Education by video
Authors: Damian Roland, Holger Wahl, Monica Lakhanpaul, Nic Blackwell, Ffion Davies
Publication date: 09 Feb 2011
Damian Roland and colleagues explain how to make patient video clips for clinical education
Most clinicians involved in teaching have contemplated incorporating patient video clips into their teaching at some point. Possibly beyond a short clip embedded in a slide presentation, to dreams of a bigger scale teaching package using real patient footage? Those who have tried often fail, as there are several practical hurdles. Our small team would like to share our learning over a few years with the successful creation of some large scale teaching packages based on patient video clips, in particular the not for profit Spotting the Sick Child resource ( [Link] ) commissioned by the Department of Health. The purpose of this article is to help you to develop your own teaching tool using patient video clips.
Overall project management
Succeeding in creating a teaching resource using patient video clips is no different from any project, whether it is service redesign in business or the health service or building an extension to your house: it needs good project management, and most clinicians have little training in this.
As eager as the team may be to start filming, without clear discussion and a document laying out the project plan a lot of time and resources will be wasted, and your project may either fail to reach completion or will look shoddy.
Negotiating skills, teamwork, delegation, coordination, leadership, timelines, budget, scope, equipment, and thorny issues of patient consent, confidentiality, and data storage are all components of the project.
There are three phases to consider:
The preproduction phase (defining your scope, planning resources and practicalities, and recruitment and induction of a team)
Production (filming, scripting, and editing)
Postproduction (how to avoid it gathering dust on a shelf).
Obtaining a budget
Research has shown that learning is enhanced by patient video clips,  but demonstrating existing learning packages and having some clear aims are often enough to convince most sponsors to part with their money. Money is needed to cover equipment costs (cameras and a software package) and payment for people’s time (junior doctors and nurses make good “filmers”; a multimedia company will give you a much more professional product but will cost money).
Forming a team
Table 1 is a suggested framework, which must be adapted to the scale and purpose of your project. Be clear at the outset about how much time each team member is likely to need to commit—then double it.
Involve all stakeholders early
Getting support from key people will help you in your postproduction phase. By doing this early people feel included and may even offer you money, their time, or patient video clips of their own.
Patient consent and confidentiality
Make sure you have a clear consent form, and allow several months before aiming to start filming to gain your organisation’s approval of the form itself; this is a sensitive area.
Getting consent to film is easier than you may imagine. In our experience, patients were delighted to help in creating any resource which would improve learning for clinicians. We often filmed in acute, stressful situations, and were rarely refused. In an acute situation, explain that the video tape can be wiped at any stage and you will discuss it again in 10 minutes or so.
Finally, beware of using patient video clips on the internet. We easily gained consent for CD/DVD/lecture formats, but internet consent required more consideration; most patients consented only if there was secure access to ensure viewing by healthcare staff only.
Creating a shopping list
Define your scope first with section headings, subheadings, and so on. Creating documents in the form of organisational charts, like a “site map,” can help all team members understand the overall scope and how the sections fit together. By putting sufficient detail on your site map, which may stretch to several pages, you will be able to create a “shopping list” for the patient video clips. Put this in a format the filming team can refer to and which can be adapted as time goes by. Make sure the list is updated regularly so unnecessary additional footage isn’t collected. Table 2 illustrates the level of detail which is useful.
You may have professional help to film, but modern digital camcorders are versatile, forgiving, and easy to use. However, an hour’s teaching from a professional is well worthwhile.
If a non-clinician is filming, an accompanying clinician needs to be specific about what you are trying to capture—it is not always obvious to them. There is also a balance between waiting for “the right patient” and filming endlessly and then trawling for useful footage in the editing stage. Remember that your audience (learners) are clinical and are quite forgiving in terms of recognising the limitations of real life patients. They will also be engrossed in the patient to forgive or not notice wobbly camera moments or some background noise. So do not aim for perfection, but equally do not film meaninglessly.
Safe data storage
The filming team must be conscientious in safe and reliable data storage. First you need a unique identifier for each patient and a subcode for each clip, if there are several (see data management). Set this up as a limited access spreadsheet before you start filming. Write each unique identifier on each consent form, keeping them with each digital tape in a safe place, and use one tape for each date of filming (this is both practical and economical).
Store the tapes and consent forms safely until data capture on to your software package. Handover of tapes and consent forms from the filming team to one or two members of the project team is best, so that you limit access to the “gold copy” spreadsheet. This protects patient confidentiality and avoids big mix-ups when data are badly transferred.
You can rapidly end up with unmanageable numbers of patient video clips unless you have a thorough, logical, and detailed layout on your spreadsheet. Poor management will lead to delays, frustration, and spiralling costs.
How to review footage efficiently
It is easy to spend a large amount of time viewing, losing, and forgetting footage. Keep your film files in the order of the main database so you can find them easily when you want to view them. Every time you review footage take time to write a clear descriptor alongside it. Do not use this time to imagine how the final product fits together—just use it to refine (and hopefully delete) your shopping list.
We found that including comments that helped you remember the clip and noted the strength of the clinical signs and symptoms helped greatly in the editing stage. For example, table 4 shows the “footage review” column on the Spotting the Sick Child spreadsheet.
During this review, remember that two clinicians are better than one—your reliability and skills as a teacher and clinician will be tested by your choice of clips.
You now have lots of patient video clips, a site map, and some choices to make. Are you going to use voiceover or text to teach, or allow the teacher to speak over your footage? Voiceover requires fine editing to match sentence length to the clip. This is time consuming and best done by a multimedia company. No speech or text allows teachers free rein, but can be boring for the learner. A “banner” with key words overlaid on the clip is a good compromise to aid concentration.
Are you going to use diagrams, photographs, footage of a teacher explaining the clinical content, or just the patient video clips? This depends on whether you have enough footage and how much time you or your media company are prepared to spend getting exact matches to the clips versus “fillers.”
How many people have a stake in the final production? Large amounts of time can be saved or wasted depending on the efficiency of this process. Clinicians may clash with each other particularly about perfection issues, or non-clinicians can inadvertently lose the clinical meaning by cutting content or mismatching to the text or voice.
If you plan to launch your product to a wider audience, revisit it at any time, or respond to user feedback, then you should have a strategy for postproduction. There is no point in creating a wonderful teaching tool that no one knows about, or one with glitches that stop people using it because they cannot be ironed out.
You should have a plan for administering and incorporating user feedback, ensuring content updates as clinical knowledge changes, and dealing with technical difficulties and promotional strategies. Don’t forget to budget for this because both time and money are needed.
However you resolve all these issues, you will hopefully have fun, and create a much more engaging teaching package than one without patient video clips. Have a clear strategy, concise overall project plan, and engage a sufficient number of people showing the various skills needed to complete your overall project. Above all, enjoy your project.
Competing interests: None declared.
- Balslev T, de Grave W, Muijtjens AM, Scherpbier AJ. Enhancing diagnostic accuracy among nonexperts through use of video cases. Pediatrics 2010;125;e570-e6.
- De Leng B, Dolmans D, van de Wiel M, Muijtjens A, van der Vleuten C. How video cases should be used as authentic stimuli in problem-based medical education. Med Educ 2007;41:181-8.
Damian Roland doctoral research fellow in paediatric emergency medicine
University of Leicester, Leicester, UK
Holger Wahl paediatric registrar Germany
Monica Lakhanpaul senior lecturer in child health University of Leicester, Leicester, UK
Nic Blackwell director of HERADU University of Leicester, Leicester, UK
Ffion Davies consultant in paediatric emergency medicine Leicester Royal Infirmary, Leicester
Correspondence to: D Roland firstname.lastname@example.org