One of the most significant fields of telemedicine is remote medical
training. It might be well to mention that if the practical use of
telemedical consultation on a regular base is going to develop rather
slowly due to a number of methodological, mental, organizational,
financial and other barriers that need be cleared the medical education at
a distance will be called for first.
Modern computer and communication technologies enable to get remote
training in medicine as similar to internal instruction as possible. It
took several decades to form the system of internal instruction and
improvement of professional medical skills. This system has demonstrated
its efficiency achieved due to the appropriate combination of its
instruction and interactive methods of thorough study of different
subject matters and practical training with further consultation and
examination. Because of this, remote training within any telemedicine
network should be based on this far-devised system of internal
instruction and be amplified with the opportunities that modern computer
and telecommunication technologies are offering.
The system of remote training and improvement of professional medical
skills should be composed of:
Remote delivery of lectures on subject matters or on current medical
trends. The said lectures should be read by leading medical experts.
Seminars for detailed study of the subject delivered in the lecture.
Practical training in making diagnosis, treating and operating and
individual telemedical consultation.
Reading Lectures at a Distance
Remote lectures can be read both on subject matters within a course of
lectures and on individual topical matters. The remote lectures
primarily aim at delivering the subject material that gives the students
basic ideas for further detailed study both at seminars and individual
Most of the leading doctors of medical centers and institutions are
involved in different instruction processes and have materials to read
lectures for students of different levels. The said materials can be
presented as manuscripts, printed matters, wall charts, slides, computer
presentations, roll video films, etc. Because of this, the telemedicine
system used by lecturers must be able to deliver any of the above
matters to remote students. During remote lecturing the students must be
able to see and hear the lecturer, to see the illustrating matters and
objects on display, to ask questions as well as to hear questions of the
colleagues and answers of the lecturer. Only in this case remote
lecturing can be as efficient as internal instructing. And as this takes
place the send-site environment should be as similar to the normal
environment at a regular lecture for internal students as possible. Thus
it is very desirable in addition to the lecturer to have an audience of
several full-time students in the room where the telemedicine unit for
remote training is installed. This helps the lecturer read the material
in the most natural way and not experience any mental problem of
teaching at a distance. And yet, he is aware that not only 10 but also
several hundreds of students can see and hear him. With no full-time
students available it might be reasonable to display images of two or
three remote students on the monitor of the telemedicine unit that will
help the lecturer to avoid the mental problem of acting as a TV
For reading lectures from a distance the DiViSy TM21 telemedicine unit
has been designed. It gives the following opportunities to the lecturer
and his assistants:
Parallel two-channel video input. One of the video cameras is directed
on the board (screen) where the teacher presents texts, drawings,
formulas, etc. The other video input either displays the image of the
teacher or a general view of the room where the lecture is read or is
connected to one of the medical units: a microscope, an endoscope, an
ultrasound or x-ray unit, etc.
Audio channel between a teacher and a student and in doing so it is
possible to fade the sound out at some of the remote sites.
Text exchange between the teacher and the students. Such exchange is
good if some one wants to ask questions. The text exchange allows any
student to send his or her questions to the teacher. It is desirable
to send such questions not directly to the teacher but to one of his
assistants who could generalize the questions received and redirect
them to the teacher at the most convenient time without interrupting
the lecture or the seminar. Questions can be asked by a microphone but
only when the teacher encourage doing it.
Transmission and displaying of matters executed in the following
office programs: MS Power Point, MS Word, MS Exel, etc. In doing this
parallel displaying of images is provided in small windows on the
monitors: the teacher or the room in one of the windows, texts,
illustrations, slides, drawings, roll video films, etc. in the other
Recording of the matters required in the students' databases during
the remote instruction session.
Opportunity to involve printed, graphic, video and audio information
for preparing training materials. The unit allows to prepare (due to
non-linear editing) and to demonstrate video/audio materials, charts,
presentations, animation and a number of other video illustrations.
Interactive work of the teacher and the students with the images to be
studied on the common working-table. For example, the teacher places
on the common working-table the image of an object from the
microscope, ultrasound or x-ray unit. This image is transmitted to
each remote student. It is possible to place on the working-table not
only the images that have been prepared beforehand but also those that
are transmitted in real time from any units used during the lectures.
Thus the DiViSy TM21 telemedicine units being both at the lecturer's
site and the students' sites make the lectures as effective as possible.
The methods of conducting seminars have much in common with the methods
used in reading lectures. However, remote seminars have additional
functions due to greater interaction and larger involvement of the
students. During seminars it is reasonable if both the teacher and the
students use real medical equipment. This unique opportunity is possible
only within remote education in the MTN(Moscow telemedicine
network)information media. It should be noted that during the seminar
both the teacher and the students can stay at their hospitals and
institutions, at their workstations, and use their own equipment.
Here's the scenario for a seminar on histology.
The aim of this seminar is to study histologic specimens. To make the
remote instruction effective in this case it is required to fulfil the
three following conditions: a continuing watch over all diagnostic
moving images in real time by all participants of the seminar, a
duplex-sound exchange among all participants of the seminar, an
opportunity to make immediate record of the most important diagnostic
stages during the session, after the session an opportunity to do
individual digital editing of the (video, audio, text) records done by
the students to store and review the material. In this case the
participants of the seminar are given a full idea how to make diagnosis
and what methods are used for making histologic diagnosis. During the
seminar the teacher can ask a student or students to point out locations
with concrete signs on the image being studied. Each student can choose
a marker of any color (to point out the concrete point(s)) or a line (to
circle a fragment on the image) and send his or her results to the
teacher. And the teacher is aware that the student from hospital #1 uses
the blue color, green is the color used by the student from hospital #2,
and the student from hospital #3 marks out in red, etc. The teacher can
store this image with the marks of each student in his or her database.
If a computer-aided microscope is available, the teacher can ask any of
the students to perform testing of the histologic preparation. In this
case the student performs testing from a distance, and the teacher and
the students can see and hear the comments on what is being done.
The realization of this scenario is possible only for remote education.
The DiViSy TM21 telemedicine unit can provide all these opportunities.
Seminars on ultrasound and x-ray examinations, endoscopic diagnosis and
surgery, etc. would be conducted in much the same way.
During the seminar some medical examinations can be done by a student
under the teacher's supervision. Thus complicated examinations or
operations are carried out with direct participation of the more skilled
Practical Training and Individual Telemedical Consultation
Practical training in various methods of diagnostics, treatment and
surgery provides for a task entrusted to the student by the teacher to
be done independently at his or her equipment. In this case the teacher
and the other students can watch the whole process of examining and
operating. An important peculiarity of this process is the opportunity
for the teacher to correct the student's actions. If the student
examining or operating starts making errors the teacher can correct his
actions. The other students can watch the whole process and it will
enable them not only to avoid similar mistakes in their independent work
but if needed to be able to correct possible consequences.
In a similar manner, practical telemedical consultation would be carried
out for real patients. So-called video consultation becomes possible
where several physicians are involved in medical examination or
Telemedical consultation and remote training
The traditional system of internal education has one important
limitation that can be get over only with the help of modern computers
and communication technologies. Because of the limited sizes of
operating rooms, laboratories for diagnostics, hospital wards, etc. the
real actions of skilled and experienced physicians cannot be
simultaneously watched in all the details by several students. And
skilled physicians may have not much time for teaching because their
main duty is to treat patients. The DiViSy TM21 technologies and
equipment may currently help not only get over this limitation but also
gives a unique opportunity to the users of telemedicine video networks
to watch all actions of skilled physicians during real sessions of
diagnosing, treating or operating and thus to get trained in the most
effective way. At the same time the skilled physician being at his
working site can supervise over all actions of his student, help him or
her to avoid many mistakes. Thus a new system of training is formed, the
education is based on watching real diagnostic and treatment processes
and individual practical work under supervision of the more skilled
colleague that results in improving professional skills. And as it takes
place all physicians stay at their working sites.
All technologies and equipment for telemedicine and remote training have
been developed basing on the requirements of the traditional internal
education and adding opportunities of modern computer and communication
technologies. Thus the DiViSy TM21 technologies and equipment give
maximum opportunities to medical institutions to create corporate
systems of consultation and remote training.
Some tens or hundreds of remote lectures, seminars, practical training
or individual telemedical consultations, if conducted, may cause
evolutional reformation of the educational and health care systems that
will integrate the experience of internal education of many years'
standing and modern technologies of remote interaction between teachers
and students, consulting physicians and persons receiving consultation.
Realization of practical educational and consultation telemedicine
sessions within the Moscow telemedicine network formed on the basis of
Comcor Public Company fiber-optical communication channels and DiViSy
telemedicine terminals has shown real perspective of this trend. Please
refer to site www.divisy.ru
to find out more about telemedical consultation.
As for now, the technologies and equipment developed can provide
effective remote medical education and improvement of professional
skills in various fields of diagnostics, treatment and surgery.