VIRTUAL TEACHING

IN MEDICINE

TELEMEDICINE

What is Telemedicine?

A SEVERELY OVERUSED AND MISUSED TERM!

“The delivery of healthcare services, where distance is a

critical factor, by all healthcare professionals using

information & communication technology for exchange of

valid information for diagnosis, treatment & prevention of

disease & injuries, research & evaluation, and for the

continuing education of healthcare providers, all in the

interest of advancing the health of individuals and their

communities”.

WHO (2002)

Components of Telemedicine

Teleconsultation Advice

Telediagnosis Pathology, Radiology

Teletreatment Advice

Tele Surgery Robotic surgery

Telemonitoring AIIMS to Andaman

Telepresence

Tele Education

Tele Learning

Tele Teaching

Supply & Demand mismatch

Maldistributed Logistics

Affordability vs. Accessibility

Teachers less

Facilities less

Demand more

Problems in Med-Ed?

Problems in Med-Ed

Shortage of resources

compounded by difference in and

lack of uniformity in imparting or

teaching/learning of medicine as

compared to Engineering and some

of the other technical disciplines Require 3D orientation

Link systems of the body

Explaining spatial concepts

Possible Solutions

Increase the numbers of Teachers

Increase resources and facilities

Decrease the Demand!!

Adopt assembly line approach to

Med-ed

VIRTUAL TEACHING

VIRTUAL TEACHING

Tele Learning

VERSUS

Tele Teaching

NPTEL - Excellent distant teaching

model by IITs and IISc

AIIMS The Virtual teaching Project

Creating the Virtual Medical Classroom

A new paradigm for the impact of

e-learning on medical teaching

REPORT ON A PILOT PROJECT SANCTIONED

BY THE NKN 1st March, 2011 to 29th February, 2012

Investigators in the Pilot Project

• AIIMS, New Delhi – Dr Manoj K Singh Pathology

– Dr A K Dinda Pathology

– Dr Rani Kumar Anatomy

• PGIMER, Chandigarh – Dr Kusum Joshi, Pathology

– Dr R K Vashishta, Pathology

• PGIMER, Kolkata – Dr U Chatterjee, Pathology

– Dr Suchandra Ray, Pathology

• NEIGRIHMS, Shillong – Dr Santa Singh, OBGYN

– Dr D K Brahma

• JIPMER, Puducheri – Dr S K Verma, Pathology

– Dr Debdatta Basu, Pathology

• IGMC, Bhopal – Dr B P Dubey, FMT

– Dr Simmi Dube, Medicine

– Dr Ashish Gohiya, Orthopedics

• UCMS, Delhi – Dr O P Kalra, Pediatrics

– Dr S N Bhattacharya,Dermatology

– Dr Arun Sharma, CCM

• CNBC, Delhi – Dr R Gupta, Pathology

– Dr Prasanjit Das, Pathology

– Dr Nishant Verma, Microbiology

– Dr Mamta Jajoo, Pediatrics

• LHMC, Delhi – Dr Manjula Jain, Pathology

– Dr Anita Nangia, Pathology

Academic Advisory Panel/The core group at

AIIMS consists of specialists from all specialties.

Anatomy

R Kumar (AIIMS)

T S Roy (AIIMS)

R Dhingra (AIIMS)

A Srivastava (KGMC)

V Bharihoke (UCMS)

Biochemistry

S S Chauhan (AIIMS)

K Luthra (AIIMS)

Biostatistics

R M Pande (AIIMS)

Cardiosciences

A K Bisoi (AIIMS)

R Narang (AIIMS)

Dermatology

B K Khaitan (AIIMS)

Medicine

R Guleria (AIIMS)

A B Dey (AIIMS)

Naveet Wig (AIIMS)

Microbiology

L Dar (AIIMS)

Neurosciences

S S Kale (AIIMS)

V Goyal (AIIMS)

A Suri (AIIMS)

OBGYN

N Bhatla (AIIMS)

J B Sharma (AIIMS)

Pathology

S DattaGupta (AIIMS)

A K Dinda (AIIMS)

Ruma Ray (AIIMS)

K Joshi (PGI)

R Gupta (CNBC)

P Das (CNBC)

Hematology

R Saxena (AIIMS)

Pediatrics

V K Paul (AIIMS)

A K Deorari (AIIMS)

S Kabra (AIIMS)

M Kabra (AIIMS)

Pharmacology

Y K Gupta (AIIMS)

K H Reeta (AIIMS)

Orthopedics

P P Kotwal (AIIMS)

S Rastogi (AIIMS)

Physiology

K K Deepak (AIIMS)

N Mehta (AIIMS)

R K Yadav (AIIMS)

A Jaryal (AIIMS)

Radiology

S Thulkar (AIIMS)

S Sharma (AIIMS)

Gastroenterology

G Makharia (AIIMS)

Surgery

A Srivastava (AIIMS)

S Guleria (AIIMS)

S Agarwala (AIIMS)

Cancer

P K Julka (AIIMS)

Technical Advisors

B D’Monte (AIIMS)

B V Adkoli (AIIMS)

P Khare (IGNOU)

T K Jena (IGNOU)

The Project

• We have developed some initial virtual

teaching modules. • Modules have been designed to promote, facilitate and encourage

the understanding of core concepts and the disease process

• We have tested these modules on the

NKN cable

• We have evaluated these modules using

detailed feedback questionnaires, filled by

students and teachers

Types of modules 1. Videos of actual lectures

2. PowerPoint with Voice over

3. Videos of patient examination, practical

experiments

4. Case-studies - correlating pathological, clinical

and curative/management aspects

5. Animated modules 2-D animation

6. Animated modules 3-D animation

7. 3-D constructs / reconstruction

8. Hologram based

Actual Lecture

The purpose of the project was to

demonstrate….

– High resolution & large sized

• Patient and specimen photographs,

• Photo-micrographs,

• Radiological images,

• Digital images/diagrams &

• Animated presentations

– All these can be transmitted and interchanged using the NKN cable.

– Possibilities: Two way interaction between teachers, students and moderators/facilitators for didactic teaching, webinars / seminars, demonstrations / practical sessions and group discussions….and so on

VIRTUAL MEDICAL

CLASSROOM

Workshop statistics

FEEDBACK RESULTS • LIKE! (96.15%)

– Graphics

– 2D & 3D animation

– Videography

– Content coverage and explanation

• BETTER THAN CONVENTIONAL!!!

IMPROVEMENT REQUIRED

• Technical difficulty(58%) – voice comprehension

– Asynchronous voice & image

• NO INTERACTION (86.6%) – Explanation

– Teacher Student Bonding

• SELF ASSESSMENT – POLAR

– INTERCESSIVE

Modules

GMC AIIMS JIPMER LHMC CNBC UCMS PGI Shillong Total

Hypersensitivity 22 39 8 44 10 80 0 35 238

Renal cell

carcinoma

23 41 6 44 10 100 0 32 256

Acute leukaemia

0 13 9 44 10 21 0 34 131

Urine examination

19 32 10 44 10 0 0 31 146

Cardiopulmonary

resuscitation(CPR)

24 21 10 44 10 7 0 30 146

Breast examination

0 33 9 0 10 26 0 23 101

Glomerulonephritis

19 10 7 0 10 13 0 15 78

Physiology of

kidney

0 24 5 0 10 9 0 0

48

Total

107 207 64 220 80 256 0 200 1144

Like(Total-1144) Picture/Video/animation 1100

96.15%

Content/understanding/revision 898 78.5%

Content/Explanation 389 34%

Idea/New Technology 400 34.9%

Dislike(Total-1144) No Interaction

757 86.6%

A/v problems 749 85.6%

Other Technical problems

515 58%

Content

121 13.8%

Suggestions • Should be interactive session at the end/Assesment/Questions

• Use modified voice over

• Solve A/V and technical problems

• Add more animation and graphics

• Insert picture of a teaching Professor ???

• Add objective / summary

• include more clinical problems/Problem solving cases

• Prepare short lectures as long lectures are boring

• Add references at the end

• Self evaluation question/s at the end

• Cover more practical topics

• Should start from the basics for proper learning

• Lectures should be available on Net

• Presentation screen should be larger

• Good because lectures are developed by the specialist faculty

• Good bulk of high class learning will be available

• Use professional voiceover

• Teacher should be in video

• Use of original patient video in really good

• Use dual screen with teacher in one and module in another screen

Students’ response • We thought more classes should be like this

• Compare to the conventional teaching it is easy to understand and

recollect

• Perfect module

• It should be a guiding tool

• Should be available in DVDs/internet

• There is no time wasted between the classes----good

• Good for students who missed the class

• We can interact with all connected medical colleges so that knowledge

can be shared

• More enjoyable/more interesting/student friendly

• We could concentrate more on the module, usually I lose my concentration

after some time in conventional teaching

• More effective that conventional;

• Place like AIIMS should prepare excellent cases like this

• Standardization of medical education

• Animation will itself clear lot of doubts

• This will definitely improve the teaching

• Moving slides are easy to concentrate

• More attractive than conventional teaching

• Requires less time to understand

• Has definitive edge over conventional teaching

• Not boring at all

• I always like to study in this way

• It is equivalent to bed side teaching

• Many distractions in conventional learning

• Uniform correct methods can be learnt

• Less motivation in the absence of teacher

• Moderator in the class

• Lack of human touch

• One way kind of teaching is boring

• Use simple and local language (hindi)

• Nothing else to dislike

• No face to face discussion

SUGGESTIONS

• Visualization will help in retaining for long time

• Very good and advanced technology

• This will definitely improve the teaching

• It should be available for even those who live in remote areas

• Better animation better understanding

Expected Outcomes

1. Extensive use of the NKN for real-time exchange of high volume images, videos & teaching modules. Patient and specimen photos, photo- micrographs, Radiology images, digital diagrams and animated presentations

2. AIIMS experts can collaborate to construct these high volume teaching modules

3. CORPUS OF MATERIAL

Comprehensive list/syllabus of VTMs adequate to cover the entire MBBS course including correlative & interactive Structure-Function case studies

*(The Virtual MBBS curriculum)

YES

YES

YES..

But will

take time

Visit of Secretary

VIRTUAL TEACHING IN

MEDICINE

WHAT NEXT?

MODULES LIKES -

AUG

NEGATIVES

- AUG LIKES -

MAR

NEGATIVES

- MAR

RATIO :

LIKES & DISLIKES

AUG MAR

BREAST

EXAMINATION

532

(72.4%)

203

(27.6%)

141

(69.1%)

63

(30.9%) 2.62 2.23

URINE

EXAMINATION

537

(64.5%)

296

(35.5%)

74

(56.9%)

56

(43.1%) 1.81 1.32

HYPERSENSITIVITY 844

(67.2%)

411

(32.8%)

246

(62.4%)

148

(37.6%) 2.05 1.66

CPR 221

(56.9%)

167

(43.1%)

189

(64%)

106

(36%) 1.32 1.78

RCC 143

(65.8%)

74

(34.2%)

46

(65.7%)

24

(34.3%) 1.93 1.91

Virtual Teaching Platform

We hope the VTP can become a vibrant,

viable, feasible, valid and reliable alternative

to traditional teaching, and add value.

eventually, because of its flexibility and

limitlessness, it may replace traditional

methods of teaching

AT A NATIONAL LEVEL

THE VIRTUAL MEDICAL SCHOOL

POSSIBLE FUTURE

OUTCOMES 1. NATIONAL MEDICAL EDUCATION

PORTAL

2. NPTETMED

3. The VIRTUAL SKILLS LABORATORY

4. SKILLS TRAINING FOR ANMs, Nurses,

Technicians

5. Continue teaching at present level

NPTETMED

• A COLLABORATIVE PROJECT

– Ministry of Health & FW, GOI

– All India Institute of Medical Sciences, Delhi

– NIC, DIT

– Other Medical Colleges/faculties

– MCI

NATIONAL PROGRAM for

TECHNOLOGY ENHANCED

TEACHING in MEDICINE

NPTETMED

• Cf NPTEL of IITs and IISc

NATIONAL PROGRAM for TECHNOLOGY ENHANCED

TEACHING in MEDICINE (NPTETMED)

While this program is initially tuned to UG teaching, it can easily be

geared to many other applications. These can include

PG teaching (as various courses)

PG teaching (sporadic/issue based)

Conferences

CME programs

Refresher courses for practitioners

Credit hours for MCI/State Councils

AND

• Nursing

• Dental

• Pharmacy

One Suggested Alternative • A judiciously crafted blend of Distance

teaching & Teleconferencing, with

strategically placed moderators at the

user end.

• Delivering a mix of Lectures, case-studies,

videos with voiceover for practical

exercises, specimen demonstration,

instrument classes, patient examination,

clinical procedures etc.

??? REQUIREMENTS

Modus operandi • An adequate group of competent faculty

• Embedded in an adequately equipped medical

college/s (for laboratories, experiments, clinical/patient

material)

• An adequate teleconferencing solution (hardware &

software) between the medical colleges

• Suitably trained & oriented subject moderators at

the user end, who can

• help explain concepts to the students

• organize & co-ordinate the teaching

• organize the evaluation process

• continuously provide feedback to strengthen the

program.

• An empowered, technically competent authority/

committee to run this project WITH

• TIGHT programming and delivery AND

• NETWORKING SOLUTIONS AT ALL LEVELS

CREATION

TRANSMISSION

DIGESTION ASSIMILATION

UNDERSTANDING

COMPREHENSION

ASSESSMENT

UTILIZATION

CO-ORDINATION

The VIRTUAL SKILLS LAB

• SKILLS

• In the Health Sciences, a very significant component

is acquisition of skills, aesthetic and manual, as well as

the correlation (at times 3 Dimensional) of manual skills

with theoretical knowledge. and there is a greater

emphasis on active Teaching, involving skill

demonstration, skill practice and an integration of

theoretical knowledge with the skill.

• These skills are varied; they include venepuncture for

diagnosis, putting a plaster bandage, suturing cuts,

conducting deliveries (deciding when an episiotomy is

required) and so on.

SKILLS MODULE

Suturing Class

LOW LEVEL CONTINUING

TEACHING • CREATE WEBSITE

• INSTALL SUITABLE LMS

• IDENTIFY TARGET AUDIENCES

• DEVELOP SUITABLE COURSE

CURRICULUM CME, REFRESHERS, PRACTICAL MODULES ETC

• CREATE MODULES

• TEACH!!!

THANK YOU