Videoconferencing for Instructional and Administrative Purposes: The Audience Reacts

Reduced funds for medical student and resident training have prompted the College of Human Medicine at Michigan State University to explore innovative instructional delivery and administrative support systems. The Office of Medical Education Research and Development conducted a demonstration project in the use videoconferencing technology to connect the main campus to three outstate sites. The objectives of the project were to provide instructional experiences for students, residents, and faculty using videoconferencing; to conduct administrative meetings; and to evaluate the use of videoconferencing in these contexts. The results of the demonstration project lend strong support to the use of videoconferencing technology for instruction and administrative support, even in light of technical constraints. Lessons were learned in the areas of working with vendors effectively, preparing presenters to use the system, and the need to test system peripherals and connections before the actual videoconference.

Several medical schools have used teleconferencing technology to "extend the walls of the campus."The state of Georgia has implemented the Georgia Statewide Academic and Medical System, a distance learning teleconferencing network that allows transmission of educational courses to remote campuses. 1The Long Island Jewish Medical Center and five other hospitals hold pediatric grand rounds via videoconferencing. 2 The NEBSAT system, Nebraska's state-owned satellite television system is used by the University of Nebraska Medical Center to transmit several types of two-way educational programming and administrative meetings. 3Baker and Bulik 4 have recently reported on the integration of distance learning technologies including videoconferencing, teleteaching and electronic mail into a decentralized medical school.HealthNet, a statewide telemedicine network, is used by a consortium if Texas' academic health sciences institutions, health department, and state office of rural health to produce continuing medical education and health education programming. 5Closer to home, a CHM Telecommunications Task Force identified the need for implementing videoconferencing technology for instruction and administration. 6

Methods
The Office of Medical Education Research and Development (OMERAD) conducted a demonstration project of a videoconferencing system from August, 1995 to May, 1996.The objectives of the project were to conduct instructional experiences for students, residents, and faculty, and administrative meetings for Community Administrators, Community Assistant Deans and OMERAD faculty, and to evaluate the use of videoconferencing in these contexts.Participating sites were the MSU/CHM East Lansing main campus, the Kalamazoo Center for Medical Studies, and two sites in Michigan's Upper Peninsula, Marquette and Escanaba.The project was funded in part by an MSU All-University Outreach Grant.A.T.&T.(now Lucent Technologies) supplied a PictureTel System 4000EX Model 200 for a rental period of six months with an option to purchase the system after expiration of the rental period.The system operated over integrated system digital network (ISDN) lines, and was capable of transmitting the image and voice of the presenter and participants, hard-copy visual aids, and computer-generated visuals.
Two survey forms were used for project evaluations: A questionnaire was used to capture participants' impressions of using the system.The instrument focused on the effect of the technology on the ability to see presenters, participants and materials, to hear presenters and participants, emotional response to using the system, and overall impression of the system to accomplish tasks.An observation sheet was given to equipment operators on which they were asked to record technical, lighting, and audio problems, as well as any impressions regarding accessory usage.

Results
A total of 28 videoconferencing sessions were held.Medical students and residents in Kalamazoo, Marquette and Escanaba attended courses in critical appraisal of the medical literature (a non-graded course) originating from the East Lansing site.The Upper Peninsula Community Assistant Dean and Community Administrator attended monthly meetings via teleconferencing rather than making the overnight trip to East Lansing.OMERAD faculty development sessions were transmitted to the Kalamazoo and Upper Peninsula sites to allow CHM-affiliated faculty there to attend.The total number evaluations received was n=164.Respondents included medical students and residents, medical school faculty, and administrators.An extra item was included on the evaluation questionnaires (n=77) provided to the students and residents.
Participants rated their emotional or social response to using technology compared to live interaction.Forty percent of respondents rated their emotional/social response to using the technology as either "much worse" (6%) or "moderately worse" (34%).Another 40% rated their response as "same", and 17% rated it as either "moderately better" (13%) or "much better" (4%).Comments ran the gamut from quite negative ("Pretty intimidating.Made 'what I said' more of an ordeal.Made me nervous.") to positive, even supportive ("Great way to learn w/o having to travel to another city!" "I almost forgot it was in the room.Additional benefits of having expertise from afar is fabulous.")Participants rated their overall impression of the system to accomplish the tasks of the conference, meeting, or educational session.There appeared to be a fairly "bell-shaped" distribution of ratings, with 42% of respondents rating their overall impression as "same"; 22% rated it "moderately worse"; 25% as "moderately better"; 1% as "much worse"; and 9% as "much better."Participants also rated their overall impression about using two-way video technology to obtain clinician input, as opposed to no clinician input.This item was asked of students and residents only.The ratings appeared to be quite skewed to the "better" end of the scale: No participants rated their overall impression as "much worse"; 13 % rated it as "moderately worse; 22% as "same"; 36% as "moderately better"; and 23% as "much better."Comments were all positive to a degree, ranging from extremely positive ("It's an impressive way of distance studying and communication.") to middling ("Better than nothing.").

Technical Difficulties
Most of the technical difficulties fell into four categories: 1) operator mistakes and experimentation, 2) equipment incompatibilities, 3) presenter mistakes, and 4) acts of unknown origin.
Several operator mistakes were attributed to a lack of familiarity with the equipment and its limitations.For example, microphone placement was a problem early in the project.Incorrect placement resulted in either a lack of volume from the speaker or audience member, or a loud hum due to feedback between microphone and monitor.We found that by experimenting with placement of the keypad (which contained its own microphones) and the auxiliary microphone we were able to come to a performance compromise that allowed anyone in the largest of the videoconferencing origination rooms to be heard at The video image, especially that of projected visual aids at the originating site, posed problems for the operator initially.The first time the system was used with projected visual aids (as opposed to using the document camera), the camera was set off to the side of the room.This resulted in a severe "keystoning" effect in the transmitted image.When we learned that the camera needed to be place "headon" with respect to the screen, this problem was alleviated.
The most serious equipment problems arose when one presenter brought a laptop computer with which to project his visual aids.
Unfortunately, the presenter was unable to test his equipment with the videoconferencing system prior to the transmission, and the results were predictably disastrous.Equipment incompatibilities prevented the use of the computer interface, and we had to transmit a projected image from the screen.As the presenter was using an LCD projection panel and overhead projector for this purpose, the room lights had to be dimmed significantly, and the resultant image received at the distance site was a silhouetted outline of the presenter against a brightly lit background.This represented the only serious instance of equipment incompatibility, albeit a very significant one.
The most common presenter mistakes were in the use of visual aids.Typically, presenters would use overhead transparencies with type face too small to be read by participants at the distance site.Although asked to bring along hard copies of visual aids for use with the document camera, this advice was more often than not ignored.There were technical difficulties whose cause could not be determined.These were most often related use of the "bridge," a piece of technology that allows more than two sites to be connected simultaneously.The bridge was used during the faculty development seminar series to connect East Lansing, Kalamazoo and either Marquette or Escanaba to East Lansing.For all sessions except the very last one, there was a marked tendency for a site to be disconnected from the bridge, apparently at random.It was not uncommon for 3 -4 of these "disconnects" to occur in the course of a presentation.
The cause or causes of these disconnects have never been found, and were reported to Ameritech by the bridge operator.It was only during the final seminar presentation that the bridge connection remained stable for the entire session.

Discussion
The results of the demonstration project lent strong support to the use of videoconferencing technology for instruction and administrative support, even in light of the technical constraints.When faced with the alternatives of 1) not having a session due to lack of an appropriate presenter or the resources to bring in one, or 2) having to travel to a site for a meeting versus staying in one's office and attending via videoconference, there appeared to be much support for the use of videoconferencing.
Several lessons were learned in the course of the project: 1. Get the vendor and local purchasing agent to communicate with each other as early as possible in the project in order to share pertinent information regarding purchasing/renting procedures.

Know exactly what equipment you want and how
to describe it before renting or purchasing.If the desired system is already installed close by, it may be useful to bring the vendor to see that system in order to understand completely the desired configuration.Much remains to be done in developing procedures for use of the system within the College and developing faculty to use the system effectively.Plans are underway to provide the remaining communities (Saginaw, Grant Rapids, Flint) with their own systems.Videoconferencing is now a powerful tool in the communications armamentarium of the College of Human Medicine.
Videoconferencing technology provides a means for sharing resources in ways not previously available.Institutions considering adopting this technology should be prepared to develop support systems to promote its successful implementation.
The audience reacts URL http://www.utmb.edu/meo/ 4 during a test broadcast before the actual session.This will identify compatibility problems with sufficient time to plan and develop alternative presentation strategies, such as either locating a compatible computer system, or switching to more traditional, paper and transparency-based presentation visual aids.