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Education & training

Training videos help residents perform invasive techniques

TORONTO – When Dr. Shelly Dev (pictured), Clinical Associate, Critical Care, started a career in medicine, she didn’t know that a prior interest in film would become part of her work as a teaching physician, but in fact, it has.

Currently, Dr. Dev is leading a new way to teach medical students and residents at Sunnybrook Health Sciences Centre. With support from the New England Journal of Medicine (NEJM) in Boston, she is creating Critical Care instructional videos that show how to perform non-surgical procedures in the safest way possible.

Non-surgical procedures are considered invasive as they are done to large, deep areas of the body and require sterility.

Examples of non-surgical procedures include: inserting intravenous lines into the neck, tubes inserted in the chest, lungs and heart, and breathing tubes inserted in the windpipe. The procedures can be high risk if not done properly; however, when done properly the risk is significantly reduced.

“We wanted to lower the potential risk of these procedures even further,” says Dr. Dev. “and we knew that if students really grasped the concepts well from the beginning, there would be less chance of error.”

The instructional videos are put together in a way that’s attention grabbing, concise and realistic. Dr. Dev uses animation, graphics and real footage to drive the lessons home. This combination of approaches appeals to the different ways people learn because, as all teachers know, not everyone learns in the same way. Simulators are often used to provide an interactive learning experience for surgical residents; however few centres in Canada are using the video approach to teach non-surgical procedures in Critical Care.

Dr. Dev is involved in all aspects of creating the videos. “I storyboard and script the videos, then film and edit them. During my internal medicine residency, I was involved in putting together a few short comedic film projects with a colleague, Dr. Vincent Chien from St. Michael’s Hospital, for the Department of Internal Medicine at University of Toronto (U of T) for the annual Christmas Skit rounds. I would write the scripts and act in them and he would film them. We’ve been working together on these types of films for six years and he has taught me a lot about storyboarding, filming, editing and production. From that introduction I had to expose myself to all sources of information on film production to continue learning and I am still learning all the time.”

Enhancing this background, Dr. Dev works with the NEJM as an editorial fellow for the section of the Journal called Videos in Clinical Medicine where she reviews video submissions and discusses ways to improve the quality of the series. As a result, she is part of a collaborative environment where she can learn from creative people in graphics/editing/animation, and be mentored in her own work by the editors who are leaders in research and academic publication.

All filming is done at Sunnybrook, in Toronto, and when it comes to capturing actual procedures, it is very similar to being on call. “Many of the procedures are unplanned,” says Dr. Dev. “They occur based on the immediate need of the patient, so essentially I have to be prepped and ready to go at a moment’s notice.” Dr. Dev then gets consent from the patient or his/her decision makers before filming.

The first video in the series covers chest tube insertion. The second video nearing completion instructs physicians on the steps involved in brain death declaration. This video was funded by the Canadian Council for Donation and Transplantation and will be distributed to physicians across Canada. Both videos will be available online for use by residents at Sunnybrook.

Funding for videos’ equipment and resources comes from the Department of Critical Care at Sunnybrook, which provides financial support for educational projects like this one. The department is very committed to keeping the momentum of the project going.

Says Critical Care physician, Dr. Robert Fowler: “There is really so much at stake when it comes to instructing our students. We have a duty to support people, like Dr. Dev, who are creating the most innovative and complete method of teaching. It is for the safety and well being of our patients after all.”

Dr. Dev agrees, “These videos are definitely tackling some of the hurdles that we were encountering as teachers in Critical Care. All teachers have different tactics and we don’t always know what works best for each and every student. It is safe to assume that a combination of methods is probably best to reinforce ideas. These days the method needs to be riveting and creative. It is not enough to simply stand by the bedside and describe what you’re doing. Students need to be stimulated more than before, as they have grown up in a more high-tech, visually stimulating world.”

When asked about the future, Dr. Dev says that her dream is to eventually make this a Toronto-based project through the University of Toronto. “It would be wonderful to create a multimedia centre through the university so that more medical students and residents can access the catalogue. Also, some of the animation and graphics have been contributed by NEJM but I have contracted work from Toronto artists in other instances. I’m hoping to exclusively enlist the help of Toronto-based student artists in the future, either from the Biomedical Communications program at U of T or from Ontario College of Art and Design, in Toronto. I think this will be a great learning experience for them and something to add to a growing portfolio. This could really become a citywide project.”

 

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