Collège des Enseignants
Société Française de Neurochirurgie
Virtual campus in neurosurgical education New information and communication technologies in neurosurgical
care and education

New information and communication technologies in neurosurgical care and education

Jean-Jacques Moreau

The use and development of new information and communication technologies in neurosurgical care and education began in the 1990’s (1). The problem was to answer to the difficulties created by characteristics intrinsic to French neurosurgery organisation : there are 350 French neurosurgeons for a population of 59 million people; 20% of them work in private practice, 70% in University hospitals. These university hospitals are disseminated through out the hexagon correspond to the public service needs. The inconvenience is the geographical distance between the hospitals creating difficulties in neurosurgical care and education.

1- Neurosurgical care

In the 1990’s we participated in the development of equipement and software to find a way of working with regard to problems related to long distance diagnosis. It was found that the transfer of medical data was reliable, easy and above all fast even using ordinary equipment (2). This device (Sigmacom) is now well implanted in our country with more than 15 regions equiped.

Sigmacom is a multi-modality workstation especially designed for diagnosis, reviewing and reporting by digital imaging. It provides a complete range of connection possibilities to existing medical imaging equipment on the market.
In fact this system helps neurosurgical management on a regional basis, avoids unecessary transfer and orient the patient toward the appropriate structure.

2- Neurosurgical education

The French Society has asked the Director of the College to define, organize, promote and harmonize neurosurgical teaching in France. The College’s role is to provide the educational program of neurosurgery for French and foreign MD’s in initial and continuing medical education (3).
To answer to this goal the college has proposed a plan that uses new principles in medical education combined with new information and communication technologies

Every learning procedure, even the most simple, gains by being built around some essential stages that create a teaching-learning process.
  • The first determines the needs –what the students need to learn for their future career.
  • The second transforms the needs into learning objectives.
  • The third selects appropriate learning means to reach these objectives.
  • The fourth assesses the degree of achievement of the objectives at the end of the process.
Students are at the centre of the learning process.
Teaching is an active process, an act of communication and students must be active and responsible in the teaching-learning process.

In France the post-doctoral program is organized, assessed and validated at a regional and inter regional level. There are 7 inter regions and each of them contains from 4 to 6 regions. The neurosurgical qualification is given by an interregional commission after 5 years of residency and an exam.
However the geographical distance between the regions and inter regions makes the organization and harmonization of training difficult.
At the same time, in France a national reform recommends that new educational technologies be implemented to train students. For this reason, we proposed a virtual campus plan of neurosurgical education.
It uses these new technologies including video conference, video streaming, E learning and evaluation for on line auto assessment. This plan was sponsored by the government during 1 year in a feasability phase.

Video conference,

An interregional teaching session model using Videoconference was built and tested by the south-west interregion. This model requires educational and technological investment.
In teaching, we work in small groups using problem based learning to resolve clinical cases (4). The final case resolution is performed by videoconference between the different regions. A feedback is given by the tutor. The problem is placed on the campus website before the session for clinical case data and may be used by another inter region later on.
As far as the technology is concerned, the system is rigid and must respect some rules:

  • prepare the different educational supports (slides, videos, radiographs,...),
  • test the connections before the session,
  • ask to be reconized before speaking,
  • be in a correct position to be seen and heard.
This year year this model has been used by 4 other interregions

Video streaming,

Digital video is becoming the medium of choice for collecting images and sound for educational and social science learning.
Video Streaming is a method of delivering digital audio or video files in real-time, via Internet, as a continuous sequence of data that can be deployed as they arrive at the end-user’s computer.
When the user clicks on the link or icon, information in these formats is streamed in real time after a few seconds of buffering time. The streaming shows video, audio and slides.
This system give the opportunity to retain the ephemeral talk and will be used in CME.

E learning,

In order to provide students with interactive course materials many medical curricula are moving towards the use of web technologies. Web accessible scientific contents will be written under the sponsorship of the main medical specialties on a national basis.
One Web site has been built :

  • to help teachers review and compile resources available on the net (for example clinical case data)
  • to help medical students and residents access the scientific and social educational information (session date, program session, pre and post tests, scientific content, bibliography, chat) and an autoassessment system
  • to help CME collegues with diffusion of information by video streaming for example

On line auto assessment.

The Script Concordance Test (SCT) has been selected to assess clinician competency in neurosurgery. This tool was created by B. Charlin from Montreal.
The SCT tests :

  • reflection in action
  • organisation of knowledge rather than factual knowledge
  • the links among bits of knowledge, not the bits
  • the capacity for action that stems from knowledge organisation

How is the SCT built?

  • The case is always a clinical situation with a problem, uncertainty and no simple solution.
  • There are relevant hypotheses and key elements that experts look for in the situation.

How is The Scoring Grid built?

  • With a group of experts
  • All answers are recorded
  • Points depend on the number of experts that have given this answer.

What are SCT key points:

  • Comparison between scripts of experts and those of examinees is possible
  • It is used for Pre-graduate, post-graduate, or CME
  • It is well accepted, cases are clinically relevant and
  • Relatively easy to build and to use on the web site at any time
  • Comparison is easy between scripts of different levels of examinees
  • And test the individual and general progression in a part or the entire educational program.

French language Medical Virtual University

This project was included in a national cooperative project called French medical virtual university (FMVU) to implement and test a new E learning based environment for medical schools. It is a hybrid concept mixing reality and virtuality.

In conclusion, this project demonstrates the feasability of computer aided learning and the interest of distance teaching through communication technology. But we must respect the principles in medical education (5, 6, 7).

References

1. The computer in neurosurgical practice. A.B. KAUFMAN. In Neurosurgery Update 1, 1990, 10, 128-137. R.H. WILKINS and S.S. RENGACHARY.

2. Viewdata processing transfer of neurosurgical documents through numeris. A simple reality, a substantial progress. B. FRANCK, I. BERRY, J.J. MOREAU, R. RAVON, C. MANELFE. Neurochirurgie, 1993, 39, 258-263.

3. Améliorer la formation en neurochirurgie. J.J. MOREAU. Editorial. Neurochirurgie, 2002, 48, 4, 307-308.

4. Problem-based learning: an approach to medical
education. H.S. BARROW, R.M. TAMBLYN. Springer series on medical education. New York, Springer, publishing Co., 1980.

5. Apprendre à devenir médecin. Bilan d'un changement
pédagogique centré sur l'étudiant. JE.DES MARCHAIS. Université de Sherbrooke.1996.

6. The University of Alberta and Alberta transportation and utilities videoconferencing project 1992-93. An evaluation report. M. HAUGHEY. University of Alberta, Edmonton, Canada.

7. Apprendre à enseigner les sciences de la santé. Guide de formation pratique. P. JEAN, J.E. DES MARCHAIS, P. DELORME. Faculté de médecine des universités de Montréal et de Sherbrooke, 1993, 4ème édition.

Top