By Ellen Camloh
It’s a debate as old as formal education itself: which instructional methods are the most effective for teaching specific disciplines?
Traditional lecture-based learning might produce a rate of just 5% retention of the material. Giving students a chance to practice the lesson by performing the task? That can add 70% to the retention rate.
This is why practitioners of highly specialized skills, such as surgery and clinical healthcare, get trained in real-life environments. They spend many years assigned to hospitals – practicing on actual patients on a rigorous schedule, training under the guidance of an attending physician – before they can complete their medical licensing.
But what about outside the hospital?
For those training to treat accident victims, the life-threateningly ill or the traumatically wounded at disaster scenes, there’s no coordinated structure to arrange real-life emergencies and practice uncommon, acute procedures in the field.
But at Monash University’s Department of Community Emergency Health and Paramedic Practice (DCEHPP) in Melbourne, Australia, one educational team is creating that environment – with video.
DCEHPP delivers nationally recognized programs that train undergraduate students to become professional paramedics. Its postgraduate Master of Specialist Paramedic Practice goes further, building on that primary training to provide advanced education and professional re-certification.
Put simply, says Emma Stam, Postgraduate Course Coordinator, “We take existing advanced life support paramedics and we up-skill them to become intensive care paramedics.”
It’s these specialists who perform the highest level of emergency interventions such as intubations, cricothyrotomies, and chest tube insertions, usually in uncontrolled settings.
According to Ms. Stam, “These are dangerous skills that aren’t necessarily frequently performed out in the real world.” And that’s the problem: IC paramedics may never get regular on-the-job training of particular emergency techniques, but they have to be ready to perform them at any time.
“We want to send our graduates out feeling comfortable and competent in performing those skills on the occasions where they’re needed,” says Ms. Stam.
She set out to build a learning environment that would not merely simulate the scenarios an IC paramedic would encounter, but in fact, immerse the student in them directly.
This Is Real
Ms. Stam says, “Simulation has been around for a long time. In a hospital setting, it’s very easy to run simulations, because you set up a hospital ward, and it’s the same environment every time. For us, every day you might go to two cases, or 14, but they’re all different.”
So she and her team devised a training method that would meet the best of both worlds: continually change scenarios to prepare paramedics for the events they would face in critical situations while controlling the environment so they can practice their skills without interfering with the health of real patients.
Under Ms. Stam’s direction and background of education design, the DCEHPP’s new Postgraduate Training Centre has recently undergone construction. A centerpiece of the facility? The Simulation and Training Room.
The Simulation room encompasses a fully immersive video experience that projects a nearly 360-degree video panorama seamlessly around all four walls.
Immediately, students are thrust into a scene just as if it were taking place live.
“It could be a car crash on a freeway, it could be someone’s nana in a nursing home who’s in respiratory distress, it could be a pediatric case of a drowning in a local swimming pool,” says Ms. Stam. “It’s the only way to put them into the diversity of the environments that they face on a day-to-day basis.”
Accompanying the surround video is environmental audio filling the room, to further compound the stress and distraction of the scenario.
What’s more, filmed and live actors may portray curious onlookers, an encroaching crowd, or even aggressive bystanders.
“We have to create any given moment,” says Stam. “There’s no instructor sitting next to them who provides details about the theoretical accident and calls out variable vital signs like a heart rate. There’s no imagining going to this case and pretending to take the mannequin’s blood pressure.”
In the Monash University simulation room, each paramedic team tends to a physical (albeit manufactured) ‘patient’ that has actual vital signs, physiological variables that react to treatment, and unknown conditions that may not be obvious until certain clinical decisions are already made. All in the chaos of a lifelike environment.
“They’re completely isolated and on their own. They have to really step it up, make those decisions in an unsupported way and justify what they’re doing,” Ms. Stam says. “That’s what they’ll have to do out there on the road.”
Learning by Immersing
During that isolated simulation, only one crew – a pair of paramedics – is in the room at a time, just as in the real world. There are no windows for other students to peer through and detract from the realism of the scene.
So what about the students who aren’t involved in that experience?
“Part of paramedic learning is watching other people make mistakes, or have great successes,” says Ms. Stam, “and anticipating what decisions the crew should make.”
With the help of staff video producer Cliff Elliott and the shared vision of her husband Nathan Stam (who is the Head of Postgraduate Programs for the department), Ms. Stam designed a different kind of training for the immersion observers.
Taking a page from live broadcasting, they implemented a NewTek 3Play video system to bring the other students as close to the scene as possible in real time and allow them to analyze it, comment on it, and interactively examine the same scene from all different angles – without disrupting it.
She says, “I met with Cliff and said, ‘we need a camera capturing system. How do we go about capturing all of this content from multiple, different views?’”
“Emma wanted body cams for the paramedics,” says Elliott. “We wanted all four angles of the ceiling cameras. We wanted everything streamed over into our meeting room,” where the instructor and other students in the cohort could switch between angles and discuss the assessment and treatment decisions the crew was making.
Most importantly, they didn’t want staff to require training on how to make the system work. After all, their focus is on intensive care paramedics, not on video technology.
Connect and Capture
After some investigation, they contacted Blonde Robot, NewTek elite partner and authorized distributor for Australia and New Zealand.
“They came in, and I didn’t know what technology was available. I just had a vision of what I wanted to create. But when they diagrammed it out on the whiteboard,” says Ms. Stam, “I could tell intuitively that they knew exactly how to create my vision using the equipment available.”
Pawel Bybel, the Blonde Robot technical consultant who worked on the video project with Monash University, agrees: the requirements pointed to the NewTek 3Play 4800.
“They were after a system that could simultaneously capture and playback video streams from multiple cameras,” Bybel explains. “They also wanted to see feeds from at least 2 cameras on the screen at the same time, so we had to include a multi-viewer, which 3Play systems have built-in.”
Furthermore, they required the ability to switch between angles both live and in captured replays, and record all the angles as separate files so they could use them in postproduction, and, ultimately, in online learning assessments.
“The simulation room has four ceiling-mounted fixed cameras, as well as two body cams,” worn by the paramedics to capture their personal points of view of the scene, says Bybel.
The body cams require wireless transmission so as not to interfere with the training, so they send HD video through Teradek Bolt wireless links, which then connect to the 3Play 4800 via SDI, same as the four ceiling cameras.
In all, the 3Play system in the classroom comprises 6 live feeds during simulation that the instructors can switch among to give observing students the close-up views they need to analyze the decisions the paramedics take at each step.
Training the Trainer
Of course, says Bybel, one of the most important considerations was that the system had to be easy to use so that teachers could use it themselves.
This was Ms. Stam’s requirement – spoken from experience: “If the user interface is too complicated, then instructors won’t use it,” she says.
Because 3Play 4800 (like other NewTek systems) is software-driven – having an interface that can be operated with mouse, menus and key commands – customers can create their own push-button UIs to perform every command in the system, and control it through any MIDI controlled connection.
The way Blonde Robot implemented this was to create a touch-screen app specifically for Monash University’s workflow, allowing instructors to control it from an iPad.
With the built-in ability to customize so many of 3Play’s functions, says Bybel, “We’ve also added the capability to zoom in on a specified part of the frame during playback,” so the students can do ‘post-game analysis’ as a group.
“The fact that we could create custom user interfaces means the instructors can operate the system after only a half-day training,” he says.
Taking Video Further
Simulation, immersion, and real-time video analysis are only the most recent visual technologies the Stams are pioneering in intensive care paramedics education.
A recent – and incredibly novel – assessment approach involves students’ exemplar videos, which means filming themselves performing high-risk skills.
“Demonstrating their competency is one thing, but by rehearsing over and over to present the technique smoothly using video, they committed the skill to muscle memory,” says Ms. Stam, and that will have a positive effect on their ability to recall and perform technical procedures when needed.
And still in the works is a virtual reality hub, placing each two-person crew in the front seat of a real ambulance. They’ll wear VR headsets from which they’ll receive dispatch information, watch themselves drive to the job where they’ve been dispatched, and talk each other through the normal pre-planning process.
Finally, the 3Play system’s recording features will extend their use of the simulation videos. By capturing each crew’s experience through the simulations, the school will amass footage of all the decisions different paramedics would make in the same scenario. They could then use each set of clips to deliver more accurate assessments.
For instance, online learners who can’t be in the simulation room itself can choose which decision a crew should take – and see the consequences of those decisions, as captured in the actual scenario.
“We saw these video technologies as solutions to a problem that we’ve been faced with for a really long time in our industry,” says Ms. Stam. “We want to put the best paramedics out on the road because it’s our families that they go and see. We want them to have the best level of medical care.”
And they hope to spread the word to other institutions, she says.
“As educators, we don’t want to keep what we’re doing to ourselves. None of this attitude of, ‘I don’t want anyone to copy what we’re doing.’ I’d be happy with that. It shows we’re doing the right thing.”
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