continuing medical education, this method is clearly significant. The impact on the learning process is being evaluated during the next year with surveys that will be sent to individuals who have completed the course.

Audio and video clearly improve the computer telepresence, and streaming the media helps avoid long delays in transmission. Our course also included panel discussions with multiple faculty. In the future, the panels could receive on-line or delayed questions through the integration of e-mail. Furthermore, a library of lectures can be accessed from any Internet terminal and could be used by residents for study or by practicing radiologists for continuing education.

A definite advantage is minimizing the time needed to create an on-line presentation because it is similar to preparing a traditional lecture. Using digitally acquired images is a simple procedure, similar to providing film-based slides. A final advantage might be creating a core curriculum that can be used for training and filling in educational deficiencies at a remote residency program. The use of commercially available software and the wave audio format allows the material to be presented without requiring dedicated plug-ins or specialized software to be downloaded. Thus, the cost for any audience member is negligible if they have hardware with a sound card already installed.

In conclusion, using the emerging Internet technology to deliver a full continuing medical education curriculum has been demonstrated and is potentially available as a technique to help practicing radiologists maintain their skills without having to travel extensively.

Acknowledgments
 
We thank Berlex and Medrad for their support in the development of this technology.

References

Top Abstract Introduction Materials and Methods Results Discussion References

 

1. Mehta A, Dreyer KJ, Novelline RA, Schultz TJ, Bell TV. Facilitating the production of digital radiology teaching files with the radiology annotation and publishing system: a software tool for radiology educators. Acad Radiol 1999;6:496 -501[Medline]
2. Tamm EP, Ernst R, Weems W. The virtual lecture: delivery of live and recorded presentations over the Internet. AJR 1999;172:9 -12[Abstract/Free Full Text]

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati

This article has been cited by other articles:

				A. G. Ryan, L. J. Louis, and W. C. Yee Informatics in Radiology (infoRAD): HTML and Web Site Design for the Radiologist: A Primer RadioGraphics, July 1, 2005; 25(4): 1101 - 1118. [Abstract] [Full Text] [PDF]

				M. Jefford, K.-A. Phillips, and M. H.N. Tattersall An Online Educational Facility for Medical Oncology Trainees: www.vmotg.org J. Clin. Oncol., May 1, 2001; 19(9): 2566 - 2569. [Abstract] [Full Text] [PDF]

This Article Abstract Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tello, R. Articles by Blickman, J. G. Search for Related Content PubMed PubMed Citation Articles by Tello, R. Articles by Blickman, J. G. Social Bookmarking                      What's this?