To deliver a course of 30 high quality, live, interactive TV programmes over a period of a year to selected hospital centres, based on a modular syllabus that is complementary to the Royal College of Surgeons of England's (RCSEng) established STEP course materials;
To import live surgical video from operating theatres within the participating centres at high quality for inclusion into the TV broadcasts to all sites.
To provide interaction with trainees and local Surgical Tutors via voice, e-mail/chat and video conferencing during the live transmissions.
The potential benefit of SANTTSUR to surgeon trainees will be in providing an interactive learning environment and high quality learning materials at the workplace. It is important to these trainees and Surgical Tutors, all with busy schedules that no time is wasted travelling to a different location. Benefits of cost saving in time and benefits to the environment are also identified. The synchronization of training period across multiple hospitals will facilitate more efficient sharing of expertise from dispersed Surgical Tutors and will encourage peer interaction at each site.
Evaluation of technical performance, quality of content and trainee perception will be undertaken. Questionnaires and interviews will be used to assess trainee perception, along with feedback from the Surgical Tutor at each site and from each of the presenters. The practicalities of supporting the administration for this scale of distance learning will also be assessed.
The viability of the approach will be considered in the light of experiences and perception of trainees. In particular the developing partnership between the University of Plymouth and The Royal College of Surgeons of England will be discussed in the context of viability. As a result of this partnership it is expected to develop SANTTSUR and STEP into a new course, teleSTEP and this concept will be explored.
Live satellite TV programmes will be broadcast from the University of Plymouth TV studio via the TDS4b uplink, on loan from the European Space Agency using the following transmission parameters:
- Uplink: 14.43583 GHz X-pol
- Downlink: 11.13583 GHz Y-pol
- Symbol Rate: 3.125 MSym/sec
- FEC: 3/4
- RF Bandwidth: 4 MHz
The equipment used is the DMV System 3000 DSNG unit, consisting of the encoder, mux and modulator in a single 5U case. Video encoding standard is to MPEG-2 MP@ML (ISO/IEC 13818-2) (Inter-frame coding, IBBP)
Audio encoding is to MPEG-2 (ISO/IEC 13818-3) layer 1 or 2.
- DVB compliant concatenated FEC (Reed Solomon 204,188)
- QPSK modulation, 70 MHz IF.
- Video PID: 0 x 134
- Audio PID: 0 x 100 (mono only, ch A)
Receiver equipment is a mixture of two systems. Eight sites are already equipped with NTL/DMV/NDS System 3000 Professional IRDs, whilst the eighteen new sites will be equipped with Humax F1 Fox IRDs. The Humax receiver's specifications state:
- QPSK/Multiple convolutional coding (DVB compliant)
- Video compression MP@ML in MPEG-2
- Tuning step size: 125KHz
- Inner FEC rates: 1/2, 2/3, 3/4, 5/6, 7/8 (DVB Spec)
- Outer FEC: Reed Solomon coding RS (204,188, t=8) DVB compliant
- Input signal data rate: 2 to 30 MSym/sec
- Video meets ETR 154 amended in ALM-95-021
- Video decoding: ISO/IEC 13818-2, MP@ML
The hospitals which have agreed to participate in the proposed SANTTSUR project are listed below and shown on the map. There is a considerable infrastructure in video conferencing, PC and video equipment installed in these hospitals. For example, facilities for broadcasting live surgery at ISDN6 or better quality are available in half of the 26 sites. ISDN2 video conferencing systems, based on the Motion Media MM120c system will be installed in 10 of the 26 sites.
Proposed Hospital Training Centres Locations
Royal Free and University College Hospital
|John Radcliffe Hospital||Oxford|
|St Mary's Hospital||London|
|University of Wales||Cardiff|
|Royal Hospitals, Belfast||Belfast|
|University of Manchester||Manchester|
|St George's Hospital||London|
|Taunton & Somerset Hospital||Taunton|
|Yeovil District Hospital||Yeovil|
|Royal Liverpool Hospitals||Liverpool|
|North Devon District Hospital||Barnstaple|
|Joyce Green Hospital||Dartford|
|Royal Surrey County Hospital||Guildford|
|Colchester General Hospital||Colchester|
|Leeds General Infirmary||Leeds|
|Sunderland Royal Hospital||Sunderland|
|Truro Cork University Hospital||Cork|
|Gloucester Royal Hospital||Gloucester|
|Aberdeen Royal Infirmary||Aberdeen|
|Mater Misericordiae Hospital||Dublin|
|Newcastle General Infirmary||Newcastle|
|North Tees General Hospital||Stockton-on Tees|
In the period following the BDR meeting on 24 August up to the date of the first weekly transmission, scheduled for 6 October 2000 several activities will take place:
- installation of equipment;
- production of a training video on use of equipment;
- "training the presenters" course.
Course delivery is in three sets of 10 lectures, transmitted weekly on Fridays, starting at 12.00 noon. During each 90 minute transmission there will be a mixture of formal presentations, studio discussion, live ISDN6 video feeds from teaching hospitals and trainee question/answer sessions via ISDN2, telephone or on-line chat. The centres will, in turn, provide additional input, for example a "case of the week" for discussion. It is expected that 15 live surgery sessions will be included within the 30 transmissions in the proposal.
The Final Review was completed successfully at the University of Plymouth on 16 and 17 April 2002.
Lessons Learned from SANTTSUR
The main success of SANTTSUR has been in the use of MPEG2 satellite as the key delivery platform. This has proved to be the most reliable platform employed in SANTTSUR. In the early stages of the application for the contract there were doubts about whether other satellite technologies were more appropriate and whether the expected implementation of high bandwidth terrestrial networks, such as ADSL would make satellite delivery redundant. In the three years of this gestation period, these alternatives have simply not happened. The decision to go with the quality, maturity and reliability of MPEG2 transmissions has been vindicated. In a period where expectations were for an enormous change in availability of terrestrial high bandwidth networks in the UK, little has happened. Equally, any suggestions of integration of NHSNET with high bandwidth educational networks is still a remote possibility.
The SANTTSUR Approach
One of the most important successes in SANTTSUR was the Training the Presenters course, with accompanying template. This has ensured a level of consistency and quality in the content delivered that was essential for the viability of the project. The confidence instilled into the SANTTSUR presenters has also enabled the development of a wider "anchorman" pool, due to the confidence of the individuals involved.
The approach has also highlighted some areas which were successful and some which were not so successful. Video conferencing was shown to be effective at ISDN6 quality for importing content but not so good when ISDN2 was used for asking questions. The culture of the trainees has been better understood and the popularity of the text messaging mode for interaction has been clearly demonstrated. As text messaging appears to be the preferred, convenient, cost-effective means for interaction, this technology will be explored further in terms of developing mobile technologies.
The generic nature of the course delivery method and course content had been demonstrated in terms of adoption by several Colleges of Surgery, not just exclusively to one.
The Strategic Plan
The original plan has proved to be effective for the transition from SANTTSUR to mrcsTV. The idea of linking dissemination with sponsorship, expansion of sites and transfer to new areas of activity has been very effective. This integrated approach will continue on all fronts.
A key issue to be addressed is in the management and administration of the distance training course delivery. As the number of sites increases it will become even more important to ensure that contacts with key staff at the receive sites is efficient and effective. It is important to continue to encourage feedback from trainees on the transmissions.
From SANTTSUR to mrcsTV and Beyond:
An Ongoing Development and Implementation Strategy This section outlines the developments and changes following the SANTTSUR funding period,.
There are specific examples of developments in the process of moving from SANTTSUR to mrcsTV that contribute to ensuring sustainability of mrcsTV into the future. One such example is the development of the presentation template. Working from the original SANTTSUR design, a new design was implemented in the transfer to mrcsTV. Apart from stamping a "new image" to show that the research project had matured into a viable entity, this was a move towards a design that was better laid out, more practical & flexible and clearer for the viewer to see (Figures 1 and 2).
|Figure 1. Example live presentation layout used in SANTTSUR
|Figure 2. Example live presentation layout used in mrcsTV.
Although this development may appear to be trivial or cosmetic, the impact of the improved presentation style was key component in the transition from research project to viable entity and was important in establishing a "brand".
Again, the introduction of a brand is important.
The most important feature of the ongoing development is the consistent approach adopted in implementing the Strategic Plan. This Strategic Plan will continue to form the basis for all further developments.