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Distributed Learning Expands Med School's Reach

A shortage of physicians in rural areas isn't a problem unique to Canada, but the highly sophisticated technology solution that the University of British Columbia has set up to solve it may well be.

The university, located in Vancouver, faced a challenge as the only medical school in the vast and largely rural province of British Columbia. UBC's medical school was producing just a third of the 400 new doctors needed yearly to meet the province's need. And because physicians tend to set up practices where they graduate, few of those doctors were settling in the rural areas that needed them most.

To both increase the number of doctors it was graduating, and to encourage more doctors to settle in non-urban areas, UBC decided to partner with two rural universities that were also on or near the west coast of Canada, though difficult to reach from Vancouver: The University of Victoria, located on the southern tip of Vancouver Island off the West coast of Canada, and the University of Northern British Columbia, whose core campus is in the town of Prince George in the northern inland area of the province.

Clearly, the cost to shuttle instructors, most of whom are doctors themselves, from campus to campus on a rotating teaching schedule would be prohibitive, and difficult or impossible during bad weather. Instead, UBC decided on a complex distributed learning solution that uses audio and video in sophisticated ways to bring not just the instructor and presentation materials, but the students themselves, into audio and video contact with each other during classes.

According to Michael Keating, associate director of technology for faculty of medicine at UBC, the university will add a final 32 students to the program in 2007, accomplishing its goal two years ahead of time of doubling the number of medical students graduated yearly.

While the university's overall investment in the system is difficult to calculate because each university built its own facilities, Keating said, the cost was in "the multiple millions [of Canadian dollars]." However, given the requirements of the three universities, he said, "I would say that we put together a solution to meet the requirements in the most cost-effective way."

In its essence, the distributed learning system sends courses taught at UBC to the other two sites in real time, using an IP-based videoconferencing system over a university-owned, high-bandwidth network. If an instructor is located in Victoria or Prince George, the content can also be distributed from there. In addition, more than one classroom can participate in an A/V session at one time. All three sites have complex A/V systems in the several classrooms that are set up as part of the system. Contents of the classroom include a number of cameras and microphones, as well as ancillary A/V devices to capture sound, and a suite of DVD players, audio tape players, VCRs, and document cameras, used by instructors for showing three-dimensional objects, such as a medical specimen, in high detail.

In addition, each campus has a staffed central control room in which a video technician can closely monitor the classrooms. The technician is responsible for making sure the right signals go to the correct classes, as well as a myriad of details including the quality and stability of the network, the quality of pictures and sound delivered, and control of cameras if a speaker is moving about the classroom.

Because the two partner universities had not offered medical courses before and were building new classrooms from the ground up, they were able to build them specifically to accommodate the complex remote delivery solution.

The system incorporates an off the shelf videoconferencing system that includes many carefully tailored parts. UBC contracted with Visual Defence, an Ontario, Canada-based company that specializes in highly technical custom solutions for security, often with integration of sophisticated digital audio and video services. UBC is using the Visual Defence Audio/Visual/Control system for its complex and technical installation. Visual Defence provided custom programming for each of the control systems that monitor the A/V system, which are from Crestron. The A/V system itself contains equipment by manufacturers including Tandberg, Biamp, and Extron.

UBC's technical team worked with a designer to come up with solution and specs, Keating said, then sent the project out for bid. The university then selected Visual Defence's product, as well as using the firm to help with system design, installation and integration of controls.

To maintain the feeling of connectedness that is important to first and second-year medical students, who often develop important bonds with classmates by moving through their courses together, the system uses three channels to transmit the full feel of classroom participation to students on both remote campuses. One channel carries the video conferencing, Keating explained, while one carries presentation materials such as PowerPoint slides.

A third channel produces content for a large composite screen at the front of the class, divided into quarters, that shows the class itself. That allows students to view each other in each classroom. "Lots of thought was put into how to support interactivity and questioning," Keating said. "We felt it was important that all students could see and hear questions, but it was definitely a technical challenge."

To address the issue of student participation, each remote classroom is equipped with push-button activated microphones, one per pair of students. Activating the microphone triggers a preset camera that shows a close-up of the two students on one screen, and cues the instructor that someone has a question—the high-tech equivalent of a remote student raising a hand.

From the front of the class, monitors allow instructors to see each classroom, in order to maintain their connections with the distant audiences. Also, cameras focused on the instructor have intentionally been placed behind those screens, rather than to the side, so that to students in remote classroom, the instructor appears to be looking into the camera and at them, instead of to one side.

The highly complex system and its careful attention to detail has drawn the attention of other universities, Keating said, who have contacted him for details and advice.

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