Articles
Register for Prof-in-a-Box: Using Internet-videoconferencing to Assist Students in the Gross Anatomy Laboratory
Stephen J Moorman
Department of Neuroscience and Cell Biology, Robert Wood Johnson Medical
School, 675 Hoes Lane West, Piscataway, NJ 08854 USA
BMC
Medical Education 2006
An Open
Access research article
Published 15 November 2006
Abstract
Background
The optimal learning environment for gross anatomy is the dissection laboratory.
The Prof-in-a-Box (PiB) system has been developed where an anatomist using
distance-learning technologies 'helps' students in a dissection laboratory at a
different site.
Methods
The PiB system consists of: (1) an anatomist in his/her office with a computer
and video camera; (2) a computer and 2 video cameras in the lab; (3) iChat AV
software; (4) a secure server to host the PiB-student 'consultation'. The PiB
system allows the students and faculty to interact via audio and video providing
an environment where questions can be asked and answered and anatomical
structures can be identified 'at a distance' in real-time. The PiB system was
set up at a prosected cadaver and made available for student use during 'office
hours'.
Results
25–30% of the students used the PiB system. Anatomical structures were
identified, questions answered and demonstrations given 'at a distance' using
the system. Students completed an optional questionnaire about the PiB system at
the end of the semester. Results of the questionnaire indicate that the students
were enthusiastic about the PiB system and wanted its use to be expanded in the
future.
Conclusion
Many of the functions of a faculty member in the gross anatomy dissection
laboratory can be performed 'at a distance' using the PiB system. This suggests
that a geographically dispersed faculty could assist in providing instruction in
the dissection labs at multiple medical schools without needing to be physically
present.
Background
We have a problem in gross anatomy:
Within the next decade there will be a critical national shortage of PhD-level
faculty trained to teach gross anatomy [1]-the way we teach
will have to change. Effective use of educational theory and distance-learning
technologies to provide lectures (delivered by geographically dispersed faculty)
to students at numerous schools is one way to continue to provide medical
students with instruction in gross anatomy when this shortage becomes reality.
However, the optimal learning environment for gross anatomy is the dissection
laboratory [2-6] where students learn to recognize anatomical
structures and their relationships in situ. To date, no one has
demonstrated that it is possible to use distance-learning technologies to
provide instruction in a dissection laboratory setting. Historically, this
laboratory dissection experience has been supervised and guided by trained
faculty in a setting with a significantly lower faculty-student ratio (1:20 at
the home school) than that for the lectures (1:170 at the same school). In the
dissection lab, the faculty serve as a resource to (1) answer questions, (2)
help students identify structures, and (3) perform aspects of the dissections
for the students when warranted. When the faculty shortage materializes, the
quality of the laboratory experience will suffer as the faculty-student ratio in
the dissection laboratory shifts toward that of the lecture.
This problem might be avoided by the development of a system where a trained anatomist using distance-learning technologies 'helps' students in a dissection laboratory at a different site. At least two of the three functions (1 & 2) of a faculty member in the dissection laboratory might be performed 'at a distance' using currently available distance-learning technologies. If this system is successful, the number of faculty needed "on-site" would be reduced to the number needed to perform the third function in the dissection lab. This could result in a geographically dispersed faculty able to provide both the lecture and laboratory experience for the students at numerous medical schools.
A Prof-in-a-Box system (PiB) has been developed that consists of three components: (1) a secure server to 'host' a videoconference; (2) a trained anatomist in his/her office with a computer and video camera; (3) a computer with two video cameras adjacent to a cadaver in the dissection lab. This system used iChat-AV software to allow the anatomist to see the students and the dissection via the cameras in the lab. The camera in the faculty office allowed the students to see the faculty member, providing a more personal aspect to the interaction. The software allowed the students and faculty to interact via live audio and video providing an environment where questions could be asked and answered and anatomical structures could be identified 'at a distance'.
Methods
Prior to choosing computers for the PiB system, the following requirements were
established (see Discussion):
Secure (encrypted) transmission
Built-in, cross-platform videoconference capability
No additional software to buy.
Cross-platform control of the computer in the laboratory from the office.
Sufficient camera resolution to identify anatomical structures
Server
Since none of the commercial (free) instant messaging servers (MSN®, AOL®,
and Yahoo®) that support videoconferences are secure, an in-house, secure server
was set up to host the PiB videoconferences. The iChat server is a Jabber®
server that supports SSL Certificates and encryption and is an integral part of
the Apple OSX v10.4 server software. The server consisted of the following
hardware/software combination:
Dual Processor G5 computer (Apple Computers)
Dual 2.7 GHz PowerPC G5 processors, 2 GB SDRAM, 380 GB Hard Drive
OS-X 10.4 Server Software
Unlimited client license
iChat/Jabber® server enabled
21" LCD Display (Apple Computers)
100 Mb Ethernet connection
The Information Services and Technology (IST) office at the university granted permission to connect this computer to the local network and have it function as a server provided it did not distribute IP addresses. IST also agreed to provide a 'static' IP address and domain name for the server. In order to facilitate future collaborations, IST also enabled data throughput on the university firewall for the ports specified in the iChat server documentation.
Office Equipment
To avoid the need to find a Jabber® client for a Windows operating system
that supports secure videoconferences, an iMac computer was used. The most
recent version of the Apple OS (v10.4) supports secure videoconferences through
the iChat software included with the computer. Therefore, the following in the
office:
20" iMac (Apple Computers)
1.8 GHz PowerPC G5 processor, 1 GB SDRAM, WIFI 802.11b/g card, 150 GB Hard Drive
iSight FireWire video camera (Apple Computers)
FireWire cable
OS-X v10.4
iChat-AV software (included as part of OS-X v10.4)
Apple Remote Desktop software v2.2
100 Mb Ethernet connection
The iSight camera and Apple Remote Desktop software
were not included in the standard purchase of an iMac computer. The iSight
camera is 'plug-and-play' and fully compatible with iChat. The Apple Remote
Desktop (ARD) software was purchased to control the computer in the laboratory
using the computer in the office (see discussion).
Dissection Laboratory Equipment
Prior to setting up a system in the lab, a standard video camera (e.g., the
iSight) was evaluated to determine if it had sufficient resolution to identify
anatomical structures remotely. In a preliminary test using just bones, the
resolution using the iSight camera was good enough to identify small structures
such as tubercles. However, the working distance for the camera was 4–6 inches
to give the necessary magnification. An inexpensive miniDV camera with FireWire
output had higher resolution and a longer working distance than the iSight
camera making the miniDV camera a better choice. The boom arm of a fluorescent
drafting light was modified to hold the miniDV camera. This allowed the camera
to be mounted either directly to the dissecting table or to the laboratory bench
top adjacent to the dissecting table.
In the gross anatomy course, one cadaver is dissected by a faculty member. This
prosected cadaver is available for the students to inspect and study outside of
scheduled class hours. The following computer and peripheral equipment were set
up at the prosected cadaver in the gross anatomy dissection lab.
Mac-Mini (Apple Computers)
1.42 GHz PowerPC G4 processor, 512 MB SDRAM, Bluetooth card, WIFI 802.11b/g card, 80 GB Hard Drive
17" monitor (Dell Computers)
iSight FireWire video camera (Apple Computers)FireWire Cable
Optura-30 miniDV camera
FireWire Cable
Drafting light boom arm
FireWire (IEEE 1394) 3-port hub
USB Speakers
OS-X v10.4
iChat AV software (included as part of OS-X v10.4)
100 Mb Ethernet connection
This system, nicknamed Dr. PiB, sat on the laboratory
bench at one end of the dissection table. The iSight camera, mounted on the
monitor, was fixed in place and allowed the students at the prosected cadaver to
be seen. The boom arm for the miniDV camera was mounted at the 'head' of the
dissection table using the standard drafting light screw-mount. From this
location, the students could position the miniDV camera on the boom arm over the
cranial half of the prosected cadaver. By moving the boom arm to the 'foot' of
the table, the camera could be positioned over the caudal half of the cadaver.
Using the ARD software, remotely switching between the two cameras was possible.
The Mac-Mini has only one FireWire port and only a very small internal speaker.
Using the FireWire hub enabled both cameras to be connected to the computer
simultaneously. The USB speakers allowed the student to hear the faculty member
without leaving the dissection table.
General Methods
In preparation for the project, the prosected cadaver was not inspected by
the faculty member prior to any PiB session. In that way, the only information
the faculty member had about the identity of a structure was limited to what
could be 'seen' through the camera.
The same faculty member (the author) was available for 'consultation' via the
PiB system one afternoon (1:30–4:30) a week on an afternoon when there were no
other scheduled classes. Dr. PiB turned itself on and logged in to the iChat
server automatically. The iChat software on Dr. PiB was configured to
automatically accept invitations for videoconferences by running the 'Terminal'
application, typing "defaults write com.apple.ichat AutoAcceptVCInvitations 1"
and restarting the computer. A videoconference was initiated with Dr. PiB from
the office and the conference was kept active for the entire 3-hour period. The
iChat window on Dr. PiB was minimized when there was no one actively engaged in
a consultation. When a student indicated that s/he had a question (usually by
saying "Dr. PiB?"), the iChat window was made visible using the ARD software.
Whenever a new student came to the cadaver, s/he was reminded that the faculty
member was available through Dr. PiB to answer any questions s/he had.
The number of students who used the prosected cadaver was tracked, as were the
times they arrived at the cadaver and the times they left. The questions they
asked were logged, as were and the structures identified or assisted in
identifying using the PiB system. In addition, any system problems that were
encountered were logged. At the end of the gross anatomy course, all students in
the course were provided with the opportunity to answer a brief, on-line,
optional questionnaire about the PiB system.
Results
The PiB system was deployed in the laboratory for 12 weeks of the 17-week
semester that gross anatomy was in session. During this time, 60 students (out
of 160 enrolled in the course) used the PiB system to 'consult' with the
professor in the box. The identity of 30 structures was confirmed, 26 structures
were identified and 14 questions were answered for the students using the PiB
system. In addition, one demonstration of the movements of the digits of the
hand was done using the PiB system.
The structures identified included the following:
Gemelli muscles
Obturator internus muscle
Dorsal Root Ganglion
Dorsal ramus
Ventral ramus
Common interosseous artery
Obturator nerve
Adductor muscles
Saphenous nerve
Coronary arteries
Coronary sinus
Lymph node on hilum of lung
Internal thoracic artery and vein
Umbilical ligaments
Left and middle colic arteries
Subcostal nerve
Ilioinguinal nerve
Branches of the internal iliac artery
Branches of external carotid artery
Medial pterygoid muscle
63 students completed the optional evaluation. The follow is a summary of the responses to the questions.
Question #1 – How often did you use the PiB?
a) Hardly at all 22
b) A couple of times 13
c) Often 1
d) Frequently 2
e) Almost every week 0
f) Not applicable 22
Question #2 – Was the PiB useful?
a) Hardly at all 18
b) To a small degree 7
c) To a moderate degree 10
d) To a considerable degree 6
e) To a very high degree 15
Question #3 – What should we do with the PiB next year?
a) Make it available next year 32
b) Use it in the laboratory in general 18
c) Discontinue its use 6
Students were also given the opportunity to comment on the PiB system. The following is a summary of the germane comments:
• I think the resource is a good idea. However I am still a fan of having a professor in the lab.
• I used PiB system just about every Friday in the 2nd block. I really found it helpful. I was impressed that it worked so well and that Dr. Moorman was really able to see what we wanted to show him with the camera. It was a really helpful addition to my studying mechanisms because sometimes a group of us would have a discrepancy about what something was/where something was and Dr. Moorman could give us a definitive answer in less than a minute on something that might have never been resolved if we all kept fighting about it together.
• It would be really great it you could have it on the prosected cadaver for a block and then maybe have it on another body (the best body for the internal ab structures, for example...) for another block. I don't know if moving the camera is just too hard, but I think that would be helpful so that at least people wont always just rely on the prosected cadaver.
• I also think that PIB is something that we should try to do with the other universities. I think it would be VERY helpful to be able to speak with profs from other places if that could get set up.
• As far as I'm concerned, the only bad thing about Prof-In-The-Box was that the Internet connection was terrible and it kept cutting out.
• I thought it was very nice of instructors to give up their free time to sit in front of the screen and help us with the cadavers like that. I think it was generally an OK idea. It was better than nothing when you were really unsure about something on the cadaver.
• Very useful and helpful to clarify information.
• Prof-in-the-box was good for checking whether or not your understanding of the location of structures was right.
• I thought the Prof in the Box was a great tool to use. Highly recommended using it again.
• Good for when you have questions.
• It was a good resource
• First of all its fun. Second of all it promotes peer teaching with the reassurance that there is a teacher there just in case there's a real problem.
Discussion
Four requirements had to be met prior to starting the project and choosing
computers for the PiB system: (1) All videoconference transmissions had to be
secure (encrypted); (2) The computers had to have built-in, cross-platform
videoconference capability so that there was no additional software to buy; (3)
cross-platform control of the computer in the laboratory from the office; and
(4) The camera in the laboratory had to have sufficient resolution to identify
anatomical structures in a video image.
The videoconference transmissions had to be secure to assure the university of
compliance with HIPAA (The Health Insurance Portability and Accountability Act
of 1996) and to preserve the confidentiality of our donors. This requirement
precluded using any of the free commercial instant messaging/videoconference
servers such as AIM®, MSN®, or Yahoo®. During the initial development of this
project, Apple Computers announced that the next version of OS-X would include
an iChat server as an integral part of the OS-X server software. The iChat
server is a Jabber® based server and can host both secure and non-secure
videoconferences. Jabber® is an open-source cross-platform set of streaming XML
protocols and technologies that enable any two computers on the Internet to
exchange messages, audio, video, and files in close to real time.
Apple's iChat software is preinstalled on all Apple computers. Microsoft's MSN
Messenger is preinstalled on all PCs with the Windows® operating system.
However, MSN Messenger can only communicate with the public IM servers and with
Microsoft's Live Communications Server software. There are commercial
implementations of a Jabber® client for the PC that allow secure
videoconferences, but these software packages are not free. The conclusion was
that Apple computers had the only built-in software that met the requirements.
In this initial project, it was desirable to have Dr. PiB be as user friendly as
possible in the dissection laboratory. This meant the students should not have
to be concerned with turning on the system, contacting the faculty member, or
switching the cameras to allow the faculty member to see the cadaver. The
student should only be concerned with aiming the camera over the cadaver. This
meant that Dr. PiB in the dissection laboratory needed to be controlled using
the computer in the office. Within the university's intranet, this can be easily
accomplished using Apple Remote Desktop (ARD) software. To accomplish this
through the university's firewall, the target computer needs a fixed IP address
and the appropriate ports need to be enabled on the firewall to allow data
throughput to the target computer. With Virtual Network Computing enabled on a
Windows based PC, it is also possible to use ARD software to control a PC.
One of the most important aspects of the PiB system is the requirement that the
camera in the laboratory have sufficient resolution to identify structures
remotely. The iSight camera has 640 × 480 resolution. The iSight camera appeared
to have sufficient resolution necessary to identify anatomical structures.
However, in order to fill the field of view with an anatomical specimen at a
magnification that allows structures to be identified, the working distance of
the camera is so short that it precludes the student and camera making
simultaneous observations. Although miniDV format cameras have the same
resolution as the iSight camera, the way the image is handled results in a
higher effective resolution. This means the videoconference image originating
from a miniDV camera can be enlarged on the computer screen without loss of
resolution making anatomical structures easier to identify. The miniDV camera
also had the advantage of a significantly longer working distance, even without
using the zoom feature. This meant that the camera could be positioned in a way
that did not interfere with the student's ability to see the dissection field
while the camera was in place. Interestingly, the students tended to place the
camera too close to the cadaver in an attempt to fill the field of view with
just the structure they wanted identified. They were routinely asked to move the
camera farther from the cadaver to give a larger field of view.
Less than a third of the class used Dr. PiB for help at the prosected cadaver.
Several things can explain this low participation rate. Since use of the anatomy
dissection laboratory outside of scheduled class hours is not monitored, the
number of students that actually use the prosected cadaver is not known. Since
Dr. PiB's 'office hours' were on the only afternoon that the students didn't
have scheduled classes, the number of students using the prosected cadaver might
be a reflection of how many students choose to spend Friday afternoon studying
anatomy in the dissection laboratory. 90–95% of the students who came to the
prosected cadaver during 'office hours' used Dr. PiB and the students who took
advantage of Dr PiB were enthusiastic about the usefulness of the system.
Although this might have more to do with students appreciating any extra help
provided by the faculty, it suggests that the PiB system represents a viable
alternative for providing help in the dissection laboratory when faculty are not
able to be physically present. This also supports the idea that a geographically
dispersed faculty can provide instruction in the anatomy dissection laboratory
using distance-learning technologies. For instance, the University of Medicine
and Dentistry of New Jersey has 3 medical schools under its umbrella. If each
school had 3 full-time faculty members on-site to teach in the dissection lab, 6
additional faculty members could be available to each school remotely via the
PiB system. By judicious scheduling of the 3 gross anatomy courses, all of the
lecture and dissection laboratory teaching could be provided by the 9
geographically dispersed faculty employed by one university. Similar
collaborations between groups of 3–4 medical schools could provide gross anatomy
laboratory experiences for the current numbers of students with 66–75% fewer
faculty.
An additional issue that we struggle with in anatomy is getting more clinicians
helping in the dissection lab. The presence of clinicians in the laboratory
creates a greater sense of relevance for the material being learned. Using the
PiB system, clinicians could be available for consultation in the dissection
laboratory without leaving the clinics.
The current version of Dr. PiB was fixed in place at one cadaver in the
dissection lab. The next version of the system, Dr. PiB version 1.1 will be a
mobile unit consisting of the same hardware mounted on a cart equipped with an
uninterruptible power supply (battery). Since the computer has an 802.11g
wireless card and the entire dissection laboratory has 802.11g wireless
coverage, the mobile Dr. PiB can be used anywhere in the lab. This mobile Dr.
PiB is being created in response to one of the student's suggestions. The PiB
system might have more limitations for helping students at their own cadaver
where the quality of the dissection might not be on a par with that of the
prosected cadaver. Having a mobile Dr. PiB will allow these limitations to be
determined.
The goals of this project were to demonstrate that the cameras and Internet AV
software have sufficient resolution and bandwidth to make 'remote'
identification of anatomical structures possible and to demonstrate a
willingness on the part of the students to receive instruction from faculty at a
different geographic location. The results presented here suggest that these
goals have been accomplished.
Conclusion
Many of the functions of a faculty member in the gross anatomy dissection
laboratory can be performed 'at a distance' using the PiB system. This suggests
that a geographically dispersed faculty could assist in providing instruction in
the dissection labs at multiple medical schools without needing to be physically
present.
Competing interests
The author declares that he has no competing interests.
Acknowledgements
This project was initiated as part of the Harvard Macy Institute Program for
Educators in the Health Professions. I thank Samuel Kennedy, Mairead Boohan,
Maria Cole, Francesca Ruggiero, and Todd Thomsen for helpful discussions during
the development of this project and Denise Dehnbostel for editing the
manuscript. This work was supported with funds from NASA, NIH, and the State of
New Jersey.
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BMC Medical Education 2006, 6:55 doi:10.1186/1472-6920-6-55
The electronic version of this article is the complete one and can be found
online at:
http://www.biomedcentral.com/1472-6920/6/55
© 2006 Moorman; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which
permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited
