AGOCG logo
Graphics Multimedia VR Visualization Contents
Training Reports Workshops Briefings Index
Also available in Acrobat format Back Next


1 Introduction
2 What is Multimedia?

3 Pedagogy and technology
3.1 Introduction
3.2 Generic requirements
3.3 The Framework
3.4 Insurrect
3.5 Conclusions

4 Networks
5 Future Work

Case Studies

Multimedia in the Teaching Space


INSURRECT (Interactive Teaching of Surgery between Remote Centres).
3.4.1. Administration

Administration of the project divides into the following main activities:-
1. General administration
2. Arrangement and co-ordination of teaching
3. Arrangement and co-ordination of network and teaching space.

General administration

Administration of the project involves a number of issues. An internal project contract was drawn up at Bristol University to define the responsibilities within the project. Drawing up a project contract was an interesting exercise as there are few models available to use as a basis for such an agreement. In practice there has been no contentious issues between project partners. This agreement is one of the deliverables of the INSURRECT Project.

Initially a steering committee was set up under the chairmanship of a clinician, Prof. M Hobsley. In practice the has only functioned on a few occasions, and a number of those meetings used video conferencing facilities on SuperJANET. At the end of the first year of teaching it became apparent that there was a need to discuss the progress of the project and a meeting was organised at Trinity Hall, Cambridge for a weekend conference. This meeting proved very successful and significant progress was made as a result. The main outcome was the decision that each session should be structured in the same way, but still permitting the individual style of teaching relating to each teacher.

Communications between sites was carried out using four methods:-

1. Facsimile - this enabled all partners to be reached but was relatively time consuming.

2. Electronic mail - this was the most convenient method but unfortunately a number of medical partners were not on e-mail, and consequently facsimile had to be used.

3. As the project continued use was made of the Internet to send out information on timetables, MCQs and general matters.

4. Video conferencing - this was used for a number of meeting between partners and for discussions, including visits from TLTP secretariat.

Arrangement and co-ordination of teaching

The notification of timetables and the list of topic for each session was organised between the medical partners. This required one project staff member with a large number of man-hours contacting and circulating information to each site. Depending on the activity and local organisation at each site, it was advisable for one person to be in touch with all teachers involved in the project. It was not practical to have a single point of contact at each site, because medical staff did not always come in frequent contact and one could not be certain messages were passed on. The medical secretaries were very helpful but for reliability it was better to have one person in the project responsible for the liaison.

At the beginning of the project there was liaison to establish the curriculum to be followed and who was to do what. This was not as difficult a problem as was anticipated as the medical curriculum is under review in many centre. The course was intended to be a basic course in surgery for undergraduate students and the General Medical Council was interested for the Medical School to develop their own core curriculum. This project gave the opportunity for the 6 Medical Schools to discuss this and come up with their version. This proved relatively easy to do. Following on agreement of the curriculum there was the decision concerning who was to teach what. Again this was divided between the sites easily, the guiding principle being utilise the expertise at each centre as far as possible.

The third issue was to produce a common timetable between all sites. This proved very difficult to get all 6 sites together at a specific time. This was complicated by the fact that one medical school was introducing its new curriculum and its basic design was very different to the existing systems. Interestingly the first time most sites were not flexible, about the second time there was much more flexibility.

Arrangement and co-ordination of network and teaching space.

The communications aspect is divided into two areas, firstly the action which takes place in the analogue domain, i.e. the production and reception of analogue audio and video signals and their display; and secondly that which takes place in the digital domain when the audio and video signals are digitised and transmitted over the network. The network can be divided between the local and long distance networks. The CODEC (compression de-compression equipment) is located at the boundary between the analogue and digital domains. It is not likely to be in the teaching space as the CODEC feeds directly into the ATM switch. Various technologies have been used to link the teaching space to the CODEC, e.g. LIVENET at UCL, Microwave links at Newcastle, SMDS from Bristol to London.

The natural division of responsibility has been between the Audio-Visual staff who are responsible for the analogue signal and the Computer Centre Network Staff who have been responsible for the digital signals. It has been important for these two groups to work well together. In the initial stages the Network Staff gave invaluable assistance in installing the links between the Computer Centre and the teaching space. The AV staff have been responsible for the quality control of the AV signal being fed to the CODECs.

In general it has been apparent to the project team that those centres which could count on the support of the AV staff in the teaching space have been able to produce the better quality images and have had greater reliability of activity within the teaching space. Those centres that have had a poor level of co-operation or even none at all have had greater difficulties, especially in the early stage when the system was being set up and commissioned for routine working. In the case of Bristol this problem was more acute as the technology was at a developmental stage.

A continuing problem in this area has been booking of resources. The network bookings, made through Edinburgh have been relatively simple to establish. It has been more difficult to ensure that the local bookings are satisfactory because each centre has its own booking procedures for local resources, and it is extremely difficult to establish a global system. This subject has been of serious concern to UKERNA and a special project has been set up to look into this matter directed by University of Swansea.

There have been a few situations where local errors have resulted in difficulties in teaching space being available.

3.4.2. Network Performance

The network teaching can fail at a number of levels:-
Network Failure
1. Catastrophic failure of the whole network
2. Catastrophic failure of a section of the network

Site Failure
3. Failure of the internal network facilities within a site
4. Failure of AV facilities in the teaching space
5. Non-availability of teaching space
Teaching failure
6. No show of teacher affecting the whole session
7. No show of support staff

3.4.3. Initial Setting Up Facilities

Each centre had to make some investment to convert teaching space to be connected to SuperJANET.

One centre, Bristol, had to have special facilities and used a different technology to the other centres. The SMDS network was used and this is the subject of a separate report.

At each site connectivity had to be made between the Computer Centre, where the ATM switch is situated, and the teaching space. In all cases very significant help was provided by the Computer Centre Network staff. In all cases an optical fibre extension was provided, and connection made to the SuperJANET CODEC, except for Newcastle which used their project funds to purchase their CODEC.

Also it was necessary to equip a room, lecture theatre or seminar room as the teaching room. The equipping of the room was usually carried out with the assistance of the local Audio-Visual staff, although in cases where there was no AV support the situation was more difficult. Manchester depended upon local expertise in the Royal Infirmary and Computer Centre, Bristol brought in a commercial company.

3.4.4. Multi-media Presentations

Equipment required and design of facilities (See http:// Sites were advised to use the standard arrangement of equipment, i.e. three cameras, with monitors or video projector, a fixed microphone for the teacher and a roving microphone for the students and appropriate loudspeakers. The three cameras included one to view the speaker, one to view the students and a document camera. A further camera was also used on occasions when a site was broadcasting and patients or other people were present.

The multi-media information used in the lectures could be slides, transparencies and video. On occasions special facilities were used such as an ISDN link to a General Practice surgery, and links to the clinical operating theatres. When a site was the transmitting site then video switches would be used to select the appropriate camera view for transmission.

On some occasions an analogue video server was used, the control being with the teacher, and slides and video was played over the network from the server located at University College London.

  • The multi-media presentations used the following media:-
  • 35mm slides
  • PAL video tape
  • Laser Video Recorder analogue video server - still and moving images and
  • animation.
  • Overhead transparencies - pre-prepared
  • Overhead transparencies - writing and drawing in real-time
  • Patients
  • ISDN links to other sites e.g. General Practice surgery
  • Audio/Telephone links to Australia and New Zealand.

3.4.5. Pedagogic Experience

Each course lasted 8 weeks, a period designed to correspond with the time spent by students on any one clinical attachment (although this ideal was not attained except in certain centres). A course consisted of 15 or 16 presentations, delivered twice a week between 9 am and 10 am. The necessity to book exact periods on SuperJANET meant that presentations had to be strictly tailored to fit the allotted time. After some early lapses of discipline, presenters realised the necessity and by the end were conforming precisely.This itself was considered by many to be a significant advantage of the system.

Structure of Presentation

At first these took the form of formal lectures, and the speakers brought along their usual visual aids, almost always slides. However, during the first year of teaching (i.e., the second year of the project) it gradually became apparent that the formal lectures translated very poorly into this new format and were considered by the students to be dull and didactic. It was also apparent that the real strengths of the multimedia facilities were not being exploited. A full conference of the INSURRECT participants was held at Cambridge in late summer 1995, these problems (together with the problems of failing to promote interaction (see below) were discussed, and remedies identified.

Subsequent presentations have since conformed more or less to the following formula (see Document: The Way Ahead for further details):-

i. The start is a patient (live or videoclip)

ii. Management of that patient is discussed

iii. The problem presented by that patient is then set in the context of all the other possible problems he might have had despite presenting in much the same manner. The procedure of dissecting the clinical presentation to determine the correct management for each individual situation is provided in the form of a decision-tree.

iv. Throughout the presentation special efforts (detailed below) are made to encourage interaction.


Most of the teaching was delivered to groups of students of 10-15 persons. Students were usually just starting the clinical part of their course;,they had previously, in the pre-clinical course, been lectured in large lecture theatres with little interaction and they took some time to adjust to the more interactive manner of the small group teaching. These small groups are consistent with the normal format for clinical teaching, but despite the small numbers in the group, the response to a request for questions at the end of each session was meeting a nil or miniscule response. The Document The Way Ahead details the procedures that were decided upon to promote interaction.

They may be summarised as follows:-.

i. Preparation Presenters are encouraged to build pre-determined periods into their hour for specific episodes of interaction

ii. Student Chairmen Students are reluctant to make comments or answer questions in case they make mistakes and are ridiculed for them. The appointment of a student chairman at each site results in a spokesperson who can focus suggestions from his colleagues without the opprobrium of being the author of a wrong answer if it is wrong.

iii. Competition: The speaker can produce an element of competition between the sites to encourage healthy rivalry and a desire to respond rapidly.

iv. Restriction of material / greater use of handouts: Because the various features above limit the amount of information that can be conveyed, it becomes more important to use handouts so as to increase the flow of information. It is important that handouts expand on what has been said, rather than paraphrasing it. Algorithms ('decision-trees, biii above) are especially valuable as they can be built into an important repository of useful information.

v. MCQ A procedure was developed using a few MCQ to test the knowledge of the students on a subject before the presentation. The students then recorded their answers to the questions for a second time during the presentation, thereby ensuring that they were immediately using the new information they had been given and facilitating its introduction into their long-term memory stores. At the end of the presentation, the speaker tooks his audiences through the questions, indicating the correct and incorrect answers. This procedure gave the opportunity for more student/teacher interaction.


The format of the decision tree proved a useful approach to the construction of CAL based upon a particular presentation. The decision tree is presented, with suitable explanatory notes, for those students who are at an early stage of their studies of a subject. They then proceed to a number of clinical presentations, making full use of the multimedia facilities available, to teach themselves how to manage each presenting problem. Later in the course, they can revise by testing their knowledge of how to deal with the problems, and if they make any mistakes the programme refers them back to the relevant point of the decision tree.

3.4.6. User Reaction

Student reaction

Student reaction was assessed in a number of ways; by questionnaire, by interview (video recording) and by special session at the end of course to discuss the programme. Some students will always prefer face-to-face teaching and did not like the presence of the network. The students were neutral about whether they felt the session could have been given better without the network.\

Teacher reaction

Teacher reaction was assessed by discussion at meetings and by individual communications by telephone, facsimile, e-mail or letter. With only one exception, the teachers gradually came round to using the principles embodied in "THE WAY AHEAD". The exception was not rejected, because despite his format of presentation he was an effective teacher whom the students well appreciated. We recognised that a few specially gifted individuals may be able to get away with breaking the pedagogical priciples, but most of us could not.

The third issue was to produce a common timetable between all sites. This proved very difficult to get all 6 sites together at a specific time. This was complicated by the fact that one medical school was introducing its new curriculum and its basic design was very different to the existing systems. Interestingly the first time most sites were not flexible, about the second time there was much more flexibility.

Graphics     Multimedia      Virtual Environments      Visualisation      Contents