Paediatric Procedures:
an interactive CD ROM

By Dr Pete Smith
Flinders University of South Australia

The Project

Creation of a national multimedia educational CD ROM project about procedures which are performed in paediatric practice.


The Problems

Procedures are things done to children to clarify the disease and to give therapy, for example, lumbar punctures for investigation of meningitis, IV insertion for giving of intravenous treatment, intubation for control of breathing. Medical students are limited in their exposure to procedures in paediatrics.

This is due to increased trends to manage patients for shorter times in hospitals, reducing case loads, the seasonal nature of paediatrics and the often urgent nature of some procedures. It is not ethical to allow inexperienced students to learn how to perform procedures on children. Important life-saving procedures are observed infrequently; however students are required to understand and be proficient in them.

There is clearly no opportunity for students to practise procedures during a medical emergency. Current teaching is limited to ward exposure, which is very variable and contingent on the resident, and registrar staff. Procedures are difficult to teach in a didactic manner.

Busy hospital staff may teach inappropriate short cuts or incorrect procedural techniques. Students are sometimes forgotten when staff are occupied with an emergency. Problems of inter-personal variation of techniques can be confusing for the learning student. Incorrectly performed techniques can be painful and dangerous to a child's well being.

Medical students are aware of these deficiencies in their education and in a recent survey (FUSA Medical School survey Nov. 1995), 70% of 4th and 5th year students indicated that multimedia resources about procedures would be a highly desirable component in their education.





The Solution

We are developing a multimedia CD ROM demonstrating and testing Paediatric Procedures. The target group is medical students who are learning clinical paediatrics. Multimedia can provide a superior level of clinical instruction than textbook or video, allowing students rapid access and selectivity of information. This is intended to be beneficial for primary learning and 'just-in-time' revision in a clinical setting.

Within Paediatrics in Australia we have excellent relationships, which have led to the creation of Paediatric Interactive Education (PIE), a consortium of all Australian Academic Paediatric Departments. The objectives of this consortium is to create high quality educational multimedia within paediatrics; to foster collaboration; to avoid repetition of projects; to share in evaluation of projects and to ensure that projects integrate into medical courses.

This consortium approach ensures that we collect the best video resources nationally available, have access to national expertise and ensure national utilisation of the final product (Smith 95). Resources for this project have come from Paediatric Departments at Adelaide, Melbourne, Sydney, New South Wales, Western Australia and Flinders.

The CD ROM contains high level expertise of specialists who are involved in hands-on procedural work in Australia.





The Program Components

• Video footage of procedures being performed correctly and using universal precautions from several Paediatric teaching sites from around Australia. The rationale behind this was not to create a 'regional' product. Procedures are narrated to explain the technical details
  
• Vignette commentaries from experts from several teaching centres for the above reason, to broaden the depth of experience and knowledge and to allow students the opportunity to receive information about procedures from recognised experts
  
• Animations and graphics to reinforce the anatomical points which are important for the procedure
  
• Simulations and quizzes to test knowledge and for self-evaluation.

Education Theory

Well-constructed multimedia can improve the effectiveness of learning (Fletcher 1990, Janson 1992), with better recognition and recall of events compared to paper-based learning (Goldstein 1994). We structure our multimedia to allow students to control the direction of their learning, in a mixed linear-hierarchical manner, which is ideal for effective interactive learning (Laurillard 1993).

Multimedia has been demonstrated to reduce errors in performance-based skills (McNeill and Nelson 1991) which is an important point in the rationale to teach students procedures using multimedia techniques. Multimedia also allows students to use their preferred sensory modes for learning (Oblinger 1993). Multimedia can explain problem areas in teaching where sounds and graphics are easily manipulated by the user according to their needs (Waugh 1995). Flexible learning allows students to selectively access information. This is a feature of adult learning principles and also can be used to reinforce clinical experiences. Immediate feedback to questions enables students to become their own evaluators.


Development Tools

The program is being developed using Metropolis 2.0. Animations have been developed using Poser 2.0, Adobe Illustrator, PhotoShop and AfterEffects.

Video has been filmed using a Sony DX1000 Digital Video Camera, digitised on a DC30, managed in Animation format, edited in Adobe Premiere and Compressed using Terran's MediaCleaner. This project has been greatly assisted by the AUDF loan of an Apple 9600/300 with a DC30 card.


Outcomes

The educational outcomes will be increased exposure to demonstrations of a wide range of important procedures and the correct methods of performing them.

We expect translation of this knowledge into clinical confidence, correct techniques, improved knowledge and practice of procedures and the interpretation of results relevant to these techniques. Students or junior doctors who subsequently undertake procedures on children will be more skilled, thereby performing procedures which are safer and which result in less pain.

The medical education objectives of Wolf and Turner (1989) are designed to be met with this program with the provision of feedback and positive reinforcement, demonstrating physical procedures in a dynamic and motivating manner. The outcomes of our educational objectives will be evaluated on full project completion. Prototype feedback has been very positive on the structure and quality of content.


References
Fletcher JD, The effectiveness of interactive videodisc instruction in defence training and education. 1990, Arlington, VA.

Goldstein MK, Clarke AE, Michelson D, Garber AM, Bergen MR and Lenert LA, Developing and testing a multimedia presentation of a health-state description, Med Decis Making. 1994 Oct-Dec; 14(4): 336-44.

Janson JL, Simulation program helps Coast Guard sink training costs. PC Week Special Reports: Graphics. 1992. January: 91-93.

Laurillard DM, Rethinking University Teaching: A Framework for the Effective Use of Educational Technology. London, Routledge, 1993.

McNeil BJ and Nelson KR, Meta-analysis of interactive video instruction: A 10 year review of achievement effects. Journal of Computer-Based Instruction. 1991;18(1):1-6.

Oblinger D, Multimedia in instruction. 1993. Chapel Hill NC: The Institute for Academic Technology.

Smith PK, Fardon M, Stoll P, Martin A, Forsyth KD. Childhood Seizures CD ROM: A national model of cooperation. ASCILITE 95.

Waugh RA, Mayer JW, Ewy GA, Felner JM, Issenberg BS, Gessner IH, Rich S, Sajid AW and Safford RE, Multimedia computer-assisted instruction in cardiology. Arch Intern Med. 1995 Jan 23; 155(2): 197-203.

Wolf F and Turner E, Congruence between student and instructor perceptions of clinical teaching in paediatrics. Medical Education. 1989; 23: 161-67


Acknowledgements

We would like to acknowledge the support of the AUDF in providing excellent development tools for the progress of tertiary software production. Graphic design and graphic production for the project has been by Matt Pike and Brendan McKinley from the Centre for graphic design and visual Communication at Douglas Mawson TAFE, Adelaide. This project has also been supported by a grant from the Committee for Advancement of University Teaching (CAUT).

Contact Details
Dr Pete Smith
Paediatrics
Flinders University of South Australia
Bedford Park, South Australia
GPO Box 2100 Adelaide, South Australia, 5001
Phone: (08) 8201-3911
Email: Pete.Smith@flinders.edu.au


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