New Methods in Teaching

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Dr. Schifrin: : "Hi, I'm Barry Schifrin. I'm a perinatologist from Tarzana, California, and I serve on the Advisory Board of OBGYN.net."

Dr. Morris: "And I'm David Morris. I'm the head of obstetrics from a unit in Adelaide, in southern Australia."

Dr. Schifrin: "We're going to talk this morning about some new developments in participatory education, and how the application of this technology within telemedicine is revolutionizing medical education. It has often been said that the greatest problem with communication is the belief that it already exists. We believe that we are using common terminology, we believe that we are communicating with our audiences but rarely get to test that notion. Dr. David Morris has recently demonstrated a technique that allows the speaker / educator to actually testing the audience's responses during the progress of the class or lecture. Why don't you tell us about this program and how you got to develop it."

Dr. Morris: "First of all, the reason I became interested in this has to do with concerns within my own unit that seemed to reflect a lack of uniformity in the terminology used for interpretation of CTG's. Another reason was to help address a very easy-to-use computer program that individual people can use to really teach themselves. But my main interest is not teaching people on an individual basis, but in groups. One of the biggest drawbacks, I think, in group discussion is real, honest feedback. Without feedback, you don't really know what you're dealing with, and that's why we use what I call the 'electronic voting system.' I have one of the units here - it's just a small box with a series of numbers on it. When I present a question to groups, I can give them a series of alternative answers, and they can then press an answer. They're the only ones who know what they've said, and so it's a non-threatening sort of situation. I can get honest, accurate feedback of what my groups are thinking, and that's often very surprising."

Dr. Schifrin: "So, in fact, you probably change the lecture as you go along, not so much in response to what your notes are, but in terms of the response of the audience to questions that you have put to them during the lecture..."

Dr. Morris: "That's absolutely correct. In fact, I seldom have a structured lecture now. I have my program with all my details on it, and I let the direction of the lecture follow the responses of the group."

Dr. Schifrin: "I'm sure sometimes it follows directions that you had not intended at all in the first place."

Dr. Morris: "Absolutely. Yes, and that's what makes it exciting. The other challenge is that I'm responsible for the training of registrars that are spread throughout our whole country. This covers many thousands of miles, and on occasion I have registrars in Darwin, Alice Springs, Adelaide, and Burnie in Tasmania. Through telemedicine facilities I can have these people participate in the sessions as though they were in the same room. This has proven to be very exciting for them. One of the very important outcomes of this is that people are feeling happier about going to remote areas of training because they don't feel so isolated."

Dr. Schifrin: "I think the benefits of this kind of communication seem obvious. What kind of obstacles did you have in trying to overcome this?"

Dr. Morris: "Cost, of course. The cost of the basic as well as the telemedicine equipment is not cheap, but it's one of the factors that we have to build into evaluation of whether it is cost effective. That's very difficult, but there's a lot of work going on throughout the world with this sort of thing being addressed. If people are interested in more information on this, there is a annual conference on telemedicine put on by the Royal Society of Medicine, and I have a web site that people can contact."

Dr. Schifrin: "It seems to me, however, that, in terms of the cost, sending all these people to individual courses around the world would probably be far more expensive if you calculated those costs, and compared them to the cost of the ongoing education that this kind of resource makes available to you."

Dr. Morris: "Yes, that would seem to be the case. The voting system can be used though telemedicine as well, and that's an area we're finding very exciting. Not only those in the base unit have the opportunity to vote, but, theoretically, those in the peripheral areas could vote and have the same input."

Dr. Schifrin: "Are they on the same registration? In other words, is all the data from both sites pooled, or can you tell the differences in responses in the various areas?"

Dr. Morris: "The answer to both of your questions is yes. I performed a demonstration of this equipment from London with my computer, and I had an audience in Adelaide. When I asked a question, the data from Adelaide came through the line into my computer in London. I displayed the total results, but by pressing one of the keys, I could show the London results or the Adelaide results, and that really stimulates discussion."

Dr. Schifrin: "I can only imagine, and I would ask who was right..."

Dr. Morris: "First, you should ask what the question was."

Dr. Schifrin: "It was Thomas Pynchon who once said, "If you ask the wrong questions, it doesn't matter what the answers are." If we reverse the notion, you can only begin to get the right answers if you ask the right questions.' I believe this is an innovative and demonstrably valuable service that helps to ask the right questions. It seems to me it also has the potential application to a far wider range of educational activities within the individual hospital as well as regional conferences where tracings from remote hospitals are discussed. As you point out, we need to refine the terminology if we are going to learn from each other."

Dr. Morris: "That's right."

Dr. Schifrin: "I'm sure many people will be interested in this technology. I don't doubt that you will have a lot of communication with others as they attempt to implement this program. I look forward to its great expansion."