A customization of Milestone XProtect® Enterprise open platform IP video management software, XProtect® Transact and XProtect® Smart Client together form the heart of MedVu, a unique video capture system for medical students at the University of St Andrews School of Medicine. With it, they can record and present their practical medical experience in the areas of Clinical and Communications Skills. Researchers at the university also use MedVu to gather evidence to support vital medical research projects.
University of St Andrews School of Medicine
The University of St Andrews School of Medicine was established at the North Haugh campus in St Andrews, Scotland in 2002. It was built to take advantage of the latest learning technology and teaching methods. The School of Medicine has over 100 staff, including academics, research, technical and secretarial employees. It offers the first three years of a seven-year medical degree to approximately 460 students.
Video system requirements
“We wanted to enable our students to build a comprehensive video portfolio proving their practical capabilities in key clinical and communications skills. Data security and ease of use were the two primary system considerations. There was also a need for students to interact with their recorded
video clips to bookmark sections of video – noting good or poor practice and areas for improvement,” states Julie Struthers, Learning Technology Consultant, St Andrews University School of Medicine. “Scalability was another key requirement for the new video capture system. For example, simultaneous recording of up to 46 clinical skills exams was required. We looked at existing systems in medical institutions around Scotland but found none that met all these requirements. MedVu had to be designed from scratch, working with Milestone and its partner, King Communications.”
Video systems integrator King Communications partnered with Audio Visual consultants Impact Marcom to submit the project tender in early 2010.
Milestone’s own professional services team was enlisted to program customizations of the video monitoring and capture system, using the Software Development Kit (SDK) for Milestone XProtect Enterprise. The system went live in August 2012.
MedVu system components
The primary focus of the integrated MedVu video system is in the Clinical Skills rooms where ‘bed head’ bays provide the equipment for students to practice skills such as venipuncture, upper limb examinations and cardiopulmonary resuscitation (CPR), by working on simulators (dummies cut off at the waist) while video recording these practical exercises for use as part of their portfolio. MedVu provides recorded evidence that the medical students are competent in a range of practical skills.
Altogether 84 cameras have been installed by King Communications throughout St Andrews University School of Medicine. Cameras are located throughout the school. In a consultation room attached to a research lab, four cameras installed over a bench view patients eating, as part of an ongoing research project into eating disorders.
To monitor the development of communication skills, two cameras are located in each of six interview rooms. These resemble doctors’ consultation rooms, where medical students practice developing rapport and investigating medical history, working with actors posing as patients with specific medical conditions.
Secure web portal based on Milestone platform
The video of the Communication Skills training exercises can be viewed on large screens in tutorial rooms nearby. Recordings are reviewed by peers and tutors, normally with the student who has just completed the exercise. The sessions can also be seen from a central technician’s room, monitoring the practical skills exams of up to 46 students being assessed at the same time.
Once the hardware was installed, King Communications designed a web portal that enabled students to view and bookmark their video clips via a secure web browser. Milestone’s professional services team created a batched export process that enabled the videos to publish to this web portal.
Security of recordings was important, so the video portal was configured for control over which video clips are shared and with whom, with the student as the originator and owner of that video. Other teachers and pupils must be authorized to view each clip by the video’s originator. Usernames and passwords further protect access to the system.
Front-end system based on Milestone XProtect Smart Client
The Milestone XProtect Smart Client interface forms the basis of the front-end system used by students at each bed head bay, controlled via touch-screen display monitors. This enables rapid and intuitive management of the video recording.
Ian Gordon, Digital Media Developer, St Andrews University says, “The level of sophistication is perhaps only made clear when evaluating equivalent systems. For example, another system we had looked into enables students to shoot videos on their own iPads, but saving, securing, recording and archiving would all be left to them. Videos could disappear if not saved properly. Devices could go missing or be broken. Video evidence could be compromised.”
Project success based on simplicity of use
The key to making the video capture system work for St Andrews University School of Medicine was having a small team focused entirely on optimizing the system to ensure that it met specific learning goals for teachers and students.
“Teachers are busy. They want to focus on teaching, not setting up technical systems. MedVu needed to be an enabler for teachers, not an irritant. So ease of use was one of the key development considerations,” says Julie Struthers. “We worked closely with King Communications to simplify the user interface at the bed head, while also making web portal access easy at the back-end. MedVu is now an integral part of the teaching of Clinical and Communications Skills.
After an initial introduction, most teachers and pupils are able to use the system without needing any additional technical support.”
She reports that students are able to practice clinical skills on dummies during weekends or evenings when no staff are around. It gives them time to practice a procedure several times, making several recordings before reviewing the clips and selecting the best one to add to their video portfolio.
HD video, audio and unique web portal
Axis 215 standard definition and Axis 5534 high definition pan-tilt-zoom (PTZ) network cameras were specified to provide high quality video images at 25 frames per second. These are integrated with external networked microphones. Speakers are positioned to relay instructions to students from the central control room. Indicator lights in the Clinical Skills bay ceilings flash red when recording is in progress.
Milestone XProtect Enterprise enables easy recording and management of the video. The XProtect video management software (VMS) integration with the university’s campus-wide Microsoft® Active Directory ensures that access is restricted to enrolled students only.
“We’ve designed and developed a unique web portal from scratch, working with Milestone’s professional services team, synchronizing with the university’s Active Directory and with its Galen Curriculum Management System database,” explains Martyn King, Managing Director of King Communications and Security Ltd. “The St Andrews University MedVu system proves that the benefits of the Milestone XProtect open platform video management system extend well beyond the traditional security applications it was originally designed for.”
Open platform allows future developments
MedVu is now being integrated even more tightly with the Galen Curriculum Management System (CMS) which stores students’ entire evidence portfolios electronically. Users of Galen CMS will log on to this single system to view their whole portfolio, including video evidence held in MedVu. The seamless integration means that they will not be aware when they are moving from Galen to MedVu.
There are also plans to enable remote scoring of Objective Structured Clinical Exams (OSCEs) by providing secure access to MedVu, so independent examiners can view the video clips. These ‘Video OSCEs’ will enable remote and objective grading of practical exams alongside others recorded at the same time.
This could create a level playing field, eliminating the inevitable differences that occur when a wide range of examiners score practical exams. It also removes management issues of organizing over 30 external examiners to stand inside each bay to score the OSCEs as they take place. There would be the added advantage of being able to pause a video when they get tired and return to it later, refreshed.
Students will also be able to create video playlists for specific review meetings, peer appraisal and showing to examiners. The Galen system has a video dashboard which provides the status of all video clips, showing at a glance whether video clips have been signed off – part of the process of building an official portfolio.
Ian Gordon adds: “MedVu has more than delivered on our expectations in terms of helping us manage and control practical tests in the Clinical Skills rooms. The Milestone-based system has proven ideal for recording sessions going on in more than 40 different bays simultaneously.”
He adds: “Surveillance systems are clearly designed to capture video from many more cameras than we use here, but the principles are the same. It is important to be able to know which recording is linked to which camera so that every video clip can be linked to a specific student in examination conditions. Milestone XProtect Enterprise makes all this easy because it is designed for complex, multi-channel video management tasks.”
The Milestone Integration Platform™ was used to develop custom forms, in addition to enabling the Milestone XProtect Transact plug-in. XProtect Transact is used to gather the video data and export it into an XML file that holds the user name, date and time of recording and any user notes describing the contents of the video clip. The XML file and the AVI-formatted video clips are then transferred to MedVu, which converts them into FLV files for viewing in Adobe FlashPlayer. Milestone’s custom-designed export batch process enables multiple exports of video clips into MedVu every 15 minutes.
The Milestone team also worked with St Andrews and King Communications to customize the XProtect Smart Client front-end user interface to make access to the system easier for students. Custom views were built with large touch screen buttons to help students easily type in their usernames and passwords before recording.
Two Milestone servers are dedicated to Clinical Skills and Communication Skills video recordings. They are load-balanced, so half of the Clinical Skills recordings sit on one server and half are on the other. The same is true for the Communications Skills video recordings. The school’s extensive research arm has a dedicated stand-alone server. Attached to that is an IBM Storage Area Network (SAN) array, providing 50 TB of storage for archived video.
Two more IBM servers running Linux® support the web portal. One of these servers is responsible for web streaming while the other encodes the video – transferring video files from AVI into the FLV compressed file format for web streaming in Flash Player, making them available to view via the secure portal. The system takes the associated XML file and loads it into an Oracle 9 database on the same server, part of the university’s Galen CMS.
SAN volumes are split, so 10 TB is dedicated to live video and 40 TB for archived recordings. Each server has a 10 TB RAID array, while the video streaming server has more capacity available. The system currently holds over 12,000 video files and over 5,000 XML metafiles. Each Milestone server has approximately 5 TB of capacity.