Gary Nieder

Online didactic materials are available for courses throughout the basic science curriculum at WSUSOM. These resources vary in terms of format (downloadable PowerPoint files, streaming audio lectures, or audio and graphics within html) and use within the course (presented only online or as a reiteration of lectures presented live). Considering the effort spent developing online lecture materials, we were interested in how different types of resources were being used by students. One tool that is available to examine web use is a server log containing information on user identity, time and location of use of specific files on the web site. Server log data for the entering classes of 2003 and 2004 were analyzed using standard log analysis software (Summary). Preliminary results indicate that students use online lecture resources selectively. A core group of students (<10%) view or download materials for most or all lectures, while the remaining students use materials from less than...

The use of patients and video recordings to teach neurology in the classroom is a valuable method of integrating basic neuroscience principles with physical diagnosis. However, this teaching method is not without practical limitations. Patient availability is often uncertain and unreliable. Analog videotape is costly to duplicate and distribute for unlimited review by individual students. And, neither format provides a convenient way for individual students to review and reinforce parts of the physical exam that may be particularly helpful to their learning. Our long range objectives are to create digital source videos depicting neurological disorders, prepare them for low bandwidth Internet distribution, and organize them into a searchable database on an Internet server from which they may be distributed, free of charge, to health care educational institutions. Our intent is to have client institutions distribute these videos \u27on-demand\u27 via Local Area Network to students within their respective institutions. We feel this will help remove existing limitations to the use of live patients and video as an educational tool, and help bring the testing of performance-based knowledge to a new level in health care education. We previously described capture and compression parameters used to prepare neurologic QuickTime videos for streaming delivery (Pearson, et. al., 1999, SOL/CHES Proceedings, Philadelphia). The present report describes the materials and strategies used to establish a website at which these streaming videos are contained in a database searchable through the HTML environment. Our site (www.ntv.wright.edu) is contained on a Macintosh G3 computer (400mHz; 256MB RAM) running Mac OS X-Apache software, and maintained in the Wright State University School of Medicine Department of Anatomy. In designing this site, our objectives were to: (1) allow onsite searches, browsing and preview of video files; (2) allow external searches to recognize all video files, especially clips of individual signs; and (3) maintain password protection for patient privacy. We achieved these objectives through creation of a database-driven website built around: (1) FileMaker 5 Developer database software, (2) Dreamweaver web building software, and (3) Lasso software designed to allow the FileMaker database to be accessed through an HTML environment. Video files at our site consist of either: short \u27clips\u27 that depict single neurologic signs, or symptoms and (2)\u27full length movies\u27 that incorporate short \u27clips\u27 of a particular patient into one continuous file. Of these two file types, only the short \u27clips\u27 are viewable over open Internet directly from our site. Consequently, the short \u27clip\u27 files are placed within the FileMaker records and used as searchable \u27preview\u27 files. FileMaker records are indexed using keywords consistent with Medical Subject Heading (MeSH) vocabulary. They also contain fields that identify relevant patient diagnostic information and point to Patient Profile pages (HTML pages) that contain all downloadable files of that patient (i.e., \u27full length movie\u27 files; neuroimaging picture files; case history text files, etc.). Lasso Web Data Engine software allows the FileMaker database program to be accessed through the HTML environment. A search and browse interface allows access to database records as well as the ëPatient Profileí pages. The search and browse page is preceded by a password acquisition page. \u27Dummyí HTML pages containing MeSH keywords in their meta tag regions provide exposure to external searches and point to the front door of our site. This strategy makes files accessible to onsite searching and browsing, as well as to external search programs, such as those designed to provide decision support in the primary care clinical environment

This QuickTime VR movie appears on a CD-ROM included with the book The QuickTime VR Book: Creating Immersive Imaging on Your Desktop, which provides an introduction to the interactive virtual reality technology QuickTime Virtual Reality. QuickTime Virtual Reality, more commonly known as QuickTime VR, is a cross-platform technology developed by Apple. QuickTime allows viewers to explore a site in 3D, rotate objects, zoom in or out of a scene, or look around 360 degrees, all while at their desktop. Millions of people are downloading QuickTime VR to become part of a new multimedia experience--from Ferrari\u27s home page, where they can fly around a car or sit in the driver\u27s seat and look around, to virtual tours of travel destinations--The Louvre museum, even Mars! The QuickTime VR Book provides an introduction to the process of creating QuickTime VR movies and larger QTVR-based projects. The concise information in The QuickTime VR Book shows readers how to add QuickTime VR content...

PURPOSE: The Individual Readiness Assurance Test (IRAT) is a critical component of TBL, encouraging individual preparation and accountability. IRATs may also be an early warning mechanism for students at academic risk. We analyzed IRAT and exam data from our gross anatomy course to assess the effectiveness of IRATs as a predictor of exam performance. METHODS: Averages from four IRATs, which preceded any of the course exams, along with subsequent exam scores were subject to Fisher\u27s exact test (N=910 students from 9 years). Groups were defined as passing or failing IRATs and passing or failing one or more course exams (70% pass/fail cutoff). RESULTS: Overall, 30.0% of students failed at least one exam. Students who failed the initial IRATs had a significantly higher exam failure rate. As a diagnostic test, the IRATs had a positive predictive value of 0.754, a negative predictive value of 0.770, a likelihood ratio (LR) of 7.16 for failing at least one exam (i.e., students failing IRATs are 7 times more likely to fail an exam) and a LR of 6.04 for failing the course. Scores from only the first one or two IRATs had a much lower predictive value. Female students had lower performance on both IRATs and exams. Their IRAT performance was also less predictive of exam performance (LR=5.19 for females v. 11.82 for males). This may be due to a significant trend of females to perform more poorly in the first two IRATs than in subsequent IRATs and exams. The predictive value of IRATs was much higher than that of entry credentials such as MCAT scores. CONCLUSIONS: In addition to its role in TBL per se, IRATs may be useful in identifying at risk students prior to high stakes exams. Formal intervention, or at least informing students of their risk, may help them remedy early academic problems

PURPOSE: Although instructional video plays a major role in medical curricula, its educational effectiveness continues to be measured primarily through subjective evaluation by the students who use it rather than through empirical investigation. The present study used experimental design to determine whether digital video recordings help medical students learn to perform clinical skills more effectively. METHODS: Over a 5-year period (2006-2010), we compared OSCE performance scores of Year 1 medical students who reviewed videos of musculoskeletal exam instruction prior to skills testing versus those who did not. All students received the same classroom instruction in performing all physical exam procedures. Students in the classes of 2008- 2010 had the additional opportunity to view video recordings of a physician performing the same physical exam competencies posted on an Internet server for voluntary use. We tracked video usage for each student through analysis of server log entries. We compared OSCE scores using One Way Analysis of Variance (ANOVA) with Bonferroni\u27s Multiple Comparisons test. RESULTS: Students who viewed videos prior to OSCE testing (\u27users\u27; N=194) performed significantly higher in competency skills ratings than those who did not (\u27non-users\u27; N=108) (mean=19.30 v.18.93; p\u3c0.05). Video \u27users\u27 also had significantly improved scores compared to students in the classes of 2006-2007 who had no opportunity for video review before testing (N=201; mean=18.92; p\u3c0.05). The performances of 2008-2010 \u27nonusers\u27 showed no improvements over those of students in the 2006-2007 classes. Among the 2008-2010 video \u27users\u27, there was no correlation between the number of video files viewed and OSCE performance scores (linear regression R=0.950; p\u3e0.05). Most video use occurred in the week immediately preceding the OSCE. CONCLUSIONS: Online video review prior to OSCE testing is effective in helping first-year medical students learn clinical physical examination skills. The data further suggest that this benefit is not due to the number of videos reviewed by the student

Although use of patients in the classroom is valuable in teaching neuroscience, both live and analog videotape demonstrations have inherent limitations. Patient availability may be unreliable, and analog videotape is costly to distribute and incorporate into presentations and examinations. The objective of our project is to create digital source videos depicting neurologic disorders, organize them into a searchable database on an Internet server, and distribute them as a neuroscience resource, free of charge, to health care educational institutions. The specific aims are to (1) create digital video of a neurologist performing the physical examination on patients with neurologic disease, (2) compress this video for Internet delivery in QuickTime streaming format, and (3) organize these video files into a searchable database on an Internet server for file transfer protocol (FTP) download to client institutions. FTP download of streamable files will allow client institutions to organize the files to suit their needs, and distribute them via their own local area network (LAN). This will assure the bandwidth necessary for delivery and uninterrupted playback of this full motion (30 fps) video. Preliminary compressions were done using Sorenson Video variable bitrate option to produce video files deliverable over bandwidths of 30-50 Kilobytes/sec (KBS). Files were formatted as QuickTime HTTP, ‘fast start,’ video which may be distributed from standard LAN servers. Supplemental patient information will accompany video file download. This ‘on-demand’ video resource will reinforce performance-based learning issues in several health care fields

QuickTime Virtual Reality (QTVR) is a well established technology used to deliver photorealistic representations of three dimensional objects. It has proven to be an excellent medium for preserving and sharing three-dimensional anatomical specimens on line. The strength of photo-based VR is its ability to capture fine surface features and textures, creating an impression of a real specimen that continues to be elusive to rendered model virtual specimens. QTVR objects can be readily incorporated into web-based or standalone computer-aided instructional programs. For example, we are currently developing a second generation web-based skull anatomy program using QTVR. The QuickTime VR Anatomical Resource is a freely accessible collection of virtual anatomical specimens that can be viewed on line or downloaded for a variety of uses in medical education. A work in progress, the collection currently includes bones as well as various organs, regional dissections and embryological specimens. Each specimen is available to users in several screen sizes to fit varied needs. In the past year our virtual specimens have been viewed or downloaded over 30,000 times by clients in 85 countries. Approximately 20% of those downloads were to clients outside the United States. (Sponsored by Grant LM06924 from the National Library of Medicine)

Development of preimplantation embryos of the Siberian hamster (Phodopus sungorus) in vivo and in vitro was examined. The timing of early development in vivo was found to be slower than that reported for the golden hamster. Progression through the cleavage stages, cavitation, and hatching from the zona pellucida occurred later, with blastocyst formation beginning on the afternoon of day 4 and uterine attachment occurring early on day 5. In vitro, morulae, and early blastocysts collected on day 4 and cultured in serum-containing medium formed expanded blastocysts and some began to hatch from the zona pellucida. With extended culture, blastocysts attached and formed trophoblast outgrowths. Outgrowth was characterized by an initial migration of small cells from the blastocyst, followed by formation of a sheet of trophoblast giant cells. Differences in the morphology of outgrowth between the hamster and mouse suggest that further comparative studies with the Siberian hamster may be useful.

The QuickTime VR object format has been successfully used to provide photo-realistic representation of three-dimensional anatomical structures. This technique creates the impression of holding a specimen and turning it for observation. Another type of QTVR is the panorama, which creates the impression that the user is standing at a point in space and can turn 360 degrees to view the entire surrounding area. Typical QTVR panoramas are made by shooting a series of wide angle photos using a camera which rotates around a fixed point. The images are then 'stitched' together to make a 360 degree panoramic image. The size of the virtual space created in this way is limited (on the small end) by the fact that the camera has to be within the space. Macropanoramas can be made from very small spaces because the photographic technique used is very different. A small spherical mirror(we use a 1 cm. aluminum-coated spherical lens) is placed in the center of the space. The image in the s...

QuickTime VR is a software technology which creates, on a normal computer screen, the illusion of holding and turning a three–dimensional object. QTVR is a practical photo–realistic virtual reality technology which is easily implemented on any current personal computer or via the Internet with no special hardware requirements. We reasoned that QTVR can provide a more realistic presentation of anatomical structure than two dimensional atlas pictures and allow observation of specimens outside the dissection lab. We created QTVR objects from various anatomical specimens, including the skull, which we have incorporated into a self–learning program. To obtain images, the bones of the skull were mounted on a rotating table, while a digital camera was positioned on a swinging arm so that the focal point remained co–incident with the rotational center of the object as the camera was panned through a vertical arc. Digital images were captured at intervals of 10° rotation of the object (horizontal pan). The camera was then swung through an arc with additional horizontal pan sequences taken at 10° intervals of vertical pan. The images were edited to place the object on a solid black background, then assembled into a linear QuickTime movie using Adobe Premier. The linear movie was processed with Apple’s QTVR development tools to yield a QTVR object movie which can be manipulated on vertical and horizontal axes using the mouse. QTVR movies were incorporated into an interactive environment, created with Macromedia Director, which provided labeling, links to text–based information and self–testing capabilities. The accompanying demonstration shows the resulting QTVR–based program Yorick: the VR Skull during development, the program was used in our medical gross anatomy course. Student feedback by survey indicated that QTVR–based programs are an effective learning tool

Before 1995, the medical Gross Anatomy course was taught in a traditional format of one hour lecture followed by three hours of dissection with four students per dissection table. There were forty–four hours of lecture and one hundred fourteen hours of dissection. Given administrative encouragement, the course was revised to 1. reduce lecture hours, 2. incorporate peer–teaching, 3. promote small group interaction, 4. introduce clinical problem solving and 5.encourage independent learning. To insure that clinically important material was not omitted, a content survey was sent to all clerkship directors. Based on results of the survey and input from a content committee, lectures were reduced to 17, of which 11 were based on embryology. All other material was covered in small group interactions and by a computer program, Beyond Vesalius. While computer time was scheduled, students had to master the material without faculty input. Once a week students were given clinical problems based on content covered previously. After solving the problems in small groups, they presented their solutions to their peers. Faculty facilitated these sessions but only provided answers after students completed their presentations. In the laboratory six students were assigned to a dissection table. During the first two hours, two students dissected and in the last hour the dissectors peer taught those who did not dissect earlier. All students were task oriented when dissecting. Most students (91%) agreed that the course provided opportunity for active participation and integrated content from basic science and clinical medicine (83%). Students (83%) felt that the small groups encouraged questions, discussion and interaction. With reference to the number of lectures, 66 % of the class felt that the amount of material presented was satisfactory. Overall, student evaluations were very positive

Mastery of the physical examination is a universal requirement in medical education. This exam requires performance of maneuvers and techniques that can be taught only through physical demonstration using real or simulated patients. The need for visual presentation is particularly crucial in teaching the neurological exam in which use of precise technique and observation of movement abnormalities are essential for physical diagnosis. Most neuroscience curricula routinely use real patients or videoclips to demonstrate neurologic disorders. Use of video in day-to-day communication has increased tremendously within the last five years. Digital video capture hardware, increasingly sophisticated compression-decompression (codec) software, and high performance playback computers have made web distribution of large video files possible for many internet users. In view of the importance of visual instruction in medical education, and recent advancements in video delivery, the question before us now is how to use present technology to make this form of instruction available to students. We have investigated the potential of digital recording and advanced variable bit rate (VBR) compression schemes for use in preparing video for distribution through the internet at different bandwidths, as well as on CD-ROM. Our specific purpose has been to identify hardware and software parameters necessary to create digital source video of the neurological exam, and process it for effective on-demand delivery using existing internet transfer modes (ie., T1-LAN). In the present project, video was recorded using a SONY DSR-200A digital video camcorder. Files were transferred via IEEE 1394 connection (FireWire) and Radius MotoDV (1.1) software from a SONY DSR-30 digital tape deck to a Power Macintosh 8600 with a Seagate Cheetah 18GB hard drive. Sorenson and Qualcomm codecs were used for video and audio, respectively, as within Media Cleaner Pro (v3.1.2). A PowerMac 9500/200 within the WSU Anatomy department was used as a server. The latest Quick Time streaming formats were tested within the WSU School of Medicine local network (T1-LAN) and at several T1-extranet sites. Data rates suitable for transfer over 56K and 28.8K dial-up modems were also tested. Our results corroborate the general conclusions that the final video quality is directly related to the cinemagraphic quality of the source video and the processor speed of the playback machine. Specifically, at a data transfer rate of 50 KiloBytes/sec (KBS), digitally recorded and VBR compressed movies of up to 640X480 pixels in size could be delivered over T1-extranet lines with excellent movement quality when played by medium-to-high end machines (233-MHz Pentium II PC; 233-MHz Macintosh G3). Delivery at a rate suitable for 56K modems (approx 6KBS) appears promising, under ideal conditions. However, attempts to deliver video at data rates suitable for 28.8K modems (approx 3KBS) resulted in significant, and unacceptable, deterioration of movement in the video playback. The present findings suggest that on-demand distribution of video suitable for basic and clinical medical instruction is possible when appropriate source, compression, and playback parameters are used

Course content delivery in the basic science medical curriculum is increasingly accomplished by lectures outside the traditional physical classroom. Over the past six years, lecture material in our gross anatomy and embryology course has been available only in an online format comprised of html pages with audio tracks. Although students appreciate the availability of online lectures, previous work has shown a wide variance in students\u27 use of online resources in our course. We have now examined students\u27 online lecture use behaviors over six years. Students accessed lectures throughout the course via a secure server which logged each page request so behaviors of individual students could be tracked. Over the six years, use of lectures increased beyond that accounted for simply by the volume of materials available (i.e., students spent more time with all the available materials). Another apparent trend was an increase in student use occurring off campus, as broadband connectivity increased, and more recently toward wireless connection on campus, with a corresponding decline in use of the campus computer labs. Looking at individual use data, the amount of online content viewed during the course varied more than four-fold among students in this pooled population. There was a small, but statistically significant positive correlation between online use and performance on course exams and quizzes. We were also able to show a significant difference in both online use and performance between males and females with males tending to use the online lectures more and scoring higher on exams and quizzes

Content delivery in the basic science curriculum is increasingly accomplished by lectures delivered online. The factors which draw some students to use online resources more than others are beginning to be explored. This project examined the relationship between entering medical students’ online lecture use, exam performance, learning styles, achievement motive and gender. We assessed learning style preference, using the VARK measure, and achievement motive, using the Achievement Motive Scale, then analyzed their online lecture use in our gross anatomy course. Exam scores for males were significantly higher than those of females and a gender effect was apparent (ANOVA) with male use higher than female. Students with higher scores for visual learning viewed lectures more than students with other preferences. There was an effect of Achievement Motive on lecture usage. Students highly motivated to achieve success are also more likely to use lectures. There was no difference in use between students with high or low motivation to avoid failure. Overall, there was a distinct temporal pattern of lecture use by day of the week or by time of day and differences between genders in use by days of the week. We also found a significant effect of success motivation on the temporal pattern of use. Findings of our study suggest a relationship between students’ learning style, motivation and their online lecture use.

The QuickTime VR object format has been successfully used to provide photorealistic representation of three dimensional anatomical structures. This technique creates the impression of holding a specimen and turning it for observation. The QTVR object metaphor can also be modified to interactively show other properties of a specimen such as internal movement or multiple levels of dissection. Our early efforts in producing QTVR anatomical objects has progressed into an on-line library of over 80 specimens, which can be accessed by educators, students and other interested parties through a password protected web site, the QTVR Anatomical Resource (www.anatomy.wright.edu/qtvr). The library is organized by object type: skeletal preparations; organs grouped by system; regional dissections; and miscellaneous specimens. The skeletal portion is most complete at this time with 55 objects including all of the major bones: skull including ear ossicles and hyoid; fetal skulls; bones of the axial...

An extensive Web site supporting our gross anatomy and embryology course, which includes various course management pages as well as online lectures, has been in use for the past 2 years. To determine how this Web site is being used by students, we examined server log files to track access to each of the Web pages on the site. Using this data, along with student responses on a course evaluation, we have been able to quantitatively characterize Web site use and gain some insight into students' perception of the site. This analysis showed that all of the resources available online, including course management information, exam reviews, online lectures, and dissection guides were heavily used and deemed useful by students. Despite universal computer ownership and Internet access from home, most use of the Web site was from on-campus computer labs, especially for lectures with audio streams. This was probably due to the limited bandwidth of off-campus connections. Data on the day of the week and time of the day of access showed peak activity at expected times, but also significant activity at all hours, as students took full advantage of 'access on demand.' This on-demand nature of the Web was also evident in students' viewing of lectures in short sessions rather than in one sitting. Online lectures were used regularly by a majority of students both before and after corresponding class sessions, however, this was not the preferred venue for all students. Although the flexibility of Web-based resources accommodates students' varying study habits, the alternative of traditional print material and live lectures should not be abandoned lightly.

The usefulness of high-resolution photo-realistic virtual objects, such as those made with QTVR technology has been limited by the very large file sizes involved and hence lengthy downloads over typical Internet connections. Several "streaming" image formats have been developed that facilitate high-resolution image distribution by using an image pyramid system. In these systems, a low-resolution image is initially downloaded. Zooming in on this image brings in additional image data to create a higher resolution image in the zoomed region. Zooming further, or panning the image brings in additional data as needed. This dialog between client and server means that only the image data that is needed is downloaded, speeding download times while permitting high-resolution viewing. We have used one of these commercially available systems, "Zoomify" to produce high-resolution anatomical VR objects which can be effectively viewed over limited bandwidth connections. The advantages of this system are its simple PhotoShop plug-in interface, ability to process static 2D images as well as VR objects and panoramas, and versatile deployment via QuickTime, Zoomify Plug-in/ActiveX, Java, or a "clientless" Perl CGI.