Project Overview

Medical schools in Canada are currently facing a feast and famine situation when it comes to developing and sharing non-commercial online educational multimedia.

FEAST
Due to the ever-decreasing cost and complexity of the required equipment, there have never been so many people working on the development of high quality multimedia materials, and entire conferences (such as Slice of Life) have even been dedicated to the subject.

The success of the open-source software movement, and the activities of groups like the AFMC's Medical Informatics working group, have given many people a vision of a possible future landscape in which sharing becomes the norm, overcoming geographic, political, and other barriers.

A wide variety of sophisticated online broadband enabled media libraries have sprung up over the past five years, all promising us easy access to huge libraries of medical education materials that we can use in our own educational programs.

Some medical schools have obtained major funding for large development projects, and have offered to collaborate with others.

FAMINE
Most of the material being developed is being done in one-time, limited-funding projects within a single medical school, often using complex formats unique to that application, and usually with no time to think about coordinating or sharing the development with other medical schools.

The fear of and uncertainty about copyright and intellectual property laws, as well as the often unstated wish to protect materials from widespread distribution in the hope of future commercial sale, have up to now severely limited the amount of material that is openly shared.

Most of the existing online media libraries, though technically sound, do not have clear plans to organize and manage the building up of content collections, and tend to contain a smattering of test content, or the collections of a few, eager participants.

Medical schools without much capacity in this area are unsure how to collaborate on an even footing with well-funded schools.

One of the hottest topics in medical education is the creation of media libraries, learning object repositories, and other online collections of digital resources. Some examples:

1. The DalMedix media library, used for internal media access (still images and video), and which we are constantly improving and adding content to. Future plans include developing a public face to it. http://www.med.dal.ca/
2. The HealthLibrary.ca is the focus for a collaborative AFMC project involving peer-to-peer searches, metadata schema, online case development, and much more. http://www.healthlibrary.ca/
3. The BELLE Project (Broadband Enabled Lifelong Learning Environment) is funded by the CANARIE Learning Program, is primarily Alberta and BC based (though McGill is part of the alliance as well) and has as its object to develop (yet another) a prototype educational object repository. It is focused on broadband learning objects-video and other high-bandwidth items that would use the CA*Net4 infrastructure to its best advantage. http://belle.netera.ca/
4. The Pan Canadian Health Informatics Collaboratory, a CANAIRE funded and BELLE-linked experimental broadband interactive e-learning environment for health informatics. This is the work of six universities (including Dalhousie) with goals that include developing e-learning methodologies, interactive technology for virtual interactions, knowledge management, interoperability standards for content, and pilot course modules. http://www.health.bcit.ca/hic/
5. MERLOT (Multimedia Educational Resource for Learning and Online Teaching) is US-based resource that boasts a continually growing collection of online learning materials, assignments and peer reviews, but does not focus much on medical education. http://www.merlot.org
6. The Health Education Assets Library (HEAL) is creating a centralized national (mainly US) repository of free, web-based multimedia teaching materials in the health sciences. The prototype version of the HEAL application is available for use, and is a fully functional, multi-tiered application for searching, browsing, and contributing to the library of files. http://www.healcentral.org/
7. Last but not least, there is the International Virtual Medical School (IVIMEDS) project, which Dalhousie has been asked to join, and to contribute material. Their concept of reusable learning objects is along the same lines as this common currency proposal, and in that it focuses on developing small discrete chunks of learning from which courses can be built. http://www.ivimeds.org

Given the number and variety of such projects, it seems reasonable to propose that enough attention has already been paid to the technical issues of sharing digital media learning objects online-the area that needs work is the development of a high quality, comprehensive, and consistent collection of content to fill them.

Proposed General Guidelines

We propose the following general guidelines for the creation of a common currency format for multimedia medical education materials:

1. Develop all material "from scratch" and ensure that signoff is obtain from all participants assigning their copyright interests to the University, which in turn will license the material for open sharing, and any non-commercial use.
2. Experiment with and develop tools, techniques, and templates that allow for fast, low-cost technical production and ease of distribution.
3. Use simple, open-standard, self-contained multimedia formats, so that they can be shared and accessed easily and widely, and on a variety of platforms.
4. Focus not on building new online media libraries or file sharing systems, but on coordinating the development of content to fill existing ones.

We intend to research similar existing material, both to find out what is already available, as well as to identify the techniques that work best. For example, sites like the University of Toronto's Neurological Exam are of great interest for their high-quality content, although the clips are designed only to be viewed from within the site, and not to be shared via media libraries, Palms, or other platforms.

For the purposes of this project, we propose investigating the possibility that the unit of common currency should be relatively small, self-contained digital video files, each covering a focused and specific medical education topic, such as a medical procedure or technique, useful mnemonic, or proper equipment usage or skill. We suggest that digital video files be used as the basis for the standard because:

• In addition to actual full-motion video, digital video files can also contain still images, animation, text, and audio-only narration.
• They are a well-developed and relatively stable and mature digital technology, with manageable compressed file sizes, and good format compatibility.
• They can be delivered in a wide variety of ways, on media ranging from PDAs and CD-ROMs to online streaming media and DVDs.

Below are some preliminary proposed standards for common currency video production, all of which are subject to being verified or disproved during the term of the project:

• The files should be kept short, ideally less than 3 minutes in length, so that the size of any individual file is relatively small, navigation within the file is easy.
• For larger topics, multiple files could be created, each of which would refer clearly to the other files in the series (i.e. Part 2 of 3).
• Titles and text can be taken from PowerPoint slides, using simple backgrounds and presentation best practices (fonts greater than 24 point, less than 8 lines of text per page, etc.).
• Minimal special effects should be used-such as transitions, animation, or complex editing-to keep production costs and complexity low.

In addition, the video should be shot at the highest-possible resolution and quality, so that it can later be exported to multiple lower-resolution distribution formats like:

• Consumer video formats (VHS, DVD)
• Internet streaming formats (RealMedia, QuickTime, WindowsMedia)
• file formats for CD distribution (AVI, MOV, WMF)
• Handheld video formats (FireViewer, Kinoma).