Interactive Video- The Future of Video for Education and Beyond

I recently discovered a cool tool for teaching- TouchCast. A TouchCast is an interactive video; meaning there is a background video and things popup that can be touched and opened up.

TouchCast Logo

I made a Touchcast on case-control studies. Check it out and see what I mean. Make sure you touch one of the YouTube videos or the web site that I put on the screen to see how it works.

I find this very exciting. I can make a background video that gives a 30,000 foot view of a topic and embed further materials (other videos, websites, etc) for those that want a deeper understanding.

So what are the limitations? For now the interactivity is limited to viewing a TouchCast via their app or their website for the interactive functionality. The videos can be uploaded to YouTube but the interactivity is lost. The length of the video is also limited to 5 or 6 minutes. This isn’t a killer for me because educational videos should be short and in this case I can embed hours of other videos if I wanted to. Finally, the other limitiation (for now, will be changed soon) is that its an iPad tool. A desktop version is coming soon. Hopefully an Android app also.

TouchCast has really broken ground here. This should open up more advancements that will do even more. The future is exciting for us flipped classroom types.

EBM Is In Jeopardy- Gamify A Lecture To Make It More Interesting

This week I did an EBM “lecture” based around the game show jeopardy. Now I know this isn’t anything new. Lots of teachers have used jeopardy format to teach. The point is that it took the content of “EBM Potpourri” (a group of topics that don’t fit well in other lectures that I give) and made it more interesting than a traditional 1 hour lecture (which is how I have given this lecture in the past).

The challenge when doing this to figure out your main teaching points and only include them since you don’t have a lot of extra space for less important topics (but shouldn’t we be doing this anyway?) The next challenge was to make gradually harder questions within each topic. I made some of the questions limited to certain learner levels only (I teach internal medicine residents that are organized into interns, 2nd years and 3rd years) to make sure every one participated independently at least somewhat. The residents only got about 40% of the questions right….but that wasn’t the point. The point was to convey my teaching points and to engage the learners. They worked in their teams (each team consisted of an intern, 2nd yr and 3rd yr) to solve problems. The competition between teams for “great prizes” (certificate of appreciation for 3rd place team, Rice-a-Roni to the 2nd place team, and lunch with me for the winners) made them take it a little more seriously.

If you would like the original PowerPoint file to use in your teaching I’ll be happy to email it to you. Contact me at UABEBM@gmail.com

What unique ways have you taught EBM topics?

Tools I Use to Make My Teaching Videos

I began developing an online course in EBM and use videos for instruction. I thought it would be useful to tell others what I use. Videos are a useful way to teach others and are more learner-centered in that learners can use them when they want and can skip around in them for the information they need.

First off your videos need to be relatively short: 3-5 minutes is optimal. Longer than 10 minutes and learners will abandon the video. You have to be thoughtful on how to break up a longer topic into shorter chunks. They need to be engaging either through your teaching style or material presentation. They need to be consistent– use the same backgrounds, intro and exits.

Here’s what you need to make teaching videos: (Note: I am a PC guy. Mac has good built-in software that I can’t really comment on as I dont use Macs)
1) Video Hosting Service: YouTube and Vimeo are 2 of the more popular hosting sites. Some of the tools below also have their own site to post videos on. I personlly like YouTube. Here is my YouTube channel.

2) Video Editing Software: I actually record myself giving intros and endings for each of my teaching videos. That way I have a “physical” presence. Because of this I need a video editor to splice these together with the main body of my video. There’s lots of video editing software out there. I use Corel Vidoe Studio Pro because it also contains a screen capture tool and seemed easy to use and wasnt too expensive ($60).

3) Screen Capture Software: I usually display a PowerPoint slide or a paper or a website when I teach. I use sceen capture software to record my computer screen and my voice. I like Screencast-o-matic because its easy and cheap (free). I bought the Pro version ($15/yr) so I have more tools available but the free version is good.

4) Video camera or webcam if you want to video something other than your computer screen.

5) Bamboo tablet: I use this to write on my screen when I explain/demonstrate how to make calculations. (http://www.wacom.com/en/products/pen-tablets/bamboo). This YouTube video shows me using the tablet and the digital drawing program I describe below.

6) Digital Drawing Program: this is the background I write (or draw) on with the Bamboo tablet. I like Autodesk Sketchbood Express because it was more intuitive to use and free. Khan Academy uses SmoothDraw but I didn’t find it as easy to use.

7) Microphone. Often they are built in to your computer or webcam. I bought a high def one off ebay for <$10 because I wanted improved sound.

8) Audacity (http://audacity.sourceforge.net/) is software for recording and editing sound. If you want to just do voice recordings this is a good program.

So that’s it. For a minimal outlay of money you can develop pretty good quality videos. There is a learning curve on editing. You will also have to decide your style. Look around at other videos and do what works for you. This guy has incredible videos but they take a little more time and skill to make.

Systems Give Us What They Are Designed To Give: Work Hour Restriction Outcomes

A colleague of mine (DB) has a great blog (medrants.com). He posted (http://www.medrants.com/archives/7199) an excellent observation that ABIM pass rates are declining since the work hour restrictions have gone into place. I commented back that why would we expect any different because systems give us exactly what they are supposed to give us. In this case less knowledgeable residents.

The proof is in the scores. Why? My theory is that they waste their off time with being off and not studying. When I was a resident in the mid 90s we had no restrictions, no admission caps and only 1 guaranteed day off a month. We stayed at the hospital until late afternoon at least if not early evening routinely. We studied alot during the day in our down time. The satellite library at the hospital was full of us studying (and yes BSing). I saw alot more patients and did alot more to them than this current generation. Interestingly I dont recall mass killings and mayhem at my training hospitals. But for some reason we have accepted a system (work hour restrictions and admission caps) without testing it ahead of time. No drug gets to market this way but for some reason its ok to let doctors get to market this way.

Doctors are on the clock

Being a doctor is complex. Clinical reasoning relies on matching the patient’s story to an illness script. You build illness scripts from studying books (print or electronic…doesnt matter) and by patient interactions. You have to see lots of patients to enhance and mature your illness scripts. Therein lies the problem…..less studying and less patients. Wow…how did we ever get these lower passing rates. Its hard to understand (sarcasm detected). Oh well it doesnt matter. I am sure the wonderfully designed quality measures will make it all better.

Vertical Reading Is Not Just For Clinical Reasoning

Recently I got interesting in more formalized teaching of clinical reasoning. I am currently enrolled in a Coursera (coursera.org) course on clinical reasoning. My reason for taking this MOOC is that I wanted to see how others teach this material so that I could improve my teaching. A great revelation I had while reading Judith Bowen’s now classic NEJM article () and which was reenforced in the Coursera course was vertical reading. The way I summarize this is that we recognize diseases best, not by their similarities, but by their differences. With vertical reading you compare 2 or more diseases by filing out a table with epidemiology, pathophysiology, signs, symptoms, testing, etc. Instead of reading about 1 disease at a time and filling in the table horizontally you fill in the table vertically and read about each component of the table for both diseases at the same time.

The reason I bring this topic up is that I am doing journal club next week and I have asked the residents to read 2 articles on seemingly the same topic. There are nuances that make the articles different but if you read them individually and separately you likely wouldn’t pick up on these nuances. Thus, the vertical reading. I gave the residents a table to fill out comparing the 2 articles. They will read them both at the same time comparing the articles on each of the elements of the table;moving vertically down the table. They should be able to detect the nuances of each article. We will see.

A New Format to Teach EBM That Worked Really Well

Last month I gave my final lecture of the year on EBM. I talked about diagnostic testing but used a new format. Well it isnt really a new format as we do this in another setting but it was new for EBM lectures. I presented a case, actually a few cases, to a colleague of mine and we discussed the approach to diagnosing these cases and sprinkled in the EBM topics along the way. The process is labelled “clinical problem solving” at UAB. Basically a presenter gives snippets of information to a discussant. The discussant walks the audience through his or her thoughts after each snippet of information is given.

I did the same thing but applied to teaching EBM principles of diagnostic testing. I gave information and asked the discussant what he thought the patient’s pretest probability was. I gave more information and we discussed testing and treatment thresholds. I gave more info and we discussed how to get to posttest probability. We covered sensitivity, specificity, LRs, choosing tests, determining posttest probability. I had quite a few questions for the audience (using our ARS) and they could compare their answers to that of my discussant.

I only changed up the format because I was bored giving the same lectures year after year. I was amazed at the evaluations of the discussion. I didnt get across all the info I normally would have but it didnt matter. We engaged the audience and demonstrated EBM in action. We demonstrated clinical reasoning (using EBM). I look forward to doing this more in the future.

Flipping Medical Education

As I am thinking about and developing a web course on EBM I have come to the conclusion we need to change the way we educate medical students. Medical schools need to be schooled on education innovation. Yes we change curriculums to be problem based or whatever the latest buzz word is but they are still mired in the one true impediment to lifelong learning—- the hour-long lecture. Perhaps it’s because medicine has such tradition that we are stuck in the teaching methodology of the last century. It’s time to flip it on its head.

WE (emphasis added by me) can’t fit it all in the curriculum. It’s just not possible

This quote is from a dean of a Canadian medical school. It reflects the problem with the current paradigm.  His focus (“WE”) is on what educators want to cover and not what the students need or want. We have this sense at medical schools that WE must lecture about everything. But that’s not possible.

Flipping is doing traditional classwork  at home and doing homework in class. What this means is that students would do online background course work (ie short videos developed by faculty) at home and class time would be spent on discussion and interactive exercises that support knowledge retention. Why do we (meaning medical educators….or any educators for that matter) force students to learn at our pace during the traditional 1 hour lecture (which is actually 50 min at my medical school)? How can we make sure students (all students!) understand the information? What if a few don’t understand a concept? Do we stop the whole class? Usually not, we just trudge along giving our lecture usually leaving some time at the end for questions which few have because their brains are numb from being lectured at.

With online learning each student can proceed at his or her own pace, taking more time on a harder topic if needed. She can also skip a topic if she has already mastered that information. Students can take time to link to other material to get an even deeper understanding if needed.

This generation of students (the millenials) are different from us older educators (I’m a gen x’er). They use technology (and to them email isnt technology!) much more than we do to communicate and learn. They prefer social, group based education. They like to learn by solving problems and don’t like as much lecture. It’s time we adapt our teaching to their learning.

This isnt easy as I am learning. Schools will have to invest in infrastructure and protect time for faculty to develop and maintain these interactive materials. The biggest obstacle though is us….we have to change our ways…..leave our comfort zone of the hour lecture.  As I am finding it has been incredibly intellectually satisfying  to develop material for a “new” teaching platform. I am hoping my course will be the sentinel event that stimulates my medical school to seriously  revamp the curriculum in a meaningful way, not just a name change but a paradigm change.