Electric Differential Multimedia Laboratory Bibliography
Donna M. Santer, MD1
Joan S. Huntley, PhD2
Michael P. D'Alessandro, MD3
Peer Review Status:
1Department of Pediatrics, Children's Memorial HospitalNorthwestern University Medical School, 2300 Children's Plaza, Chicago, IL 60614
2Second Look Computing, Weeg Computing Center, University of Iowa, Iowa City, Iowa 52242
3Department of Radiology, Electric Differential Multimedia Laboratory, University of Iowa College of Medicine, Iowa City, Iowa 52242
Send Correspondence to:
- Donna M. Santer, MD,
- Department of Pediatrics, UIHC
- 200 Hawkins Drive, Iowa City, Iowa 52242
Abstract
Textbooks are now available via computers. These new electronic
textbooks or multimedia textbooks (MMTBs) appear similar to
conventional books but differ in function. In addition to text and
images, they contain video and audio clips and allow the reader to
dynamically interact with the content. MMTBs are digitally based and
can be quickly and inexpensively updated and repurposed for lectures
and handouts, and made available on-line via computer networks for
distance learning. We present the concept of computer generated
multimedia textbooks (MMTBs), describe their creation by an easy to
use sophisticated authoring system, and describe the underlying
instructional design approach to guide future authors of MMTBs.
Key Words: multimedia textbooks, instructional design, medical education, electronic textbooks, electronic publishing, computer-aided instruction, multimedia
Introduction
The medical information explosion is a significant problem for
today's and tomorrow's pediatricians. Conventional medical textbooks
and journals are expensive, bulky, and rely primarily on text but are
easy to use. Electronic textbooks or multimedia textbooks (MMTBs) are
now available via computer and are one possible solution to this
information explosion. MMTBs are similar in appearance to
conventional books but differ in function. In addition to text and
images (both black and white and color), MMTBs contain video and
audio clips and allow the reader to dynamically interact with their
content. MMTBs are digitally based and can be quickly and
inexpensively updated and repurposed for lectures and handouts, and
made available on-line via computer networks for distance learning.
The video and audio clips are helpful adjuncts in problem based
learning and patient simulations, where greater fidelity to real life
scenarios is achieved via sound and motion.
Previous computer aided instruction (CAI) programs have been produced using customized software and special hardware for each individual program. Thus these programs cannot be easily modified, updated, or repurposed by the author or user. In addition, production of CAI programs has required the author to have programming skills in addition to his or her expertise in the content area. We seek to share insights we have gained and make the pediatric community (both future authors and users of MMTBs) aware of this contemporary form of communication and instruction and its potential future applications. We present the concept of the MMTB and describe the creation of a pediatric MMTB by an easy to use, and sophisticated authoring system which is commercially available, universally applicable and requires no programming knowledge. We will also describe our underlying instructional design approach to guide future authors of MMTBs.
Methods
A detailed approach to the creation of MMTBs has been previously
presented and a brief overview is presented below. (1) We created
ElectricAirway™, a MMTB designed to teach medical students and
interns about common pediatric airway diseases including: the croup
syndromes, acute epiglottitis, tracheo/laryngomalacia, and subglottic
stenosis. ElectricAirway was created using interText™
(Intellimation, Santa Barbara, CA, USA) a multimedia authoring tool
developed in part to support this research. interText is HypercardTM
(Apple Computer, Cupertino, CA, USA) based and runs on Macintosh
computers (Apple Computer, Cupertino, CA, USA). Other similar
commercially available authoring tools are available such as the
Multimedia Viewer (Microsoft Corp., Redmond WA) for Windows platforms
and the Voyager Expanded Book Toolkit (Voyager Co., Santa Monica, Ca)
for the Macintosh personal computer.
interText is a generic media processor that processes media similar to the way a word processor processes words. It accepts prepared text arranged in individual files and compiles them into a textbook shell so they appear in the form of a book. The author then annotates (links) specific words or phrases in the text to other related media including video and audio clips, radiographs, diagrams, pathology images, supplementary text, etc. through the use of pull-down menus. These specific words or phrases can also be linked to text in another part of the MMTB. Using a mouse to click on the annotated words allows the reader to view the related media. Thus, the media "pops up" and adds information to the relevant area of the text. (Fig. 1) The author can later easily modify the MMTB if needed, by additions and deletions of text and media through the use of pull-down menus. Although the MMTB can be protected so students cannot modify the contents, there is the option for the author to allow the student to modify the MMTB as they use it. Students can create their own set of multimedia notes by copying, pasting and rearranging the media; thus, turning the MMTB into an interactive learning environment that facilitates knowledge exploration and construction.
Once the MMTB has been created, navigation is as simple as reading a printed textbook. The reader opens the book to the Table of Contents. (Fig. 2) The reader may go from the Table of Contents to any chapter simply by clicking on the chapter name. Once in the chapter, (Fig.1) the chapter name and page number are highlighted at the top of the screen. Navigation buttons below the chapter title allow readers to return to the Table of Contents, as well as move forward or backward one chapter or page at a time. These navigation tools are simple to use and virtually eliminate the chances that the reader will become lost within the MMTB.
Other features of the MMTB are included in the pull-down menus at the top of the screen. One example is the ability to take notes in the margin of the book. (Fig.1) These notes use word processing features and are easily modified, edited, and reformatted. The reader's notes, a page, a chapter, or the entire book may be printed. Another feature is the ability to search for words, phrases, etc. within the book, to find associated material easily and quickly.
Results
Our work resulted in a MMTB (ElectricAirway which is distributed
on Compact Disc Read Only Memory (CD-ROM)), and a tool (interText)
for the creation of MMTBs.
ElectricAirway has 18 chapters and is divided into three main sections: an introduction, a discussion of pediatric airway diseases, and a conclusion. The introduction section consists of the first 5 chapters and includes the title page, table of contents, dedication, and credits. The introduction also devotes a chapter to more extensive information on navigating through a MMTB. Prefaces and forewords would also be incorporated in this area if appropriate by simply adding an additional chapter to a MMTB.
The second section contains the major content - pediatric airway diseases. A chapter of educational objectives helps readers understand what the author expects them to learn, thereby guiding their subsequent reading. Each disease chapter presents sequentially the epidemiology, pathogenesis, clinical manifestations, differential diagnosis, evaluation, treatment, and prognosis of the disease. Throughout the text corresponding media is annotated, e.g. a movie of a child with croup as he presents to the emergency department is shown when the text describes the characteristic cough and appearance. An insight we have gained is that a high media to text ratio is preferable as reading a large amount of text on the computer screen over an extended period of time can be fatiguing to the reader. However, text is important as readers are familiar with text and reading is a faster form of imparting large amounts of information than audio or visual communications. Text is also easily searched, whereas other forms of media need to be indexed before being searchable.
Summaries of each aspect of an individual disease are presented with audio and pop up supplementary text to emphasize and review the material. Similar multimedia treatment is accorded to key points (Fig. 3) presented in the chapter. Each disease chapter also contains questions with pop up answers for the student to test their understanding and to provide immediate feedback. References are also presented using pop up text.
A separate chapter presents a multimedia summary of the key elements of the pediatric airway diseases presented in a table form. (Fig. 4) This multimedia study sheet draws upon the media previously presented, encouraging a directed review of these key elements by allowing the student to directly compare several pieces of media on the screen simultaneously. For example, the student can compare radiographs of a child with croup to those of a child with epiglottitis.
A chapter of case studies has been included so that students may work through realistic patient presentations and simulations of these disease processes. For example, the student is presented with a 6 month old well infant who woke her parents with a "terrible sound." An unknown sound (stridor) is presented to the student and patient management questions concerning history, evaluation, and treatment follow. These questions test the student's newly acquired knowledge in a pertinent clinical situation.
The third and final section of the MMTB provides diverse references including a dictionary, an index of the media contained within each chapter, and an index of media by type (i.e. all videos in the MMTB together, all the diagrams together, etc.). (Fig. 5) These indices allow students to review all the media within a particular chapter, or all media of a particular type, in a single place without having to search through the MMTB. This encourages the student to self quiz, make his or her own comparisons and contrasts, and simply browse in an unstructured review of the material. This section could also include appendices pertinent to the text such as references for normal laboratory values, growth charts, standard abbreviations, or other reference tables as well as indices of other types. Students can personalize their MMTB by incorporating their own multimedia reference material.
The metaphor of a printed textbook was used in designing the MMTB because the instructional design principles of printed textbooks have evolved over centuries, and are therefore familiar and easy to use for the reader. The creation of a standardized textbook shell providing the same navigation and organizational tools for each MMTB by interText provides an overall structured instructional design. However, considerable flexibility is afforded to the author, thereby accommodating individual needs and purposes. The number of chapters, the arrangement of chapters and the layout of content within each chapter is left to the author. Thus, MMTBs can be used in any field of academic pursuit.
Discussion
MMTBs offer eight distinct features that are unobtainable in
printed textbooks.
Computers are becoming more inexpensive, reliable and easy to use. Handheld portable multimedia textbook players are now reaching the mass market and in a few years will be found as readily as stethoscopes in the clinics. Computer networks are becoming more prevalent and offer access to vast quantities of medical information. The question is not if, but how, MMTBs will be used in medicine. We envision MMTBs being pervasive throughout pediatrics and medicine in general, because of their advantages as already discussed. They will be used by students of medicine regardless of specialty, level of training, or location of practice. The individual's use will vary from the teaching of basic information to medical students, to updating practicing physicians about new advances or accessing specific patient care information. In today's academic fiscal environment, it is no longer efficient or economical for faculty to present the same basic information to students on a repetitive basis. MMTBs can be incorporated into the curriculum by transferring core lecture information for each area of medicine to a MMTB and allowing medical students and residents to learn and review at their own convenience and pace. After self-studying the MMTB, learners then meet in small discussion groups with a faculty member. The faculty can thereby shift their teaching role from that of repetitive lecturer, to that of facilitator and tutor. The learners' knowledge is then integrated with the teacher's experience. Therefore, the time of the student and teacher is more effectively utilized. These same techniques would find broad applications in pediatric Continuing Medical Education as well. ElectricAirway has already been used to instruct approximately 200 medical students. Other MMTBs have been used by practicing physicians, and are currently being used to instruct medical students, residents, and fellows at the University of Iowa in pediatrics and radiology.
Little has been written in the medical literature about the instructional design of electronic textbooks, (6-7) but the instructional effectiveness of traditional computer-aided instruction and on-line databases has been discussed. (2-5, 8) Research into the instructional effectiveness of MMTBs has begun. One study showed a MMTB to be as efficacious an instructional technique as a lecture. (9) A randomized, prospective, inter-institutional study comparing the instructional efficacy of ElectricAirway to a printed textbook and a lecture has recently been completed and the data are currently being analyzed.
Our key breakthrough has been to separate the creation of the multimedia content from the creation of the multimedia textbook. (1) The physician does not have to be a computer programmer to create a MMTB. Instead, multimedia content for the MMTB is supplied by the physician or content expert and the task of MMTB creation can be performed by a medical graphic artist. Currently, on average, our MMTBs contain the amount of material found in several lectures. Thus, our experience has been that the time required of the physician to create content for a MMTB is not much more than would be required to create these lectures.
In clinical medicine, the compilation of numerous patient and colleague encounters over time - experience - cannot be simply conveyed in text. However, experience can be reproduced by the multimedia simulation of patients and clinical situations in MMTBs. In this way, we can move the traditional medical paradigm of "See One, Do One, Teach One" from the pediatric clinics to wherever medical information is taught or needed.
Acknowledgments
The authors gratefully acknowledge the support of the Weeg
Computing Center at the University of Iowa. This project was
completed as a joint research effort between the Weeg Computing
Center and Department of Radiology at the University of Iowa College
of Medicine
Figures
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copyright © 1992-1997 the Author(s) and the University of Iowa. All rights
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Last Modified: March 04, 1997