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Expanding the Frame – Telesimulation Essentials

A collaborative workshop at the intersection of art and medical education


Expanding the Frame is a series of education projects created in collaboration with faculty from Weill Cornell Medical College and the School of Visual Arts.

Introduction

In person simulation training is a critical part of medical education. Now, in the current socially distanced learning environment, we urgently need to develop a new set of skills that will help us translate that same experience through a digital medium. Translating what we do into the digital space presents us with numerous skill-based and technical challenges that fall outside of the traditional scope of the in-person simulation expert.

To overcome this challenge, we started working with faculty from the School of Visual Arts in NYC: collaborating at the intersection of art and medical education, and reaching across disciplines to create an enhanced telesimulation format. Our goal was to provide medical simulation experts a simple set of tools that could help them transform their in person skills into the digital space. We believe this collaboration represents a fruitful model for future opportunities to improve what we do in medical simulation by finding expertise and inspiration outside our traditional academic siloes.

We recently shared some of the results of our initial efforts at the 1st Annual International Telesimulation Conference in a workshop: teaching basic principles of lighting, audio, camera angles, point of view, choreography and scripting, and presenting participants with a new enhanced telesimulation script template that incorporates these principles into the traditional in person simulation case. This page has some of the fruits of that event, including the new telesimulation script template available for download.


Core Concept

The digital medium has rules. there is a basic cinematic “syntax” of lighting, audio, camera angles, points of view, scripting and choreography. If this syntax is not respected, a simulation designed for the in person experience may appear disorienting; making the narrative impossible to follow and obfuscating the intended learning objectives for the remote learner.


Lighting

Light plays an important role in video quality. In the hands of expert filmmakers lighting sets the mood, creates drama, and helps to convey key elements of the story.

Lighting for telesimulation does not need to be at the level of the professional cinematographer, but a basic understanding of the principles of lighting and avoidance of common lighting mistakes can ensure your learning objectives are achieved.

For telesimulation we suggest the use of natural or “practical lighting.” Practical lighting in film is the use of regular, working light sources like lamps at hand, ceiling lights, surgical lamps are all examples of practical lighting.

Prior to the telesimulation:

  • Consider the source(s) of the lighting available
  • Play with various combinations of lighting to find what works best
  • Position the scene in relation to your light sources
  • Place camera(s) to avoid glare, halo effects and other lighting problems

Audio

Clear audio is an often overlooked but essential part of telesimulation.

  • Assess the telesimulation space for background noise. Even seemingly “quiet” background brown noise can be loud in the remote learning space.
  • Consider in advance what audio inputs and microphones you are using and where they will be placed.
  • If recording via a platform like ZOOM adjust the audio presents for better quality.
  • The use of an omnidirectional microphone to capture audio in a telesimulation is a simple upgrade.

Camera Positioning

Cameras are the conduit through which your learning objectives are delivered. Even the placement of a simple static camera should have intention: it should help convey the narrative, have a point of view, and ensure that the simulation develops smoothly.

A two cameras video setup, one with a static wide angle, and a mobile camera such as the OSMO mobile with iPhone used in our demonstration, for close-ups and details can provide more effective translation of information during a telesimulation.


Choreography/Blocking

While simulations are often live events that are not always predictable, an understanding of the intended learning objectives combined with the development of a predetermined choreography or blocking of key movements and camera angles can enhance the learning objectives of the case.

  • Choreograph in advance any actors or confederate’s movements within the frame.
  • Design simulation “set” to encourage desired movement within the frame.
  • Lead in person participants to key locations with intentional placement of necessary equipment

Scripting

The enhanced tele-simulation case template is the MASTER PLAN or script. It contains all the key components of a classic in person simulation, but also includes all the audio/video equipment, camera angles, choreography, and blocking used to best capture the essential information and translate it into the digital space for remote learners.

  • Telesimulation scripts should include audio and camera equipment in addition to traditional SIM equipment used for cases.
  • Create a simple list of best shots and sketch of any camera movements.
  • Use an enhanced telesimulation script template that integrates these elements

The Enhanced Telesimulation Script Template

A good in-person simulation script has a specific style. For telesimulation we’ve adapted a basic shoot script for filmmaking and integrated it into the simulation script so you can use it to plan your next telesimulation more effectively.


Technology Hacks & Equipment We Used In Our Demonstration

  • Basic webcam attached to an IV pole
  • An omnidirectional mic
  • Osmo Mobile Gimbal for the iPhone – This device transforms your iPhone into a steadicam that compensates for shaky hands and allows for more effective camera angles
  • Remote Platform – ZOOM Highlighting use of
    • Spotlight feature
    • How control the multi-camera setup
    • Use of preset audio inputs

Before & After Video Samples

Watch this space for more information and details from the workshop on 9/23!!


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