A STUDY OF 'I'ELEVISION AS A (CHANNEL FOR THE
COMMUNICATION OF CONTINIJIATION EDUCATION
TO THE PRACTICING PHYSICIAN

Thesis Ia: the Dag!“ of M. A.
MICHIGAN STATE UNIVERSITY
Jack ByreI Frank
I96?

IIIHIHLIIZIIIIQIIQIIHI mum “II“ I "II III

 

ABSTRACT

A STUDY OF TELEVISION AS A CHANNEL FOR THE
COMMUNICATION OF CONTINUATION EDUCATION
TO THE PRACTICING PHYSICIAN

by Jack 9. frank

Traditional medical Communication.——Readin¢, gersonal

 

contaCts, professional meetinbs ano intra—mural postarnuuate
courses haVe been the major activities through which phy-
sicians have acquired new medical knowledge. Ihile mecical
knowlecge was relatively limited and the yngsician's none of
practice single, these techniques were Meyerently satisfacto—
ry. however, the factors affecting meeical gractice nave
chanceo. Arthur S. Elenming, former secretary of health, ecu-
cation and Jelfare, has "...emghasizes that the greatest weak—

ness in the fields of mecical care and greventstive Meeicine

lies in the provision for continuin; the eoucntion of practic—
ing physicians End staoec the neeo for an action program to
transnit scientific developments rapidly to the practicing
guysicisn."l

The Problem tneer Stucy.——Thus, a question is raise;

 

as to the effectiveness of the traditional forms of ICLICRI
communication. If these forms were adequate, woulo the
problem of continuing the neeicsl eeucation of gracticinb
physicians be as great? It was the purpose of this research

to exenine the means throw n which the uracticint 2n“sicinn
K4 ‘ L i e}

)

acquires new inowleege and to eeternine how the newest HCClun
of communication, television, can te usie to facilitete this
process.

Sources Usec.——The major sources utilizee for this

 

study were articles in trofessional neeical Journals, reports
of the Council on medical felevision, proceedings of con—
nittees and special reports of the American necical Associ-
ation, anc personal communications.

Findin;s.--The grofessional orientation of the phy-
sician has changed. where fifty years 393 the critical eun—
cational and research processes were foune in practice, touay
the physician must base nis gractice on concepts underboinb
steacy chance at the hence of aggressive researchers. Still,
to find the information so essential to effective practice,
the contemporary physician must resort to virtually the same
media of communication that were used in earlier periods.

Attemets to modify the traditional means of neuical
communication have not fFOViCCL a solution, but have further
complicated the problem. In the Opinion of some physicians,
activities such as hOSpital and medical society meetings are
ineffective as sources of information. The potential of the
postgraduate course, a most significant means for furthering
the physician's knowledge, is affected by geographical factors
often its location makes it better suited to the needs of the
instructor than to those of the physician—student.

[1‘ fl

ihe nos serious evicence of the ineffectiveness c1

presently employed media of medical communication, is foune
in the Opportunity that exists for sources outside of the
medical profession to provide essential information to the
profession. Much of the physician's information about new
drugs is provided by the manufacturers of those drups.

The need exists for physicians to have convenient
access.to essential new medical information. The provision
for such access should be physician oriented; it should have
the validity that can only be afforded by sources within the
profession. dducationally, it should have proven merit as an
effective means of instruction, and it should possess the
ability to transmit new information rapidly.

When considered as a channel for medical communi—
cation, television possesses all of the attributes of an ef—
fective means for the practicing physician to acquire new
accical knowledge. With consideration given to its liabili-
ties, still there is no other convenient means available that
can brinp into focus the knowledge to be communicated, the
means of communication, and the needs of the physician, with
the clarity that television can do so. It is apparent that
medical communication must be reoriented to fit the life of
the contemporary physician; television provides an effective

and Comprehensive neans for facilitating the reorientation.

 

 

ldouncil on hesical Television, deport of the first
NBStIUE (Jew York: Institute for Advancement of neeical Coa—

A STUDY OF TELEVISION AS A CHANNEL FOR THE
COMMUNICATION OF CONTINUATION EDUCATION
TO THE PRACTICING PHYSICIAN

By

Jack Byrel Frank

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS
Department of Television and Radio

1961

i )

I . ‘ K C. ‘
/I\ (- SIC /3 (4t 3365.-.: [L'l‘\ {3-1, I) ‘('\,\-\.\C A} g

U‘ 0"} 0 4'1-

9/3/04

To my parents
Albert Frank
LilCTCd To her Frank
to ackiowledge in some small
measure the dedication the
have shown to their children.

IimFAQd

This study is an attempt to examine some aSpects of
medical conmunication. Essentially, it is an attempt to de—
termine new the practicing physician acquires new knowledge
and how the newest medium of communication, television, can
be used to facilitate the process of acquisition. The study
evaluates the effectiveness of the traditional forms of medi-
cal communication and formal postgraduate medical education,
in terms of the needs of the contemporary physician. It con-
siders the inadequacies of the channels presently used for
medical communication, and suggests some dimensions for an
effective system of medical communication. Against a back-
ground of the applications that have been made of television
to medical communication, the medium is considered as a
channel in relationship to the other elements: the source,
the message, and the receiver, in a process of communication.
Finally, an attempt is made to reconcile the communicativecm»
mands of a dynamic medical science with the advantafies of
modern c0mmunication, so as to determine the role of tele-
vision in medical communication.

To gain some measure of insight into an aspect of a
profession, when one is not a member of it, necessitates more
than researching the literature of the profession. It calls
for the assistance of the profession itself. The members of
the medical profession have been most helpful during the
preparation of this study. I am eSpecially grateful to the
Council on Medical Television, Institute for Advancement of
Medical Communication, and its executive secretary, hr. John

R. mackenzie, for making available much pertinent infor-

mation; to Dr. C. H. William nuhe and the Council on Medical
Education and HOSpitals, American Medical Association, as
well as to other divisions of the Association, for providing
valuable resource materials; to Dr. David S. dune, University
of Kansas Medical Center, for his valued correspondence and
assistance not only in providing information, but also in
pointing out areas of inquiry; and to Commander Edward w.
Bird, National Naval Medical Center, Bethesda, Maryland, for

making available his Medical-Dental TV Reference. The ac-

 

knowledgment of a special debt is made to Dr. Douglas D. Vol—
lan, whose comprehensive study of postgraduate medical edu-
cation provided much valuable information for the initial
sections of this study.

To Mr. John Price, Department of Speech, Rhode Island
University, acknowledgement is made for a suggestion that the
writer combine two interests, medicine and television; the
combination has found eXpression in this study.

Professor Walter B. Emery, College of Communication
Arts, hichigan State University, has provided invaluable as-
sistance and guidance during the preparation of the mammcmpt.
his attitude toward scholarly research, tangibly demonstrated

in his own writing, has been a source of inspiration.

-iii—

I‘HY

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The Liacitignal Channels of medical Communi—
cation

The hature of the messape in ledical Co muni-
Cation

Communicative Techniques Utilized for the
Instruction of the Practicing Piysician

The Coaxunicators of Medical knowledbe

lhe Arrangement of Postyraduate Courses

The Sponsorship and financing of Postgraduate
hedical nducation

II. ‘HE E ICIICIHU I YSICIAK: dSCmIVfim CF MLJICAL
COI'II-IUialQ-IIIC AIxI) DIS'I'JLIpIIJAII'I‘ CI‘1 I511". nAIbrii‘J
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The Iracticina Ihysician as a Student
beterrents to Physician Participation in host-
5ra€uate Froprams

III. THC MEAD FLH A Lfifi oflAIIhh Cr‘ LSDISAL COEHUAI-

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The The adequaci::s of Tracitional Channels of
Medical Communication

The Serious Consequences of Ineffective Medi-
cal Communication

Tne Characteristics of an Effective System
of hecical Communication

1V. TLLSVI S CS: SICIIFICA”TI&IILIC1TIUIS TO InulCAL
GUI: tnlCAllOn.................................

The evolution of hegicalx "‘eievis=ion
The heCical Television perience

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Introduction: A Channel Concept of Television
A Consiteration of the Source in heCiCEl Com—
municatiin
iscciver nelnteo anmmxhxretions in medical
Communication
VI. TdeVlSth AS A ChAhLmL IA The PdUCdSS OF unal-
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Television in Lcdical COmmuhication: A
Consideration
The Television medium
VII. Tad nCLs OF TanVISlCJ I: LCDICAL CCthgICATlOn. 108
The heed for an effective medium of hedical
Communication

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I.~¢TnUJUUTICN

Grant me strength, time and opportunity to cor-
rect what I have acquired, always to extend its
domain; for knowledge is immense and the spirit
of man can extend infinitely to enrich itself
daily with new requirements. Today he can dis—
cover nis errors of yesterday and tomorrow he
may obtain a new light on what he thinks himself
sure of today. Oh God, Thou has appointed me to
watch over the life and death of thy creatures;
here I am ready for my vocation.

Cath and Prayer of Maimonides
12th Century Physician

The Indications of a Problem
in Medical Communication

To open his address to the Council on Medical Tele-
vision, at its second meeting held at the National Institute
of health in April of 196J, Ciltert Seldes chose the follow-
ing quotation: "If you cannot, in the long run, let everyone
know what you have been doing, what you have been doing is
worthless." With these words from Erwin Schroedinger, Nobel
Laureate in fhysics, Hr. Seldes expressed the need that ex—
ists "...for communicating the implications of highly Speci-
alized knowledge to a wider spectrum of both the scientific
community and the general public."1

Mr. Seldes pointed out that advances in technology, re-
markable as they have been, have produced isolated
intellectual fraternities which by choice, or for lack
of prOper outlets, confine their exchange of information
to those within the same group. he emphasized the great

 

1Council on medical Television hewsletter (new York,
i‘iay, 1900), p. 30 .

-1-

need for wider diffusion, not of all the technical intri-
cacies of Specialized knowledge, but of a broad under-
standing of dynamic research fields that can be used by
those less specialized for deveIOping concepts and
values.

Speaking to the Council at its meeting in October of
1960, Arthur S. Flemming then Secretary of Health, education
and Welfare, "...emphasized that the greatest weakness in the
fields of medical care and preventative medicine lies in the
provisions for continuing the education of practicing phy-
sicians and expressed the hOpe that Ehe discussions of the
Council 'will result in an action program to transmit scien-
tific deveIOpments rapidly to the practicing physician."2

Mr. Seldes has expressed both the reason why scien-
tific communication must occur and the reSponsibility that is
incumbent upon those engaged in scientific pursuits to com-
municate the results of their efforts. Secretary Elemming
has indicated the implications that effective communication
of scientific, i.e. medical knowledge, have to the practi-
cing physician, and through him to the general public.

However, there is more of significance in what both
hr. Seldes and Mr. Flemming have said. There is the strong
suggestion that a problem in communication exists--one which
has seriously affected medical practice. Justification for
such an assumption is found in Mr. Flemming's statement that:
"...the greatest weakness in the fields of medical care and
preventive medicine lies in the provision for continuing the
education of practicing physicians..." The question that
follows is: if the present means for medical communication
were adequate, would the problem of continuing the medical

education of practicing physicians be as great?

 

lIbid.

 

2Council on Medical Television, Report of the First
Meetinh (New York: Institute for Advancement of Medical Com-
munication, 1960), p. l.

 

-3-

The consideration of this question renders suSpect
the effectiveness of channels traditionally used for medical
communication. If once effective, have they been made inef—
fective by the changed circumstances under which medical com-
munication must now occur? It is possible that a number of
variables have functioned in the medical communication pnxmss
to work against its effectiveness. What has been the effect
of a change in the relationship of the practicing physician
to nis sources of information; of the rapid and extensive
increase in medical knowledge; of the change in the mode of
practice of the physician?

If the traditional channels of medical communication
are indeed found to be ineffective, the need arises to find
new and effective ones. The potential of a new medium of
communication for medical applications was recognized almost
with the first practical demonstration of television. "The
use of black and white television in teaching medicine and
surgery was recognized as a possibility before World War II,
but the first formal program...was not presented until the
winter of 1947...at the Johns Hopkins hospital..."1 In the
ensuing years television has found utilization in a variety

of medical applications.

 

1K.A. Elsom and G.F. Roll, "Color Television as a
hew medical Teaching Aid: Report of Two and One-half Years
sxperience," American Medical Association Journal, 147 (De-
cember 15, 1951, p. 1550.

CHAPTER I

now The PHACTICING PHYSICIAN
ACQUIRES new kMOWLEDCE

The Traditional Channels of
Medical Communication

The physician's communicative activities.--In pahaps
the most complete study that has been done in this area, Dr.
Douglas D. Vollan found that there are five general types of
activity which serve communicative functions for the pnnfiic-
ing physician and enable him to continue his education.1 The
activities include:

(1) reading of medical books, monographs, periodicals,
and the abundant literature that every physician re-
ceives from pharmaceutical firms; (2) individual pro-
fessional contacts between the physician and his
colleagues, consultants, pharmacists, and the repre-
sentatives of pharmaceutical firms; (3) attendance at
hospital meetings, such as staff meetings, clinico-
pathological and radiological conferences, and journal
club meetings; (4) attendance at national, state, and
local general or special medical society meetings; and

 

lDouglas D. Vollan, Postgraduate Medical Education In
the United States, A Report of the Survey of Postgraduate
Medical Education carried out by the Council on Medical Edu-
cation and Hospitals of the American Medical Association,
1952-1955, (Chicago: American Medical Association, 1955).
Dr. Vollan's survey of postgraduate medical education, done
for the Council on Medical Education and Hospitals, encaqmms-
ed 10 monflmsin the field observing postgraduate education in
the United States, attendance at portions of some fifty
courses, and interviews with 481 individuals at 222 insti-
tutions and organizations offering postgraduate instruction.
In addition, questionnaires supplemented the information re-
ceived from 159 of these institutions and organizations, and
physician opinion was based on 4923 physician replys.

 

.4-

-5-
(5) attendance at formal postgraduate courses.1
Other activities which contribute directly or indirectly to
the physicians continuing education would include: research,
individual study of patients, teaching, preparation of medi-
cal articles, and informal visits to distant medical schools
and centers.2

Medica Reading.--On the average, physicians devote
some four hours per week to medical reading.3 In as much as
this figure represents one—third of the time available for
such activity,4 reading becomes a significant way in which
physicians continue their education.

Every conscientious physician maintains a library of
basic medical works for ready reference, which are
supplemented by new monographs and texts or by the use
of the library. To this must be added an estimated
5,000 medical journals published throughout the world
on which he may draw... End) the great quantity of
advertising material he regeives in the mail each day
from pharmaceutical firms.

Reading was considered by the respondents in the Vollan study
(to which reference was made above) "...to be the most ef-
fective method of continuing their education, and if time
permitted, they would almost double the number of hours spent
in this activity."6

For centuries, the journal has been used as an im-

 

libid., p. 15. 21bid.

3Vollan states (p. 15): "The approximately 5,000 phy-
sicians responding to the questionnaire administered in con-
nection with this survey reported an average of 667 hours...
devoted to all five of the above Eommunicativa activities
in the aggregate. This would represent about 22% of the
average American physician's total professional activity.
Thirteen hours per week is 21.7% of 60 hours per week, which
was shown to be the average work week of physicians by Rusk
and coworkers..." Since Dr. Vollan states (p. 16) that "a
third of the time reported by the reSponding physicians was
devoted to medical reading," the equivalent in hours would be
4.3 hours per week that the average reSponding physician in
the Vollan study devoted to medical readinn.

4Vollan, p. 16. 51bid. 6Ibid., pp. 16-17.

-0-
portant medium for written medical communication. Tracing
its origins to the proceedings of the great scientific socie-
ties of the 18th Century, the journal was the successor to
the books or monographs that had been published privately by
post—Renaissance scholars who desired to eXpose their work to
their colleagues.1
The medical journal in its modern form, however, was

not introduced until the 19th Century, when such journals as:
The Edinburg Medical and;§urgical Journal (January 1, 1805);
The Lancet (October 5, 1825); The American Journal of Medical

Sciences (1827): and The Journal of the American Medical As-

 

sociation (July 14, 1883); were first published.2 Now print—

 

ing some 100,000 articles annually, the 5000 journals publish—
ed in the world (600 in the United States alone) provide the

medium for much of the new medical information to reach the

3

practicing physician.

Professional Contacts.-—Of equal importance to read-
ing as a means for acquiring new medical knowledge, in terms
of time devoted to the activity, is the professional contacts
that the physician has with his colleagues and others.4

The bedside consultation with a specialist is probably
one of the most effective educative situations to which
the practicing physician is exposed, especially when
time permits the job to be done thoroughly. Informal
discussions with colleagues in hospital cloakrooms and
corridors and with the corner druggist also add to his
daily education....'The detail man has more to say about
the practice of medicine today than anyone in the

 

1Arthur L. Bloomfield, "The Problem of Keeping Up
with hedical Literature," Annual Review of hedicine, 6:xi
(Standford, Calif.: Annual Reviews, Inc., 1955), p. xi.

21bid.

3Charles D. May, "Selling Drugs by 'Educating' Phy—
sicians," The Journal of Medical Education, 56:1 (February,
1961), p. 12. *

4Vollan, p. 17.

-7-

country'1 The representatives of pharmaceutical firms
enjoy an ideal pedagogical situation in their interviews
with physicians. The influence of such meetings, which
is heavily commercial, is considerable, although their
content is generally confined to drugs.

In terms of educational effectiveness, physicians in the Vol-
lan study rated professional contacts third, after reading
and postgraduate courses, and expressed only a slight desire
to increase the time Spent in this type of activity.3

Hospital Meetings.--Hospital staff meetings and
conferences account for about one-fourth of the time pmwflchnm
devote to continuing education.4 "Regular staff meetings at
which attendance is required for hospital accreditation ac-
count for most of this time..."5 Responding physicians in
the Vollan study rated the effectiveness of these activities
fourth and indicated the desire to spend less time at them.6

Medical Society heetings.--Attendance at county,
state, and national association meetings, along with special-
ty society meetings account for only about five per cent of
the time spent in continuing education.7

[Ehilg ...such meetings give physicians an opportunity
to rub elbows with leaders of medicine and to discuss
social and economic aspects of practice, physicians
rated these meetings lowest on the educational scale
and eXpressed their desire of cutting the amount of
time spent at them in half.8

_ Postgraduate Courses.--About five per cent of the
time devoted to all five activities was Spent in attendance.
at formal postgraduate courses.9 The Vollan study reports
the probable average mean number of days physicians attend

postgraduate courses at 5.26 days per year (for the 4,925

 

lVollan, p. 17, quoting: W.A. O'Brien, "The Develop-
ment of Continuation Medical Education," in Trends in Medical
Education, edited by M. Ashford (New York: The Commonwealth
Fund, 1949), p. 220.

2VOllan, p. 17. 31bid. 41bid. 51bid.
61bid., p. 18. 71bid. 81 91bid.

 

 

 

 

bid.

 

 

 

-8—
respondents in the study , with an average attendance being

1 In terms of im-

three courses over a five year period.
portance as an effective method of continuing education, post-
graduate courses were placed second only to reading. Respon-
ding physicians desired to increase the time devoted to this
activity over 200 per cent.2

Postgraduate courses can offer training with
definite objectives, designed for the specific needs of
physicians covering a limited field in an organized
manner, with the use of participative methocs as well
as lectures, and can be arranged to suit the time and
situational requirements of practicing physicians.

lostpraduate medical education functions to provide
continuing education for the practicing physician.

The early years of school and h08pital training provide

a basis for understanding human biology as well as dis-
ease and the ways in which it can be altered or prevented.
It is the purpose of postgraduate medical education to
keep this basic learning fresh in the minds of physicians,
to add new deveIOpments in medical science to their arma-
mentarium, and to enlarge their knowledge in their spe-
cific fields of interest.

In addition to increasing the physician's knowledge,
postgraduate medical education has other objectives. It
should serve as a stimulus for further study and even research.
It should result in enhanced confidence in his professional
relationships so that the medical care he gives is improved.
It fosters mutually advantageous relationships between the
medical school and the physician. The physician receives in-
formation from the school, while the school maintains its
contacts with the demands of actual practice through the phy-
sician. Professional bonds too, are developed between phy-
sicians who became fellow students during their postgraduate
courses.5

The Vollan study divided postgraduate courses into

two basic types: the true refresher course, and the special

 

llbid. 21bid. 3Ibid., p. 10. 41bid. 51bid.

 

 

 

 

 

-9-
course. The refresher course is "...designed to review basic

medical knowledge and acquaint the physician with recent de—

"l

veIOpuents..., while the special course is "...designed to

expand the physician's understanding of one narrow field or

aspect of his own area of practice...."2

A complete refresher program should cover the
preventive, diagnostic, and therapeutic aspects of
medical practice, either in a single over—all program
or in separate units. Both the contraindications for
the use of new diagnostic methods and laboratory pro-
cedures should be emphasized. Similar careful con-
siderations should be given to therapeutic aSpects,
since the injudicious or premature use of some new
therapeutic products or methods that are brought to the
physician's attention through advertising or other medi-
ums i3 can best be avoided by clear presentation of
the facts in an organized manner.

Special postgraduate courses, "...designed to eXpand
or enlarge the physician's knowledge and understanding of one
particular field or subject in medicine,"4 are usually idaud—
fied by "...the name of a specialty such as surgery or a sub-
ject such as carcinoma of the alimentary system."5

A physician may take special courses for a number of
reasons. Probably the most important arises from the
recognition that his practice has become heavily weufimed
in one particular field, such as traumatic surgery if

he is in an industrial area or geriatric problems if he
is in a region that attracts retired persons. Others
may wish to acquire knowledge in entirely new fields of
medicine that are not yet considered specialties but
that may require protracted periods of study....Still
others take gpecial courses to satisfy their intellectu-
al curosity. .

Vollan concludes that postgraduate education must be
the result of long-term planning by the sponsoring insti-
tution so that an integrated program covering all the subject
needs of the physician will be covered in a definite period

of time. Such scheduling would allow for physicians to ar-

 

H

 

 

 

Ibid., p. 55. 21bid. 31bid., p. 58.
41bid., p. 64. 51bid. 61bid., p. 66.

 

 

 

I‘ll It! v.11. (III.

-10-
range their own schedules to permit attendance at postgradu-

ate courses in a comprehensive sequence.1

The Nature of the Message in
Medical Communication

The levels of medical knowledge.--In his study Vol-
lan makes the following classification of new medical
knowledge:

(l)knowledge that is of practical everyday use in medi—
cal practice, (2)information about the new diagnostic
and therapeutic services available through specialists
in the region, (3)similar services available only at
large medical centers, (4)1nformation concerning exgaip
mental clinical advances not yet in common use, and (5)
theoretical advances in basic medical science that may
not have immediate practical application.

The innumerable new developments each year described in the
huge volume of medical literature, fall into one or another
of these categories,3 and so constitute the essence of medi—
cal communication.

In terms of significance to the receiver of medical
communication, the first level of practical information is
essential to both the general practitioner and the Specialist
with apprOpriate variation in specific content. As message
content it is essential to every adequate refresher course.
Because his resources must include the services of nearby
Specialists, the second level of knowledge is of special im-
portance to the general practitioner. "Although he does not
need to know the details of new specialist techniques, he
should know their rationale, indications and what is to be
expected of them."4

Again, the general practitioner finds the third level
important because it pertains to the special services avaihw-
ble only at large medical centers; while the specialist must

know the use and location of the new diagnostic and thera-

 

11bid., p. 72. 21bid., p. 58. 31bid. 41bid.

 

 

-11-
peutic facilities that may be too expensive or too compli—
cated for use outside large medical centers.1 The strictly
experimental advances in clinical medicine under development
in large medical centers, constitutes the fourth level and is
of interest to both the general practitioner, who need not be
fully informed on these develOpments, and the specialist.2

The fifth level includes those strictly theoretical
advances in the knowledge of human biology and basic
medical science that aid in the understanding of the
human being but that may not have immediate clinical
significance. When these advances are fundamental to
an understanding of basic medical science they should
be incorporated into all refresher programs, for gener—
al practitioners as well as specialists. The chief
value of this type of material is intellectual stimu-
lation.

Communicative Techniques Utilized for the
Instruction of the Practicing Physician

The physician as a postgraduate student.--The practic-

 

ing physician as a postgraduate student differs considerably
from the undergraduate medical student.

The physician who becomes a postgraduate student has a
number of characteristics that tend to raise Special
educational problems. The lack of specific extrinsic
rewards for the physician—student requires that the
methods used be such as to demand and maintain his inter-
est. The lack of sustained contact between student and
instructor over a long period minimizes the benefits of
continuity enjoyed in other phases of education. On the
other hand, the practicing physician can readily relate
new factual knowledge to his own practical needs, which
tends to increase the value of didactic presentations.4

Postgraduate teaching techniques.--For the purposes
of reference it was found convenient in the Vollan study to
divide postgraduate educational methods into two broad cate-
gories. Because the first involves learning by eXperience,
it has been designated as being "participative" learning.

The second which refers to learning through lectures and

 

llbid., p. 63. 21bid. 31bid. 41bid., p. 73.

 

 

 

-12-
demonstrations by teachers, with the student taking a more
more passive role, is known as "didactic" learning.l Di-
dactic techniques allow for the communication of much factual
information through lectures and demonstrations, but do not
develop judgement and perfect technical skills to the degree
possible with participative techniques.2

Participative methodS.--As the mainstay of under—

 

graduate and graduate teaching in modern medical education,
participative learning has been advocated whenever postgradu-
ate medical education has been studied.3 "Participative
methods can be classified as those in which learning results
from the physical and mental manipulation of things, people,
or ideas."4

Laboratory work.—-The laboratory experiment is an
example of participative learning by the manipulation of
things. In the study of science, it is of special value when
basic principles and scientific attitudes are being establish-
ed.5 "hasic sciences such as anatomy and microbiology have
long been taught as laboratory courses on the postgraduate
.level. More recently subjects such as clinical pathology,
Iwadioisotope techniques, and electrolyte balance have used
triis technique."6

Clinical work.--New knowledge and clinical judgement

air‘e gained from carefully supervised individual clinical aa%»
7

VVC)Ik; the perfection of technical skills is also aided.

Such experiences are of value to physicians seeking
postgraduate medical education because they can offer
Opportunities for learning sensory skills, such as
diagnostic procedures, as well as the motor skills in-
volved in operative techniques and other therapeutic
measures. Such work must be limited to individual or
small group teaching and is not generally practicable
in larger postgraduate classes.

The seminar.——Often considered by many medical edu-

 

 

 

 

llbid. 21bid. 31bid., p. 74. 41bid.
5Ibid. 61bid. 71bid. 81bid.

 

 

 

-13-
cators to be the most effective forn of postgraduate edu-
cation involves the manipulation of facts and ideas in a

1 "To be of greatest value, seminars

thoubhtful discussion.
must be restricted to small groups. Eight to ten individuals
with an 'instructor' whose purpose it is to lead the dis—

cussion and bring out the thoughts of the participants constr-
tute an effective seminar group...."2

Didactic methods.--Practical considerations often

 

limit the use of participative methods, and make the use of
didactic methods necessary.

Eidactfa methods are of two basic types: direct
teaching in which the instructor and students are pmfifint
tobether, as is the case in lecture, panel, demonstrations,
and clinics; and indirect teaching through exhibits, re-
cordings, radio, motion pictures, and television, which
bring teachers and students together through some inter-
vening medium. The direct type has the advantage of per-
mitting at least some two—way contact. Indirect methods
make it possible for both teachers and students to remain
in their own areas, thereby saving the time that might
otherwise be lost in traveling.

Lectures and panels.—-The lecture, as a form of di-
rect teaching, can be utilized for the presentation of large
mount of information in predipested form; the presentation

of new, unpublished material; or to introduce, orient, or
sun arize a general subject.4 "The greatest value of the
lecture, however, is probably as an inspirational device
through which the leaders of medicine can be brought directly
into contact with practicinb ph;sicians."5
"The panel method is useful in presenting different
points of view on a subgect, eSpecially when the panel is
limited to a rather narrow subject."6
Demonstrations.—-Utilizing both the visual and the

auditory senses, the demonstration is a more advanced form of

 

llbid., p. 76. 21bi'

41bido, Era 77-78.

04
I
‘
”3
I

 

 

 

\fl

 

 

-14-
didactic presentation than the lecture or the panel.1

A...useful fo m of demonstration is the clinic
in which the patient is presented with all of the diag-
nostic material pertinent to his case....The well pre-
pared clinic, directed toward the needs of the phy-
sicians in the group, is a valuable method of post-
graduate medical education. The clinical-pathological
conference, is well established in undergraduate and
graduate medical education but has not been used ex—
tensively in postgraduate teaching. Ward walks, grand
rounds, or departmental rounds have been used in a
number of postgraduate programs in recent years. In
some instances bedside teaching has developed because
a small attendance at a lecture course made it possible
to go on the wards. Observation of surgical techniques
or other therapeutic procedures were at one time widely
employed in postgraduate courses, but in recent years
this type of observation has been eliminated from most
postgraduate programs by the development of organized
graduate training.

Responding physicians in the Vollan study rated damzk
strations second in importance as the most valuable teaching

zaethod.9

Indirect didactic methods.--"Indirect didactic meUufls

 

include these forms of education that use some intervening
medium to transmit instruction from teacher to student at
some distance.4
nadio, telephone, and recordings.--Sharing the value
of ease of reception because the physician may use them at
his leisure, radio, telephone, and recorded postgraduate pro-
grams have all been used with varying degrees of success.5
"The greatest single value of radio in postgraduate medical
education is its timeliness in presenting new factual matenmd

b The utilization of telephone fa-

and urgent medical news."
cilities for the transmission of medical programs makes con-
fined reception possible. Additionally, telephone trans—

mission allows for the provision of two way communication and

 

11bid. 21bid., p. so. 31bid.
41bid., p. so. 51bid., p. 81. 61b1d.

 

 

 

-15-
the presentation of panels composed of a number of members—-
each possibly in a different city-—by a conference call hook—
up. decordings allow complete flexibility of presentation,
thus enabling the physician to listen when and as often as he
desires to a program. 'hlthough recordings can offer the same
kind of educational values as are found in reading, they do
constitute a change of pace for the busy physician and can be
a.well-reviewed and condensed source of new medical bundedgde

Filmstrips and motion pictures.—-Sound film strips,
sound motion pictures, and television are indirect didactic
methods that combine both auditory and visual stimuli, with
the well adxmmd benefit that accrues from a presentation made
to more than one of the senses simultaneously. "Postgraduate
kits containing records, a set of color slides, and a viewer
have been developed, as have tape recordings with integrated
filmstrips. These make available to physicians in remote
eareas courses of study that can be used in office or home as
time permits."3 "Sound motion pictures have become imneasflgr
ly popular in recent years, particularly as a method of tamfls
ing skilled techniques and in demonstrating phenomena of
motion not readily shown otherwise."4

Television.--"Television has all of the values in-
herent in any form of didactic learning, with the exception
of personal contact with the instructor. It adds active and
timely visual stimuli to the values of radio."5

Ancillary techniques.--Postgraduate courses can
often be enriched by the use of a number of ancillary
educational techniques, including blackboards, black-
light writing, charts, models, slides, opaque pro-
jectors, micrOprojections, recordings of heart and

 

llbid. 21bid., p. 82. 3Ibid., p. 83.

4Vollan, p. 83 quoting: R.P. Watson, "The Current
Status of Films in Medical Teaching," Southern Medical
Journal, 43:90} (October, 1950).

5Vollan, p. 83.

 

 

-15-

sounds, electron-cardioscopes, motion pictures, short
films, film clips, exhibits, and television.

Other ancillary techniques that have been used in—
clude: systematic home study assignments in conjunction with
a course; a course syllabus with examination questions, in
some instances; reading guides and bibliographies; and case

histories.2

The Communicators of medical Knowledge

Postgraduate teachers.--Postgraduate teachers "u.vary
from the colorful, dynamic speaker at a large lecture program
to the quiet, unobtrusive 'brain—picker' conducting a small
seminar."3 The majority are faculty members of the under-
graduate, graduate, and postgraduate medical schools that
offer postgraduate classes.4 At times the staff of an affini—
ated hOSpital assumes the responsibility for postgraduate
teaching, and some large hospitals develop their own post-
égraduate programs, with outstanding staff members serving as
faculty.5 The members of a single department in a medical
school sometimes serve as the basis for a program developed
by a specialty society or other group; in other instances the
instructors are selected from a number of nearby medical

6

schools, to afford greater representation. "One organizatrni
employs a full-time itinerant instructor who does extra-mural
extension teaching exclusively in one field of medicine on a
two year contract."7

"Postgraduate instructors need not be the outstanding
authority on the subject nor the original contributor of a
major advance in medicine."8 However, "big names" in medicine
do draw large attendances for courses, even though they do

not always prove to be the best teachers and it is necessary

 

 

 

 

 

 

 

-17-
to have lesser known, but more effective teachers, take over

the classes.1

Actual experience in the practice of medicine
is important for the effective postgraduate clinical
teacher. It is the unusual person who can transmit
practical day—to-day clinical facts or principles to a
group of practicing physicians if his only experience
has been in a medical school or hospital....The ef-
fective postgraduate instructor must have the ability
to translate his own deep understanding of an involved
subject into terms of the over-all needs of the practi—
cing physician. This usually requires integrating
basic science considerations with 'practical' clinical
material....

Faculty utilization.-—"The amount of medical school
faculty time devoted to postgraduate teaching has been a
matter of considerable concern to many medical educators."3
In addition to the actual time devoted to teaching, Vollan
"...found that about three hours of faculty time were used in
,preparation and travel for every hour of instruction given."4

The increasing rate at which medical school
faculties are being drawn upon for appearances at medi—
cal society meetings and postgraduate courses has given
some medical educators concern over the possible di-
lution of the undergraduate teaching program.5 The de—
mands of postgraduate education have been increasing at
a rate far exceeding the increase in the number of medi—
cal school instructors.

In considering the faculty problems related to post-
graduate medical education, Dr. Vollan concludes:

One of the major needs of postgraduate medical education
is to enlarge the teaching force, drawing on such sources
as the staffs of large hospitals, research centers, phy—
sicians in smaller towns, and residents. It is equally
important that definite proportions of medical school
faculty time be assigned to postgraduate teaching, with
the full recognition that this is one of the instructors'
primary duties, not a secondary chore. Faculty time cafld

 

llbid., p. 89. 21bid. 31bid. 41bid. 51bit.

6Vollan, p. 90 quoting: J.E. Deitrick and R.S. Bmmmn,
Ledical Schools in the United States at Midcentury, (New York
he draw-Hill, 1953), pp. 307-308, 334.

 

 

 

 

 

-15-

be much more efficiently used by the development of a
well-organized and coordinated system of all postgradu—
ate activities within each region.

The Arrangement of Postgraduate Courses

Among the many unique features of postgraduate
medical education that set it apart from undergraduate
and graduate medical education are the time and place
arrangements of individual courses. Courses must be
made available at times and places that are suitable to
physicians engaged in active medical practice. Apart
from the general nationwide maldistribution of post—
graduate Opportunities, it has been shown that one of
the chief deterrents to greater attendance is the fact
that courses are offered at times unsuitable to many
physicians. In postgraduate education time is at a
premium, since the practicing physician cannot leave
his patients for long periods and desires to obtain the?
maximum possible benefit in the shortest possible tine.‘

Time arrangements of courses.--Postgraduate courses
of from about 40 to 83 hours total instructional time are
.likely to meet the needs of most physicians."3 Concentrated
courses offer instruction in an uninterrupted sequence of
course-days; intermittent courses separate individual class
sessions by periods of time.4 A third category of post-
graduate instruction, the "tailor—made" course, is arranged
on an individual basis to fit the Specific needs of the phy-
sician.5

The concentrated type is the most frequestly
used and preferred by physicians, especially by those
located at some distance from teaching centers. The
most desirable length of such courses is from one to
two weeks. To meet the needs of physicians in cities
in which medical centers are located, as well as for
much extramural teaching in small centers, some inter-
mittent courses are desirable. The best arrangement
for these would be midweek sessions at weekly inter-
vals over a period of several months. "Tailor-made"

postgraduate courses to meet the neecs of an individual
physician can constitute a valuable adjunct only if

 

lVollan, p. 94.
4ib1d., p. 100.

Ibid., p. 95. 31bid., p. 113.
Ibi

 

 

\J'IR.)

Qi

 

-19-

given the same care and attention as regular courses.l

Location of postgraduate courses.--While traveling

distance is of little consequence to the regular student who
is in residence at a school for a period of time, it is a
significant factor to the postgraduate student who attends
courses that are of short duration. Accordingly, consider-
ation must be given to whether the physician should travel to
the class—~or the class be brought to the physician.

The maximum number of miles physicians will travel to
attend courses is of great signifiCance to postgraduate
course planners. Nearly two-thirds of the physicians
reSponding to the questionnaire En the Vollan studiiindi-
cated that they would travel 100 miles or more to attend
a complete concentrated course. Distance does not appear
to be a major factor in determining attendance at concen-
trated courses, but over a fifth of the respondents indi-
cated that they would not travel more than 10 miles for
the individual session of an intermittent course, and
only 6% would travel 100 miles or more.2

However, a geographically oriented study of post-
graduate courses and enrollments that the Council on Medical
Education and hospital published in 1959 and which was based
on a two year analysis of the information collected for the
year 1956-1957, disclosed an astonishing mobility of phy—
sicians enrolling in postgraduate courses.3 The study showed
that almost one-third of the enrollments were of physicians
who came 53 to 230 miles and some came more than 300 miles.
"It is definitely apparent that in all regions, physicians
travel much farther to enroll in postgraduate courses than
had previously been assumed. Their actual performance is

thus different than is their attitude as it was reported in

 

llbid., p. 113. 21bid., pp. 106-107.

3American Medical Association, A Geographically Ori-
gpted Study of Postgraduate Courses and Enrollments in the
United States for Physicians During the Year 1956-1957, A
Report Prepared by the Council on Medical Education and
HOSpitals (Chicago: The American hedical Association, may 9,
1959), p. 219.

 

-20-

the Vollan study."l
Intramural courses.--with readily available faculty
and teaching resources at hand, intramural courses are con—
sidered to be educationally superior to the extramural type

2

by most medical educators. Intramural programs utilize two

types of facilities:

(l)the existing plants of medical schools and their
hospitals and schools of public health, whose primary
purpose is undergraduate or gracuate teaching; and (2)
facilities whose primary purpose is postgraduate edu-
cation.

Facilities essential for Optimum postgraduate education in-
clude: lecture and conference rOOms, laboratories, autopsy
rooms, x-ray departments, pathology museums, teaching aids
and equipment, a well—stocked medical library, administrative
facilities, and access to patients both in the hOSpital and
in the outpatient department.4 Continuation centers, of whhfli
there are only a few, combine educational and living facili-
ties.5

Extramural courses.-—Extramural courses in
large cities include large 'congresses' and annual
courses offered by national specialty societies as
well as some hospital programs. dxtramural courses
in small centers are generally of the intermittent
type, designed for rural general practitioners. Ex-
tension teaching via television and home study are
other extramural forms less commonly used. Probably
the most desirable use of extramural postgraduate
work is in didactic sessions that bging new factual
medical knowledge to the physician.

The Sponsorship and Financing of
Postgraduate Medical education

It is readily apparent that Sponsorship of an activi-
ty and the control of that activity bear a close relationship.

For that reason, who it is that sponsors educational programs

 

lIbid. 2Vollan, p. 137. 31bid., p. 139.
41bid. 51bid., p. 113. Ulbid., p. 114.

 

 

 

-21-
(such as postgraduate medical courses) is significant.

Postgraduate medical education is a complex ac-
tivity, requiring considerable administrative skill and
resourcefulness. A great variety and number of insti-
tutions and organization are active in this field. Some
have had over a hundred years of postgraduate eXperience,
while other have only recently entered the picture.
Sponsors may operate postgraduate programs, COOperate in
their operation, or merely contribute to their support.

Sponsors of postgraduate medical education.——Vollan
has classified the Sponsors of postgraduate medical education
into five broad categories. These categories include: (l)nedb
cal teaching institutions, including undergraduate, graduate
and postgraduate medical schools; (2)5eneral and Special medi-
cal societies; (3)governnent health abencies; (4)independent
medical groups such as hospitals, clinics, and postgraduate
assemblies; and (5)public and lay organizations such as volun-
tary health agencies, foundations and pharmaceutical firms.2

Medical schools are taking the leadership in
this field and with appropriate staff and budget can
probably meet most of the needs. Postgraduate schools
cannot be expected to increase significantly in number,
although some additions may be desirable in certain
areas. The activities of the Speciality societies will
probably continue to serve much of the refresher needs
of specialists.3

Financing postgraduate medical education.-—"Faculty
renumeration constitutes the largest item of cost. Adminis—
tration is often costly in this field because of the large
number of details involved in course planning and publicity.
Travel is often an element of cost where extramural teaching
is donef4

Sources of income.--Einancial support for postgraduate
courses is attributable to three sources: "(l)the funds of
the institution or organization producing the progran, (2)

various contributing agencies, and (3)fees paid by the phy-

 

“J
H
01
H'
p)
o

llbid., p. 115.
31b1d., p. 12b. 41bid., p. 136.

 

 

 

 

-22-
sicians attending."1

The physicians themselves are willing and able to meet
the major costs of postgraduate education....The con-
tinued financial backing of various contributing
agencies is desirable for the present, eSpecially if
unrestricted 5 ants are made, leaving the direction of
the programs in the hands of competent medical educators.
The most important aspects of cost to the physician hin-
Self are expenses of travel and/loss of income from
practice while away at courses.

 

 

llbid., p. 129. 21bid., p. 136.

Ch/dflfhhi II

Th; PRACTICIhG IHYSICAK: HJUEIVQK CF HleCAL
CUMMUJICATION AND DETERMINANT OF THE
NATUdn CF LEDICAL COMMLNI ATION

The lracticing Physician As a Student
The need for continued stucy.——Not only does the dy—
amic nature of medical knowledge make it necessary for the
practicing physician to remain a student throughout his pro-
fessional life, but professional ethics, as recognized by the
American hedical Association, also demand continuous study.

Section 2 of the Principles of hedical ntnics of the American

 

Medical Association states quite succintly: "Physicians Shhfld
strive continually to improve medical knowledge and skill and
should make available to their patients and colleagues the
benefits of their professional attainmen s."1 It is the AS—
sociation's Opinion "...that physicians are ethically bound
to improve their own medical knowledge and to contribute new
knowledge to medicine."2
Challenged by the demands of his profe sion, and con-
strained by ethical considerations, the practicing physician
represents a unique educational entity. As the receiver of
medical information he shapes the process of medical communi—
cation; his particular characteristics must be considered if

the process is to be effective. For in effective communi—

 

lEditorial, American Medical Association Journal, 173
(August 13, 1963), p. 1664.

21bid.

-23-

~24-
cation "...the receiver is the most important link in the am}
munication process."l Accordintly,in this chapter the effect
of the practicing physician on the process of medical communi-
cation will be considered.

The motivation of the physician-stucent.--Unlike the
medical student, intern, or resident, the motivation of the
practicinb physician to continue his studies does not come
from the promise of some tangible reward for his efforts. "In
postgraduate medical education the end—result is not an ad-
vanced degree or other evidence of advanced standing in the
profession but rather inner satisfactions on which no ob—
jective value can be placed."2

Some physicians are motivated by a sincere desire to
increase their knowledge of medicine in order to do

a better job for their patients and some by a fear of
the results--medical and 1egal--of not practicing
modern medicine. Others are simply curious, seeking
always to expand and deepen their knowledge of the
fields in which they work....A desire for increased
prestige among his colleagues and his patients--to say
nothing of increased self-esteem—-motivates some phy-
sicians...Es doeg the desire to excel in one narrow
aspect of a field Ehica is an element of basic human
nature. ’

For still other ph;sicians, postgraduate courses offer an
Opportunity for a brief interlude in an arduous practice, the
concurrent occasion to attend social activities and school
reunions, or the opportunity "...to Justify use of newly
purchased diagnostic or therapeutic equipment that may repre-
sent financial as well as medical gains to them."4

The experienced status of the4physician—student.—-Un—
like the undergraduate medical student, the physician-student
undertakes courses with much eXperience and knowledce of the

suhgect already in his possession.5 Accordingly, pcst;m%Mate

 

1David R. Berlo, The Process of Communication (New
York: Holt, Rinehart and Winston, Inc., 1960), p. 52.

2Vollan, p. 33. 31bid., p. 31. 41bid. 51bid.

 

-25-
medical education is a specific form of adult education.

The physician's frame of reference is entirely differ—
ent from that of the medical student. he tempers pure
fact with judgment, and he constantly thinks in terms
of practical applications rather than in terms of the
probability of an item turning up on an examination.
he is better able to comprehend basic principles, since
he can relate them to experience, than is the under-
graduate student. As his practice has d monstrated to
him his own weak points, he is on the lookout for ma-
terial that will meet his own peculiar needs. This
tends to point his interest to Specific subjects....

It must also be remembered that when the physician
becomes a student, he cannot abandon his status as a phy-
sician. The responsibilities of his practice, though perhaps
geographically removed, are still with him in thOU5ht while
he attends a postgraduate course.

Since he is undertaking postgraduate study concurrent
with the pursuit of his medical practice, he feels
acutely the need to make every moment count....The phy-
sician...realizes that every moment Spent in a post-
graduate course is time and income lost form his
practice.2

Contributing to the relentless pressure of time upon
the physician are a sixty hour work week;3 the time con-
suming activities of reading and hospital staff meetings each
week; and attendance at a county, state, or national medical
society meeting at less frequent intervals.4

Individual differences.--A number of variables: back—
ground, training, location, age, and type and field of the
physician's practice,5 affect the use of communications by
the physician and the nature of the communications planned
for him.

Field of practice.—-Practicin5 physicians may be
classified according to the following fields of practice:

"(1)full-time general practice, (2)general practice with

 

llbid. 21bid., pp. 31-32. 35ee footnote 3, pages.
4Vollan, p. 32. 51bid.

(N. .’

-40-
particular attention to a specialty E.e., part-time special-
istg, and (3)full time specialty practice."l

General practitioners constitute over sixty per cent
of the practicing physician population.2 As a result much of
available postgraduate education in medicine is designed for
the yenerol practitioner. A study during the year 1956—195
by the Council on hedical Education and Hospitals reported
that slightly more than two—thirds of the postgraduate anuses
offered were planned for general practitioners, one—fifth for
Specialists, and about one-tenth for both.3

There is a tendency to associate postgraduate
education primarily with the general practitioner. This
perhaps reflects an assumption of greater need for such
work among this group as compared to specialists, who
have had years of graduate training, in addition to the
greater breadth and complexity of general practice....
The fact that hoSpitals and medical society meetings
are oriented more to the needs of the general practition-
er, and the very breadth of the field makes journal
reading less suitable to his needs.

because of their greater participation in hospital
and medical society meetings aid closer professional con-
tacts, the educational needs of specialists are met in a
manner that differs somewhat from that of the general prac—
titioner. Specialists were found to spend more time in post-
graduate courses than the other groups,5 and Vollan infers
that, on the basis of specialist performance, "...increased
training stimulates a desire for further postgraduate work,
rather than reducing it."6

Special postgraduate courses devotee to a narrow fluid
of medicine, find their greatest appeal for the part—time

Specialist "...because of his tendency to give special at-

 

 

 

ation in the United o
”57) pp. 1431—37.
2

4V011an, pg. 3 —33, 51bid.’ p. 34. 61bi"

J
CF
01
d
([1
U)
23
*1
H
r} a
C .2
‘2.)
B
C.)
(‘4
03

f)

O
n

O
k)!
\T

O

 

-27-
tention to one aspect of dedicine, in which he generally has
limited formal training."1

Type of practice.--A physician's mode of practice-—
individual, member of a group or clinic, or member of an in-
stitutional staff--seems to influence his ability to take
postgraduate work.

The solo practitioner may have difficulty finding some-
one to 'cover' his practice at the particular tine he
wants to take a course. On the other hand, individual
me bers in a group practice may be expected to take
postgraduate work at regular intervals as a normal part
of their professional activity.

Location of practice.--Physicians in smaller cities
seem to depend more on postgraduate courses, while those in
laryer cities utilize hOSpital and medical society meetinbs
along with professional contacts, for medical education.3

Lumber of years in practice.--"All things considered
it appears Erom the Vollan studfl that the heaviest demand for
postpraduate education comes between ten and thirty years
after graduation. These are also probably the most active
years in piactice."4

Professional affiliation.--In general, physicians who
are members of state and county medical societies; national

pecielity or general practice societies; or are affiliated
with hOSpital; attend postbraduate courses in hither per—
centages than those who lack these affiliations.5

Variations in academic and other bachground.--Jhile
admission requirements vary, most institutions offering post-
braduate courses require the physician-student to: have an
h.D. degree from a medical school approved by the Council on
Medical ddu ation and Hospitals of the A. h. A.; some in ad-
dition, require an internship or evidence of residency train-

ing; other certification in a Speciality; others lieensure to

 

llbid. 21bid., p. 3b. 31bid., p. 38.
41131610, I). 39.0 SIbiCio, pt 43.

 

 

 

 

-25-
practice in the state; some local county medical society
membership.l

Special problems are posed by some groups. ln the
South, the admission of hebro ph;sicians to postpraduate
courses has presented a problem.2 Graduates of inadequate
nediCal schools; foreign graduates, with language and back-
ground differences; Osteopaths, licensed to practice medicine
and surpery in some states; all pose problems in providing

for their needs 'n admitting then to postgraduate courses.3

'—

Nhile the inclusion of dentists, nurses, technicians, social

'Wfi‘-“

workers, physical therapists, and related personnel--to when

some courses are Open—-may result in a dilution of the course

"““

quality.4

Deterrents to fhysician Participation
in Postbracuate Programs

While a series of obstacles operate to reduce phy-
sician attendance at postgraduate courses, this fact must be
considered in terms of the existence of two antithetical phy-
sician groups. The first group is composed of "those who
apparently find time to take a great deal of postgraduate wnk
find the seconfl those who do not attend at all....It is ap—
parent...that there is at least a small group of physicians
who do not encounter obstacles to such work or have foun“
ways to surmount then."5

Deterrents to attendance.-—In the Vollan study the

 

prime deterrent to attendance at postgraduate courses was
found to be the inability of the physician to find someone to

care for his patients while he was away.6

however, in the
later Kansas stud“ the actual erfornance of *h‘sicians did
d J

not bear out the findinp of the Vollan study in this particu—

 

llbid., pp. 40-41. 21bid., p.42. 3ibid.

41bio. 51bid., pp. 43-44. Olbid., p. 44.

-29-
lar iHStCMCCg’ There was found to be no sipnificant differ—
ence in the number of postgraduate hours taken by 533 phy-
sicians who had partners to care for their patients and the
366 physicians who had no partners to care for their patmmts?

In orcer of decreasing importance, other deterrents
to attendance described by physicians in the Vollan study in-
clude: unsuitable time at which courses are offered——a factor
more important to general practitioners than to specialists;
cost involved in postgraduate course attencan e-—eSpecially
travel ane living expense and loss of income from practice;
the nultiplicity of hospital and medical society meetings——
especially for specialists with their greater nunber of afflfli~
ations; subject matter unsuitable for for their needs——was a
breater deterrent to general practitioners than to Special- ‘
ists; previously unsatisfactory experience with inadequate

courses; nd lack of inforaation on the availability of the

a
q 1 '7
courses of1ereu.’
still other reasons which were of lesser numerical
sibnificance‘WNJOf equal strength as deterrents to postgradu-
ate atteneance were also given in the Vollan study. These
included:

...sickness, semi—retirement, recency of graduation or
residency training, other 'extra—curricular time—con—
suning inte ests,‘ family responsibilites, medical teach-
inb duties, repetition in the courses, poor tranSpor—
tation facilities, bad weather, research, and in sone
cases being too busy or, frankly too lazy....done phy-
sicians feel they cannot absent thenselves fron their
offices for postgraduate work because of the criticisn

of their patients for not being available.

 

1h. Delp, J.U. Rising, and H.D. Lelligan, "University
of Kansas Progran in Postgraduate Ledical Education," JAhA,
1o4 (1957) 9957“-7b.

[Do-1 7' a" . r-
“1010. JVollan, up. 4o—47. 41bid., p. 4/.

.L

CHAITER III

THE NEoD son A new ChAhhfiL

0F AEUIUAL CbhHUKICATIUh

The Inadequacies of Traditional Channels
of hedical Communication

The negative effect of ineffective connunication.--
when irthus S. Flemming, as secretary of health, education,
and Welfare, enphasizec "...that the preatest weakness in the
fields of medical care and preventive medicine lies in the
provision for continuing the education of practicing phy-
sicians...,"l he most clearly indicated that a serious panda.
exists in contemporary medical communication. To otherwise
conclude from hr. Flemming's observation would seem to over—
look the obvious. ”he unavoidable question that he has posed
must be: if the present channels for medical communication
were adequate, would the problem of continuing the medical
education of the practicing physician exist-—would there be a
"weakness" in medical care and preventive medicine?

The effectiveness of traditional channels of sedical
communication therefore becones subject to question. Lernops
once effective means of co nunication have been circumscribed
by the chances that have oceured since their introduction.
Conceivably, a nunber of variables have functioned to affect
the process of medical communication. Source and receiver
relationships have changed; the dynamic nature of medical
science has altered medical knowledge; and the demands of

upon the practicing physician have been intensified. Even

 

1Council on hedical Television, Report, p. 8.

-33-

-31-
the channels of conmunication, themselves, have undergone
metauorphosis producing an anomaly. The anomaly is an ab-
errant souree o medical communication.

The seriousness of ineffective medical communication
and its consequences cannot be overestimated. Channels of
conmunication that do not serve adequately to convey messages,
in effect, nullify those messages. A message that does not
reach iksdestination can produce no effect and may as well
not have been prepared; for when a message does not reach th
receiver communication has not occured. When the messaae is
new medical information that has been revealed by research,
the seriousness of its not reaching the practicing hysician
becomes apparent. If the implications of medical research
cannot be effectively com unicated to the practicing phy-
sician-—within whose domain it is to apply the benefits of
research to his patients-~then why have medical research at
all?

It should not be necessary to make a case for
the importance of continuing educational opportunities
to the practicinb physician. But since the pressures of
time anc work are progressively widening the gap be-
tween the practitioner on the one hand and scientific
research on the other, it is apparent that this must be
done and corrective steps taken. hedical progress must
not be allowed to outdistance the scientific and pro-
fessional comretenee with which the physician helps his
community....

Why are traditional channels ineffective?——The prati-

 

cing physician today is faced with an impossible situation.
he is forced to still use the same sources for obtaining in—
formation that have been used in the past, while the con-
ditions under which he conducts his practice have changedcxmb
pletely.

Until fifty years ago, more or less, clinical practice

 

1Ward marley and Arthur S. Cain, "A Preposal for a
National Academy of Continuing Ledical dducation," Journal of
hedical Education, 36 (January, 961), o. 33.

J.

 

”3..
(-

\n

provided the ¢rist and impetus for medical education

and research. The practicing physician refined the
observations, experiments, and conclusions for studies
which lagbard academic institutions slowly enbraced.
medical schools went only so far; the critical edu—
cational and research processes were found in practice.
how the situation has changed. Practitioners are hard—
pressed to remain abreast of the accelerating expansion
of medical-scientific knowledge. An inspired and vigor—
us body of teachers and investigators steadily alters
the concepts upon which professional practice is based.
The practitioner, his scientific perception gradually
blurred by time and his educational diet stinted by
geography and distractions, is engaged in a difficult
struggle. he wants to conduct his professional practice
on a basis of current scientific development and medical
theory, but has no practical, efficient, or easily ac-
ceptable educational opportunity to aid hin....The medi—
cal schools themselves have difficulty maintaining under-
graduate programs which enbrace the implications of in-
creasinp scientific activity. But the practitioner,
faced with the denands of his community and the individu—
al problems of his patients, is left to inadequate de-
vices for obtaining, evaluating, and adapting new know-
lecpe——let alone contributing to it.

hedical reading.——Considered by the physicians in the
Vollan study to be the most effective method of continuing

heir education,2 medical reading has some serious lnmfletioms

as a medium of medical communication. The "...bountiful armnr
of literature at present Evailable to physiciang is of
questionable value to the man who has not the time to spend
;;any hours even in screening what is and is not pertinent to
his practice.")

The result of Ehg vast plethora of medical
writing, now completely out of hand from the standpoint
of the potentirl reader, is a frantic attenpt on all
sides to concentrate, abbreviate, abstract, and condense
a subject in such fashion that the doctor has some faint
chance of covering the ground. Some of these attenpts
are good and useful; others unfortunately introduce a
new fora of distemper: The reviewer or ceipiler faced
by a vast and often highly specialized literature issues
an article which is little more than a list of titles,

 

.. .7. .1. "_) - ' 1
llbic., pp. oj-o4. eVollan, p. 16. 101d.

-33-
and which is really nest useless.1
The journal, the nest frequently encountered form of
written medical communication (some 53o) are published each
year), has been criticized for being ”...more a repository of
da‘a than an organ db» 'ned to interest and enlighten the

osi;
o . . . . .. .1
reader."‘ Its Journalistic appeal 18 often limited by a ateur

- . '1 r‘ o ' - ' i
a pedantic style.) "suite llflltfic

(I;

editin; (tr-jI writing, an
resources are available to the editor for taking the journal
more attractive with art work and colored illustrations or
nore interesting throuQn enlisting the aid of skilled
writers."4

The financial subsidy L,ained through advertise-
nents is a doubtful blessing. The journals cone to be
regarded as profitable property and as vehicles for
advertising rather than scientific periodical‘. Eucfl
...journals say become diverted from Eheifl preper
function as outledfl of free and pointed criticism. This
lush support inflates the number of publications beyond
the natural needs, and the plethora of papes encourges
acceptance of inferior articles....5

a,i4_ ,_. ,. 4 JL- ,1,” ' ' ., ., _ ' »—,:'~..,-
nfluuutf Subhuht of who i,.r.,~,SiCian's ~Votential reading

material is "...the t,reet quantity of advertising material he
r
receives in the nail each day from pharnaceutical firns.O
It cannot be denied that nuch of this is dignified and
more useful than the journals and posturaduate programs
sponsored from within the profession. The temptation
to the busy physician, driven by deeperation to seek
short-cuts through the forbidding Jungle of academic
creations, is so great that in all probatility the read—
ership of the trade publications far outstrips that con—
manded by professional sources....lt is risky to depend
on materials beyond the scrutiny of independent editorial
staffs and of necessity *eiicoted to vested interes a

U.

Also available to the physician are the resources of

his personal library of basic aedical references, new publi-

cations, and libraries.8 however, with the average lflwsician

 

lBloonfield, p. xiv. ghay, p. 12. 31bid.

41bid. 5Ibid., p. 14. 6Vollan, p. 17.

(Hay, Ibid. OVollan, lbid.

 

-34-
devotinc soae four hours yer week to medical reading,1 the
amount of material that could be read would be limited.

frofessional contacts.--The value that can be attuned
to professional contacts as a form of medical communication
is subject to considerable variation in quality. host valu-
able is the contact that affords the physician the opportuni-
ty to ueet with a Sgecialist at a bedside for consultation.3
The informal discussions a physician holds with colleagues
and druggists would vary in educational significance. lharua—
ceutical representatives exert considerable influ>nce in
their contacts with physicians, but such meetings are, of
course, heavily commercial in nature.3

hospital ueetin;s.--"Although in large teachinb hQSpL-
tals such meetings are of considerable value, their emnxmtxnl
effectiveness in most hospitals is limited by the nature of
the clinical material and their emphasis on administrative
matters."4 ”he concensus of physician opinion is that less
time should be devoted to this type of activity.5

henical society meetings.-—"Since by their very
nature these meetings are almost exclusively limited to
lecture sessions, their educational value is limitec to that
of lecturing in Leneral."6

Postgracuate courses.—-While postgraduate courses, in
their conventional form, have the potential for providing the
practicing yhysician with a continuing education, practical
considerations have made them less effective than would be
desired.7

The effects of an increased body of knowledge.—-Per-
haps most instrumental in rendering traditional Channels of

:nedical coanunication ineffective, is scientific advancement

 

lIbid., >. 5. See footnote 4, Chap. I. 21bid.,rtl7.
51bid. 41bid. 51bid., p. 18. blbid.

7See Chan. II, pp. 28-29:"Deterrents to rhysician
tion in -ostgraduate lrograms."

 

 

-35-
itself. for it is this advanC*nent that nas so increased the
body of medical knowledge that it can no longer be dissemi—
nated by conventional means.

Two or tnree decades ago, medical journals, scientific
neetian, and societies were reasonably adequate, lo—
gistically, to professional requirenents in tne adap—
tation of new knowledge. Formal postpraduate probrans
in some neoical schools and the expansion of the resi-
dency systen supported the practitioner's continuing
coapetence. however, these m‘asures gradually fell
behind the haunting eeucational requirenents of the
practicing ghysician and the forces with wnich as had

to cope. New elenents rose to become POWCFiUl forces

in xeoical practice. Science was providing medicine
with new knowledbe, new and Specific therapeutic agents,
and new scientific methods of an increasingly cooplex
nature. 1

_ M-_—g

It is paradoxical that reSearch, one of the finest
functions of medical science, should, in effect, have a dys—
functional connooation for medical communication. It is the
traditional channels of communication that have served to

facilitate the dysfunction.

The Serious Consequences of Ineffective
Ledica Connunicatio

A no ical comnunication anomaly.——The hiatus in com—

 

munication that has resulted from the use of ineffective
channels, has produced serious consequences. Just as nature
abhors a vacwiu,so the vacuwnin medical infornation could not
long withstand satiation. Within medical circles, the need
that exists for physicians to have a readily available source
of information was too great; outside the profession, sources
with varying intentions——sone vested--stood prepared to pro—
vide information. The result has been the development of an
anomalous source to nest the otherwise unsatisfied needs of
the practicing physician for new information.

It is in a most important area of aeoicel communi-

 

1Barley and Cain, p. 34.

-30-
cation that the mAMPlDUS source has found a domain: the pro-
vision of infernation on the utilization of new crubs. when
the source of 1n11r1 tion on d ug utilization is tne yharna-
ceuticnl nanufacturers who produce the drugs,1 the full

portent of the existence of an a alous source 1:1 a systen
of coanunicetion becomes apgarent. The standards of aggxnsa
for the safe use of a new drug may well suffer when the

evaluator of the drug is also its nanufa cturer and adv oca e

Industry seized an opportunity and met a need.
Lent intustrial empires can: 0 to tie, end u: on tne oh};-
sician for their existence. lusiness comEetition was
inevitatle and keen; it is growinb prOpTGSSiVBlJ more
keen. and in tia's :._t11‘1osp:‘1ere, with the elements for
confusion atoundin; in his journals, in his mail, and
on his radio-—ane now with coztue rcial 'zneiical' tele-
vision about to ade its voice and sights to tnc melee——
the practicing physician finds that critical discern—
gent within the limits of his available time and ener—
a; is well nigh impossible. More and more the fud—
sician is beiflfi asked to aptly measures "rescrited for
Lin rather than those determined by him.“

hhile it is not the furgose here to examine the pro—
notional ethics of the gharnaceutical industry, or to de—

ter: ine the va litit of the research that is cited in thegro—

 

:tL 61106 ir his article, "Sellint Drugs by 'Educatihg' Phy-
sicians s." The article was submitted "...for critical review
to tLC 1h30101an Council—-an indepencent grouo of eighteen
eminent physicians who organized in 1956 'to see‘ means of
maintainin, hich standrrds for tre material on health that is
eisscniz. ate d tnrot a the media of mass co1munication.' sn-
corse e11t of or.1-Wa '3 article was made by the Council as
follows: "The lh;sic ians' Council...endorses this essa; as an
accurate, sanitaele, and ,olstrnctivc ar‘l‘C1s of matters of
najor iniortance in relations betteen the InCCical biofess101
11c the pharmaceutical industr3. " Eootnote to "Sellinb DTLLLS
'ACucatin;' lhusicians," The Journal of -.eiical “cucation,
(Janna y, 1961), t. 1]
For the point of View of the phe rnaccuticel indts tr;
ec: John G. Seerle, gt. gl., "Tne l-harnaceutical Industrg,"
e Journal of hedical ntncation, (January, 1961), pp. 24-32.

lDr. he; supyorts this conclusion with considerable

Qf' :V"

K») r)”
("\1"

se
T

Zuarley and Cain, Ibid.

r'rr

notion of oruis,l the consequences of such gronotion is of
concern as a malfinction of the s;steu of necical communi-
cation. for clearly when a on unication s;sten oermits an

anonalous source to reilace he acceptec sources of infor—

F4 d- a

nation, then the s;sten itse f must stand indicted. Mnen it
gernits the communication of information that leads to conse—
quences antitnetical to the ver; ioeals of the profession the
system was ecsignee to serve, then there would seem to be no
furtner need of proof tgat the scsten is ineffective. The
neeical grofession is dedicated to service to hunanit5; the
s¢stem of medical connurication in use lay, permitting
s

toc
ransnissionscfl'questionsble integrity, con titutes a 61°—

d.

service to humanity.

The Cnaracteristics of an affective systen
of heeicel Communication

lrerequisite considerations.--If an; moeifications in

 

the present system of medical communication are to succeed,
they must of course take cognizance of the factors that have
functioneo to render the gresent sgsten ineffective. This
mooifieo sgstem must be orientee so that it fits the connui—
cative needs of the passician, an; not the reverse. Moreover,
it shoulo be oesicned to meet tne needs of meoicine as a pro-
fession, with the profession exercising its legitimate right
to serve as the authentic source of me ical communications.
Just as the practicing thsician cesires to utilize tne ad-
vances in nocical science for the betterment of his patients,
so too, leeical connunicetors should be concerneo witn uti—
lizing new ant effective hannels of communicetion for the
'betternent of the profession.

Tne essential requirements.--As established by narlcy

 

ano Gain the requiregents essential to rectify the umxxuranua

 

lSee hay, pp. 11—12; Searle, et. gl., pp. 25-25-

-33-
situation that has resulted from ineffective nedical connuni-
cation, is as follows:
The need is for: First, educational enterprise in the
real sense of the term—-continuing comprehensive edu-
cational programs which effectively interpret the
changing body of medical knowledge in a manner appnxni—
ate for nature nenbers of a learned profession; second,
a method of tranSdissien or delivery which meets the
practical considerations of the physician's everyday
situation; and third, an effort that is protected agnnst
exploitation from any quarter.1

The authors conclude that "if the need cannot be met in these

ways, the gap between accunulating knowledge and the prac—

. . ,. . . . . . o
titioncr's abilit; to use it will certainly increase."‘

“he proposed plan.-—As conceived by Darley and Cain,

 

the first requirement would be not by the establishment of a
"national academy on Continuing medical Education."3 "The edu-
cational requirements of the practicing physicians would be
placed in the hands of perceptive, academically free phy-
sician-scientists whose experience, abilities, and dedication
would constantly serve the objectives of the Academy."4 The
reSpective talents of adninistrative medical educators, out-
standing practitioners, and distinguished medical scientists,
would be utilized "...in the development of definitive
prograns of interest and value to the practitioner."5

The second requirement, effective, convenient
transnission and delivery, could be met superbly by well—
tested motion picture, television and radio educational
techniques and facilities....lt is progosed, therefore,
that the notion picture, television, and radio be the
principal teacning media to be considered by the Acade-
my. Around these media can be developed all the printed
supplements, and the two—wag telephone and mail question
and ansver methods that have contribu ed so much to the
success of education in other fields.

"A board of regents or governors who would be care-

fully chosen representatives of the major professional socie—

 

 

1barley and Cain, p. 34. 2Ibid. 3Ibid., p. 35.
41bid. 51bid. 61bid.

 

 

ties and the Association of American Medical Colleges..."1

would neet the final requirement.

bvious y, financial support of the proposed
Academy would have to be substantial. For the early
phases of development, funds should be supplied 03 the
professional agencies represented. This would guaran-
tee maximun independence during the all important con—
ceptual and planning period. Later, with actual prepa-
ration for the first series of progrrms well under way,
a stronb case for support would be reed; for presen-
tation to private foundations and voluntary health
agencies. Industrial support could also be considered
if it cane without strings. It is not unlikely that
grants—in—aid could be obtained from various bureaus of
the b.5. Departnent of health, Education, and Welfare.2

within the framework of tne proposed "National Aca—
deny of Continuing hedical Education," is the potential for
reducing the hiatus in medical information that has resulted
from the continued employment of ineffective channels of con-
nunication between the medical researcher and the practicing
physician.

The proposed Academy should function with a
graduate school philosophy of high level scientific
and professional education. It would provide inte—
gration, continuity, and constant revision of basic
scientific and professional concepts. Its mission
would be to fill a void rather than replace a process;
to provide a focus and reinforce the special efforts
of local, regional, and national professional groups.
Should this materialize, it would serve as an ia~
portant liaison point with the educatiolal activities
of professional ncdical orpanizatiOhs, hospitals, and
postgraduate divisions of medical schools....

The United States rublic health Service...is be—
ginning to provide total support for clinical research
institutes. This will make possible a great deal more
research...in the clinical usage of drugs, which in
turn will greatly augnent our already vast store of was
kind of knowledge. Difficulty in the transmission of
this kind of knowledge to the practicin;_profession will
correspondingly increase Etalics hing. This proposal
suggests a mechanism that can handle this development in
adequate stride, free of much of the stress and strain P
of the competitive situation that presently pertains...?

 

llbid. lbid., p. 56. 31bio., p. 37

 

 

CHAPTI‘JH IV

TLLEVISIOh: SI“EIEICAE' APPLICATIONS
TO MdDICAL COLHULICATIOE

Introduction

Television in medical communication.—-If the shutgmds
of medical practicezan3U3h3maintained at a high level, thecfiL
fective communication of new information must be assured be—
tween the medical researcher and the practicing physician. It
is apparent from the evidence cited in the preceding chapters
that the traditional channels of medical communication do not
function effectively to meet the communicative needs of con-
temporary medical practice. Therefore, new and effective
channels must be utilized for medical communication. One new
channel that may be employed for medical communication is
television. In this chapter, as a part of the consideration
of how television can serve medical communication, some of
the significant applications of television to medical communi-

cation are reviewed.

The Evolution of hedical Television
A new electronic device in a new era.--Tne United

States was in a period of transition in the year 1946. 'Mnid
War II had ended and the much anticipated post-war era had at
last arrived. Industry, converting from War to peacetime,vms
engaging in the fabrication of new products that could only
he promises during the war years. Among those promises now
becoming reality, was an electronic device that not only re-

produced sound, as did radio, but also produced small moving

-40-

-41-

pictures with the sound. Most remarkable about the device
was the fact that it could not only perform botn electronic
feats at locations remote from their origin, but could do so
simultaneously with their actual occurrence.

Television, still an electronic wonder in 1946, was a
novelty for the few hundred having receivers in a few metro-
politan areas. In Washinoton, Iresident Truman's annual
message to the Congress was televised and marked the first
such use of the new medium.1 Washington and flew York City
were linked for the first time to carry the Lincoln Birthda‘
cerenonies from flashington,2 and it was suggested that this
might be the initial section of an eventual 6300 mile chain
that would cross the country.3 The year also saw the first
permanent television network established when WABD opened in
hew fork,4 and the manufacture and sale of the first peace-
time—produced receiving sets.5

The first medical telecast.——In Chicago, experimental
television station W9KLK was on the air. Among its limited
presentations was an interview program called, "Tea Time."
Early in 1946 the director of the Bureau of health Education
of the American hedical Association appeared on the program
to discuss the nutritional values of various types of lunches
that were shown. The program marked what was probably the
first Open circuit telecast to present information of a medi-

cal nature.6

 

1New York Times, January 2, 1946, p. l.

 

2;§;Q., February 7, 1946, p. 12.
3;p;g., Larch 13, 1946, Iv, p. 9.
4;g;g., April 16, 1946, p. 33.
5;p;g., June 2, 1946, p. 38.

6"Pioneer health Telecasts," JAnA, March 23, 1946,

p. 791. The AMA participated in this and other early tele-
casts for the purpose of developing methods and techniques
'P...so that the medical profession will be ready in the fumne
to make use of this new medium as it has used older media..."

-42-
Appraisin5 the new medium editorially, the Journal of
the Anerican Medical Association pointed out in 1946:

...Television offers a medium which has sone of
the cna rz1cteristios 3f ra adio and some of those of the

sta5e, appee ling prim aril1 to the eye rather than to the

ear as does radio. Television should be a particularly

useful medium for the demonstration typ e of education
pr05ran. Television makes possible demonstration an< ex—
hibit, appea .ling both to tb e visual and to tr e auditory
pathways to the brain. Irocedures difficult to describe
by word of month alone can be visually demonstrated by
brin5in5 before the canera such procedures as the takin5
of blood pres sure, banda51n5 first aid, bloodcountin5
and the use of the X- 233....

rioneerin5 in the use of television for health edu—
cation, the American medical Association presented the first
in a series of such pr05rans over J9KBK, Chica5o, on April 2,
1946.2 The series, believed to be the first telecasts spxis‘or-
ed by or5anized medicine, was telecast on a sustainin5 basis.
It made evident to the producers the difficulty of developin5
an acceptable television format. Dramatic episodes enacted
by professional actors, portions of films, and interviews
were all used in the atte pt to circumvent the lecture type
of presentation considered inadequate to maintain viewer
interest.

The first sur5i ca 1 application of television.——While
television,e&sa.broadcast ncdium, was still in an embryonic
state of d‘veIOpnent, it was sufficiently developed as an
electronic e1 tension of human vision in 1947 to achieve dis—
tinction in a non-broadcast application. Dissatisfied with

the custox 1a1j' Mist hod of dewiistrat1n5 su r5ica1 operatin5 tank-
Iaiques to students and visiting ph,s1c1an Trimble and Aheaa
(monceived the idea of usin5 television to nable observers to
prwiperly see the operatin5 field--without th heir brin5in5 con-
tamination into the Operatin5 room.4

lIbid. 21bid., may 13,
June 8, 1946, p.
4;§;§., hay 1o, 1947, p.

161.

H
\0
4s.
\]
Prj
.

 

 

\‘T

\N
H
0‘
P-
Q.

 

exxn
H we
I

H

-43-
Utilizin5 two m noehrome cameras, one clamped to the
over head Operatin5 light to provide a close-up view of the
operatin5 site, and the other placed in the 5allery to 5ive a
5eneral view of the activity in the operatin5 room, Trimble

nc Reese demonstrated the feasibility of televisin5 sur5ical

f1?

irations for the first time on February 27, 1347.1 The ee-

0
*t)
O

casion was the biennial heetin5 of tie Johns hopkins hedical
and dur5ica1 Association, in Baltimore.2

"five operations were transmitted to ten receivers in
four different classrooms...,"3 accompanied by a step b; step
description of each Operation by the Operatin5 sur5eon over a
loudspeaker system. Th's telecast, althou5h "...the use of
black and white television in teachin5 medicine and sur5ery
aoparently was re005nized as a possibility before World War
II, flag the first formal pr05raa in this nediua...."4

Television for lar5er medical audiences.--In Cleve—
land, preliminary experiments with television as a means of
medical teachin5 had been initiated at the Cleveland Clinic
as earl; as 1946.5 In Larch of 1947 portions of a post5radu-
ate clinic were televised to some 203 physicians attendin5 a

/

refresher course.0 A symposium on "Carcinoma of the Stoiach"

L,

was televised in Lav of the some year from the Crei5hton he-
norial—St. Joseph's hospital in Omaha, hebraska, to an ad-

jacent hotel where a staff meeting was held:7

11bid., January 3, 1948, p. 62.

2Ralph l. dreer, hedical Television to Date, A deport
to the Conference on "The Potential Use of Television in lost-
5raduate Education," Chicago, debruary 5, 1955, sponsored by
the Council on hedical Education and hospitals of the andcan
Medical Association (Chica5o: American medical Association,
1355), p. ‘5.

jJAiuA, January 3, 1948, p. o2.
5

a,

1 4, ,.
4418010 and 3011, p. 1550. Ibid. Coreer, loid.

 

 

n ‘ l ‘1
{Isid.

-44-

Continuin5 the trend of usin5 television for presen-
tations to lar5e medical audiences, The American College of
Sur5eons, 'n co-Operation with the Radio Corporation of Amefir
ca and the sponsorship of the Johnson and Johnson Research
Foundation, presented the first 1ar5e scale post5raduate
sur5ical trainin5 pr05ran in September of 1947. From its orb-
5in in the Law York MOSpital, he program was transmitted to
the waldorf Astoria hotel where fifteen receivers had been
set up in the ballroom.1

The next lar5e audience to witness sur5ica1 procahnes
via television, was provided by the 1948 annual meeting of am:
American Medical Association at Chicago. A pr05ram sponsored
by E. R. Squibb and Sons was transmitted from the Passavant
Memorial hospital to three separate receivin5 points within a
radius of one mile.2 '

health education programing in l947.-—In this early

 

period, television was not only receiving consideration as a
means for furtherin5 professional medical education, but was
also bein5 developed as a medium for providing the 5eneral
public with health information.

Durin5 1947 the majority of the pr05rams were in the
nature of 'spot' news presentations....The technique
involved utilization of an appropriate filh back5round
for orientation of the viewing audience....This was
given added variety by introduction of discussion be—
tween the television h.C. and a physician to simplify
as much as possible the technica aspects of the medi—
cal subjects. Included amon5 subjects presented in
this way were rabies, anthrax, cancer, brucellosis,
cost of medical care, child health care and the pli5ht
of the havajo lndians.

A reqpirement in medical television: color.-—Whiletflm

 

early applications of television for surgical demonstrations

served to illustrate the value of the medium to medicine, they

 

lCreer, Ibid. 21bid.
BJAEA, Say s, 1948, p. 165.

-45-
also made evident the obvious shortcomings of monochrome teha—
vision to a field where color is often significant. It be—
came apparent that if television were to achieve its fullest
usefulness in medical applications, color would be required.

In teaching situations, medical television without color
is a scientifically inadequate reporter. Cyanosis, pallan
pigmentation, depigmentation, jaundice, rubor, graying
and other physiological color changes are essential to
complete the pathologic picture. In dermatology, surgery,
and pathology, color is practically a sine qua non.

Two systems of color, the field sequential and the
dot-sequential, had been sufficiently develOped by 1947 for
demonstration before the federal Communications Commission to
determine which one would become the broadcast standard.2 In
the fall of 1948, Snith Kline and french Laboratories-~the
lhiladelphia pha‘naceutical firm--discussed the possibility of
manufacturinb color television equipment for hrspital use with
the Research and Engineering Laboratories of the Columbia
Broadcasting System. The resultant color television camera
and camera chain were first used at the 1949 Annual Sessionof
the American hedical Association.3

The first medical color television progran.--When the
American Medical Association met in Atlantic City, New Jersey,
in June of 1949, the televised appearance of 1.8. havdin, Pro-
fessor of Surgery, University of Pennsylvania School of Medi—
cine, and the presentation of an appendectomy, were the first
items on a program that served to initiate he use of medical
color television.4

The color television dehonstration presented by
the faculty of the bniversity of Pennsylvania hedical

 

lFrank Warren, Television in Medical Education, (Chi-
cago: American medical Association, 1955}, p. 14.

2New York Times, January 28 and 33, 1947.

 

Bnlson and Roll, pp. 1553—51. The color receivers
were built " Zenith Corporation with Webster-Chicago Campany.

'1‘;
U

4JAhA, April 23, 1949, p. 1157.

-46-

school sad the staff at the Atlantic City hospital,
with the co-ogurat'on of Smith, Kline & French Laho-
retories, attracted a Lost of viewers. The program
was beamed on a closed circuit from the local hospital
to the convention hall. Ten receivers with twelve
inch screens project,d a color imape. Occasionally
the color image was changed to black and white, and
the contrast was striking. Surgical procedures repro-
duced satisfactorily; however, there is room for im-
provement as far as delicate skin lesions are con—
cerned.1

Assessing the place of television in medical teaching
on the basis of the presentation at Atlantic City, the Ameri-
can hecical Association Journal commented editorially:

As a teaching acdiun color television has great
potentialities. Television will not replace motion
pictures. Television is a form of visual education
which could be coordinated and integrated with other
tecnniques of teaching. This new teaching device comes
at a time when medical educators are beginning to ap—
preciate and understand the intelligent use of motion
pictures. The sponsors of the color television pro—
gram are to be complimented for the contribution to the
advancement of medical teaching. Physicians attending
this s ssion have witnessed another milestone in the
evolution of visual education.2

r711

ine first network television health show.—-The first

 

health education program ever presented on a television net-
work was viewed and heard from the hational Broadcasting

Company television studio in Radio City, new York, on June 16,

q

1949. Transmitted as far west as Chicago, the program, "Your

Good Health and the Eight”

U'

Atom," dealt with the use of the
radio-isotOpes in medicine-—particularly radio-active iodine.
The program format featured an interview with Dr. Iaul C.
Aebersold, Chief, Radio-isotopes Division, United States
Atomic Energy Commission, Oak fiidge, Tennessee, on the princi-
ples of radio-activity and demonstrations of how radio-active

- n ‘ o ‘ v u 1 c 7
iocine can be shown in the therie of a patient.)

 

llbid. 21bid., July 30, 1949, p. 1099.
Ibid., August 13, 1949, p. 1223.

-47-

he first permanent installation of television at a

H

medical sch»ol.-—When, in 1349, funds were appropriated ior

 

the evaluation of television for medical education at the
University of hansas school of Medicine, it was the Logo of
the department of surgery, charged with the resyonsibility of
implementing the program under the direction of Dr. Eaul
Schafer, to obtain color equipment similar to that used at
the American medical Association session in Atlantic City.
However, television equipment was in limited supply at that
time, and while color equipment was unavailable, it was found
that even the available monochrome systens were not suited to
medical requirements. As a result, it was necessary to de-

velop equipment eSpecially suited to routine use in surgical
ecnonstrations.l
Thus, on September 13, 19.9, a single canera
chain of demington hand Inc. vericon television was
installed in one of the operating rooms at the Uni-
versity of Kansas Medical Center. Since this camera
employed an orthicon tube it could be mounted verti-
cally above the operative field with its optical system
aligned directly in the axis of a specially designed
Wilmot Castle major Operating light.
...The vericon camera carried a two lens turret

which could be rotated remotely from a control area that
:as established in the gallery. Remote optical focus-
ing was accompolisned through a motor drive attached to
the_flcxib1e orthicon aounting...the program audio and
vidio signal together with intereoaaunication audio were
distributed over proper conductors to an auditorium in
the basement of an adjoininb building. Here was located
a monchrome projection systen that displayed an imaQe as
large as 6 by 8 feet.2

Other medical television events in 19 9.--In addition

 

to tne denonstration at Atlantic City, color television was
presented for the Colorado State Ledical Society in Septemben
and to the Clinical Congress of the American College of

1Paul w. Schafer, "Television at the University of
kansas Hedical Center," JAMA, 152 (May 2, 1853), p. 78.

21bid.

_‘_.O “MA-‘35 It“-

-45-
our;egns, neetin; at Chicago, in October. At the latter gree
sentetion, the protran originated at St. Lukes hospital and
was vieved at the hospital and at a viewing room at the
Stevens lote

In Uccenber, the first micro—wave telecast of an oper-
ation was transmitted and mtrvcd to inauo‘ ura te an era of
'ntra—city[§i§]medicnl broadcasts. Ori inating at the Johns
Hopkins hospital in Laltimore, the proLram was transmitted to
the Americzn heeical Association Convention in Washington,

D. .2

The 195l "dlinic on Television in Health educatiorJL—
By 1951, television had developed sufficiently as a medium of
mecical communication, to merit a conference devoted to the
exgloration of the problems involved in its use as a device
in the health e;uc:tion of tie 1u lie. The America: medical
Association sponsored, "Clinic on Television in health fidu-

ation, was held in flew York City on October 16, 195 , anu;»as
attcneed Ly 233 regret entatives o: ne works, advertising agei-
cies, health and mediCCl or onizations, eth a drug houses,
universities, sonool systems and others interes tee in rezch—
ing a mass audience t rough the necium of television.3

Audressing the clinic, or. Louis M. Bauer, lresident-
elect of the American heeical Association, in emphasizing the
otligation of the Americrn Ledical Association in Jeucetinp
the outlic to grevcntive meeicinc, pointee out that this re-
onsibilit; restce not only on mecical and allied yrofiss sions ,
but also on radio and television networks and stations in as—
sistin; the As soci tion to realize its objectives in hetter

health eeucation.4

 

1h. chonnell, "Surgerv Cn Color Television," Ameri—
can Journal of nursing, 5) (hey, 1990), p. 277.

 

I“

dWarrcn, p. 76.
5J3 A, December 15, 1951, v. 1532.
41bid.

_49-
The first installation of color television at a seei—

hool.-—Two years after it has gioneeree with a none—

0
1:“ .1
H
r '1
O

 

chrcme television installation, the University of Kansas “ECL-

gain pioneeret with the first color television

cal Center a;
S'Stem to be ternancntly installed at a medical school for
cailv undergraduate and postgraduate medical instruction.l
First demonstrated on November 29, 1951, the new color sgsten
graphically illustrated the conviction of the school "...that
television had a proger and important place in he medical
school curriculum...EnE]that monochrome television presented
such sharp limitations that it would have to yield in favor
of color...if full advantage were to be gained from this ex-
citing audio—visual technique."2

nequiring two 3ears of co—operative effort between
the Lniversity of Kansas and three commerical firms for its
grcoaration, the new equipment featured console type color
television eirect-view receivers, each enabling 30 to 40
stucents to view the ogerative field closely in natural<xfler.
A two—way sound system carried the voice of the one ating
surgeon and permitteu the audience to ask the surgeon
questions. To enahlc the doctor-instructor in the classroom
to guise the operating surbeon—lecturer toward the host ad—
vantageous field of View, an adeitional audio line was auceu
to permit private communication.3

The camera, which utilized the highly sensitive imabe
orthicon tube, could not be mounted vertically or left in a
stationary Position on a brightly illuuinateu scene for more
than a fe; seconds without resultant irreparable damage to the
$1,2JO picture tube. As a result it was necessary to cesign
an operatinL light that pernittec horizontal mounting of the

camera and a renotel; controlled motor uriven tilt-pan.uwcha-

 

F—J

25Ckafer, p. 9

v, 0

Ibid., December 8, 1951, p. 1458.

 

\N

JAnA, Ibis.

 

 

-59-

nism to postiton the camera.1

Utilization of the new color systen required that
changes be nade in the curriculum.

The entire surgical curriculum has been revised so that
the new color television can be used to best advantage.
At present EQREIthe junior medical students studying
surgery will be required to attend an hour and one-half
session of color television teaching each morning for
five days a week for the eleven weeks they study surgery
that year. An elective program will continue on the
television until noon each day for those stuuents free
to attend.2

The first closed circuit medical program telecast

coast to coast in color.--When the American hedical Associ—

 

ation Clinical Session convened at Los Angeles in Decenber of
1951, "...color television was one of the most pepularfeatuN£
of the proyran. Space was available for 700 physicians to be
seated before 14 color television receivers, but it was insuf-
ficient to accomodate all...who wished to see theunErografl".3

Of special interest...was an operation for coarctation
of the aorta....It was viewed on television not only
at the A.m.A. meeting but at the University of Chicago

V

medical Center and at the headquarters of tne Columbia
broadcasting Systen in flew York City, where medical edu-
cators, medical school eeans, and other physicians were
assembled....

The program, complete with a two—'ay audio systen to permit a
question and answer session between Los Angeles and hew York
City, established a milestone in medical cenmunication as the
first closed circuit, coast to coast, medical color television
:9 I‘Og'JI‘a‘u . 5

The second installation of television at a medical
school.--ln September, 1952, the University of Pennsylvania
hedical School, under the leadership of lrofessor 1.5. davoin,
Professor of Surgery, became the second such institution to

install color television on a permanent basis.6

 

‘9

lSchafer, Ibid. ZJAI-iA, lbid. jl‘oidqfleceznoer ;_~:,1;51.

4Ibid. 5Greer, p. 2. 0Warren, Y. 76.

\
x}
J.

-51-

The advent of large screen color television.--An_in—

 

novation at the American Medical Association Annual Session
held in.New York City, in June of 1953, was large screengnc—
jection television in color. Other innovations made on this
occasion were; the first three camera color program on medi-
cal subjects, when clinics at Cornell University—New York
Hospital Medical Center were transmitted to the sessions at
the Roosevelt Hotel; and a symposium format-—in which six,
two-hour programs are used to develop and explore single enti-
ties in medicine--for use in television teaching.l

In considering the value of large screen television
for medical applications, the American Medical Association
Journal has said editorially:

The Annual meeting of the A.I‘-'1.A. in New York...En June
of1953 saw the unveiling of what might be considered--
from the viewers point of view--the most striking ad-
dition to Smith, Kline & French equipment in years.
The telecasts there were received on two 4% x 6 foot
screens, Specially built by C.B.S. These huge screens
provide a picture 27 times larger than that available
on the 12 inch screen previously used, rendering an
image of great clarity. When the camera is focused on
a surgical field, the view obtained by physicians in
the audience is often better than that available to
some of the operating team.2

An attempt to use open circuit for confined reception."
Because confined reception, as a means of privacy, is often a
necessary consideration in medical television to protect the
relationship that exists between patient and physician, and
also to prevent the possible misinterpretation of medical in—
formation by viewers in a general audience, early medical
telecasts were usually transmitted via closed circuit. How-
ever, in October of 1953--in an attempt to develop a means
for using Open circuit for medical telecasts-~the New York
Academy of Medicine, in co-operation with station NOR-TV,

telecast the first scrambled image medical program. The

 

llbid., pp. 76-77. 2.1mm, November 21, 1953,13. 1401.

 

-52-
program was seen at the Academy of Medicine in New York, the
Academy of Medicine in New Jersey, and the Flower Hospitalznui
New York Medical College.1 However, as the result of techni-
cal difficulties, this initial attempt to utilize Open circuit
facilities while maintaining controlled program reception,
failed.2

The first medical color television network.-—Undertflm
sponsorship of the American Cancer Society, in association
with the Columbia Broadcasting System, the first medical
color television network was established on October 21, 1953}
Uniting Boston, Philadelphia, Pittsburg, Detroit, Toledo, and
hew York, the series of thirty one-hour, closed circuit tele-
casts, "Telecolor Clinics," originated from the Columbia-
Presbyterian Medical Center and the Memorial Center foernKEr
and Allied Diseases, in New York City.4

The effective use of visual-aids such as plaster and
Sponge rubber anatomic models, flannel boards, and magnetic
boards, made the series a distinctive one. "More production
'kpgg hgw' and organization went into these programs than any
other medical television program presented...Eo that timj."5

The initial open circuit telecasts of postgraduate
courses.--When physicians in one-doctor western towns found
it impractical to leave their communities medically unattend-
ed to take part in clinics and postgraduate courses, a medi-
cal television innovation made it possible for them to remain
in their communities and still to meet their educational re-
quirements. As the result of an idea originated by Dr. John
Bowers, dean of the University of Utah College of Medicine,
and G. Lennet Larson, president of Salt Lake City television
station KDYL—TV, the first medical postgraduate course on a

commercial station was telecast via open circuit in November

 

1Warren, p. 76. 2Greer, pp. 2-3. 3Warren, p. 77.
4JAnA, October 3, 1955. p. 499. 5Greer, p. 3.

of 1955.1

neaching an audience of some 83d doctors in small
towns of Utah, Idaho, Wyoming and Nevada, the series was tek>
cast by the division of graduate and postgraduate medical edd-
cation, University of Utah College of Medicine. The N.K.
Kellogg Foundation supported the series partially, through a
grant, and station KDYL—TV co-operated in the effort.2

Programs were devoted to presentations on such varied
subjects as: diabetes, gallstones, kidney stones, calcifi—
cations in the pancreas, calcifications in the bones of a
fetus, and syphilis. The problem of keeping the generalgphhc
from viewing the Open circuit telecasts was solved partly by
the presentation of the medical telecasts during the stations
non-broadcast hours. An additional measure was a press con-
ference to request a press blackout on the series; only phy—
sicians were advised by mail. The series produced a quick and
overwhelmingly favorable response from the doctor-viewers and
the American hedical Association, while provoking no com—
plaints from the public.3

Fivegpears of medical television--viewed in l953.—-

 

With some five years having passed since the unprecedented
medical telecast at Johns Hopkins in 1947, medical television
had attained sufficient experience and stature by the year
1953 to have developed a marked degree of sophistication.
Commenting editorially on the changes in medical television
as evidenced by the presentation at the American Medical As-
sociation convention at New York City in the summer of 1953,
the journal of that organization noted that as the result of
the efforts Of the participating physicians, visual materials
were being utilized in the presentation of clinics and samral

very effective methods Of presenting operations had been de-

 

n. 92.

J.

2JAHA, December 19, 1953, p. 1458. 3Newsweek, Ibid.

lNewsweek, November 23, 1953,

-54-
veIOpec.l

Eowever]...perhaps the greatest change of all
flag to be found in the motives of the persons attend—
ing the program-—the audience itself. For the first
five years--the novelty eficct Eas considered to be
the reason wh* physicians attended the television
dcmonstrationé. As it developed, audiences did not
get smaller when the element Of novelty faded; rather
they increased in size. This was gratifying testimony
to the place medical color television had won in the
estimation Of physicians no longer impressed with its
'newness.‘

Further evidence of maturity in medical television.--
The additional achievements of medical television in 1954,
serve as further evidence of itsicmntion as a maturing medium
of medical communication. Widespread local use Of television
for medical purposes was noted when the American Medical As-
sociation announced that some 90 county and state medical
societies were actively producing, participating in, or
planning prOgrams of public health and general medical inter—
est.3

The University Of Utah embarked on its second series
of postgraduate medical programs, and Smith, hline a French
celebrated five years Of medical closed circuit color tele-
vision programing at the American Medical Association con—
vention at San Franciso, in 1954.4

The American Cancer Society, upon completion of its
series of 33 programs, added one specially prepared presen-
tation that demonstrated the first integrated use of tnmuxnn—
tinental and local color facilities.5 In September, the
American College of Physicians presented a one hour black and
white television symposium on "The management of Hygntemmon"
which was carried via the closed circuit Box Office TV net-

work to 26 cities from coast to coast, where it was viewed on

 

lJAhA, November 21, 1953, p. 1100. 21bid., p. 1101.
3Warren, p. 77. 41bid. 51bid.

_J)_
29 foot screens.l Participatingjn.the program, sponsored by
the Wyeth Laboratories, was a panel of distinguished p
sicians which included Dr. F.h. Smirk of New Zealand.2

Applications and innovations in l955.--A demonstration

 

of new methods of abdominal hysterectomy for the OklahomaCth
Obstetrical and Gynecological Society, on January 15, 1955,
marked the first use of the Radio Corporation of America com-
patible color system in medical television. Another unique
feature of the closed circuit telecast was the result of the
impracticability of moving the heavy camera equipment tempo-
rarily into a hospital operating room. As an alternative, a
part of the television studio was made into an improvised
Operating room.

The First Inter-Agency Symposium.--"The Application
and Scope of Television in Medicine," was the subject of the
First Inter-Agency Symposium Sponsored by the Armed Forces
Institute of Pathology in January of 1955. A discussion of
problems of mutual interest to the users and manufactures of
television equipment for medical applications was the purpose
of the symposium. Demonstrations of Radio Corporation of
America compatible color and the use of color television for
inter-city consultation were also given.4

histological slides were placed under a micrOSCOpe in
Baltimore and beamed in color to a group of pathologists
in the new Armed Forces Institute of Pathology in Wash-
ington, D.C. Although this consultation service may
have some value in the future, it was interesting to
note that on the basis of seeing the image on a tele—
vision screen, not a sings pathologist in the Washing-
ton audience was williné to make a diagnosis of any of
the 6 or 8 slides projected.5

The hedical Journal of the Air.-—Designed to bring

 

new advances in medicine to physicians quickly, the American

Medical Association presented Videclinic, an unprecedented

 

 

lCrecr, p. 4. 2warren, p. 77. 3Greer, Ibid.

4Ibid., p. 5. 5Ibid.

a“ mtg-..—

...--4

-55-
hour and one—half postgraduate medical program on February 3,
1955. The program, with an estimated audience of 23,333 phy—
sicians in 51 cities, was projected as the "medical Journal
of the Air,” and demonstrated advances in medicine to ””.help
bridge the gap be ween the time a scientific paper is pre—
sented at a medical meeting and the time it comes to the at-
tention of the practicing physician through normal publi—
cation channels."1

Produced by Saith, Kline & French, the closed circuit
program which was transmitted to an auditorium in each city,
featured an address by President Eisenhower from the White
house, and the discussion and clinical demonstration of "The
hanagement of Coronary Artery Disease" by thirteen authori—
ties in the field of cardiology. Consisting of live and
filmed pick-ups from Boston, Cleveland, Minneapolis, Chicago,
and New Orleans, the program required the largest mass edu-
cation closed circuit network that had ever been attempted.2

A second Videclinic, again under Smith, Kline dihench

 

sponsorship, was presented on Kay 9, 1955 for some 25,333
physicians, interns, and senior medical students in 34cfiides.
The clinical conference featured the latest work on the fight
against mental illness and included live and filmed reports
from physicians and hOSpital in the United States, nurope,
and Sngland.3

Color television for the Army hedical Center.--Instal—

 

latrnlwas begun in the late summer of 1955 of the nation's
first compatible color television equipment for hOSpital use?
Installed by the Radio Corporation of America to serve three
government activities located at the Walter Reed Army medical

Center, Washington, 0.0., the e425,830 system featured the

mm -- -...

 

S, l 55, p. 515.
I

bid, Cotober 1, 1955, p. D.

J
'2: . _ ,4
)ICIC.’ Hay 7, 1955, 0° )5. L}

-57-
first medical color television canera designed for ceiling
mountin; in operating ant autopsy rooms.l

Bedside clinical session telecast to 5D cities.--On

 

(

January 16, 956, the first in the series, Grand mounds, pre—

 

sented the initial bedside clinical session to be telecast to
some fifty cities from the Tufts University School of hedi-
cine and the Jew dngland hedical Center in co—Opcration with
the Boston City hospital, and the Upjohn Company. Featuring
a distinbuished L,roup of surgeons and gastroenterologists and
a radiologist, the program utilized audio-visual techniques
which made it possible for the audience and the examining
physician to simultaneously stuty such criteria as abdomiral
examination, heart sounds, bowel sounds, percussion and the
like.2

Television for psychiatric training.—-Television fa—

 

cilities were built into the new University of Nebraska lsy-
chiatric Institute which was Opened in early 1956. The

purpose for incluCing television facilities in the institute
was to facilitate showing acvanced students how experts actu-
ally treat mental illness. Cameras placed at ports adjacent
to each treatment room enable the control room to select the

picture of the most significant treatucnt for ‘ransmission to

.71
t

. . -.. . j . w 1 . .
Viewers in an auditorium.) -ne black and white, closec
circuit s;stem, has been used on an intermittent basis for
small and large groups of medical students, nurses, and

graduate medical groups.4

 

lRadio Corporation of America, Halter need Army hedi-
cal Center Lscs RCA Compatible Color Television for medical

v—v-

education, KCA Publication TV—11757, p. 5,

 

 

 

2"The Grand dounds," Ovefflow, January, 1956, p. 2.

BJAnA, July 12, 1:55, p. 1166.

4David S. huhe, 3:. 31., "Television in the Teachinb
of fsndiatr“° Re;ort of Four Years' Preliminary developmentfl

d .

Journal of heCical Education, 55 (October, 1960), p. 316.

 

 

—58—
five medical meetian linked b3 television.—-An

elaborate sjsten of connunications made it possible to unite
some 2933 physicians attending annual medical association
meetings in five states, with a panel of five authorities in
a Chicabo television studio. The closed circuit yrobraa as
a joint effort of the Council on Mental Health of the Ameri-
can Hedical Association and five state societies, in co-oper-
ation with Shith, Kline and French Laboratories, explored the
subject: "The Physician and Emotional Disturbance." The houn-
1on5 postgraduate seminar held on hay 6, 957, for pmfiflcians
at meetings in Florida, Kansas, Louisiana, Oklahoma, and
North Carolina featured a two-way audio system which enabled
questions from the various meetings to he answered by the
panel members immediately.l

Other "Grand Rounds" gresentotions.—-Followin5 the

 

1950 gresentations devoted to "The Cardiac Patient in Stress"

and "dancer," the Grand Rounds series continued with programs

 

on: "Pre—halignantsnm halignant Lesions of the areast and
Colon,” and "Diagnostic and Theraeeutic Advances in Liver‘bis-
eases," in 1957. Each of the programs attracted an audience

of approxinately 20,19) phjsicians.‘

The seventh Grand Rounds presentation was a closed

 

circuit program originating at the Annual meeting of the
American hedical Association at San Francisco, in June oflsfih
Transmitted to physician-audiences in Boston, dbicago, Cleve—
land, halamazoo, Philadelgnia, new Iork City and Syracuse,
the ninty minute QTOCTEA was in two parts. The initial muuty
.ninutes of the telecast covered the convention as it was in
prodress and showed the outstanding exhibits on displaj in

the Scientific thibit section. The final sixtj ninutes were

 

-——-—-——.

 

l a . ' ‘. r " . "
Jfihfl, Maj Z5, 1357, p0 4b50
"dranc Rounds: the Work Lehind 1t," Cverflow, June,
1957, P- 25')-

F /
L~. _ 1
— I 4_

/

C

devoted to a nanel discussion of "The Current Therapy 31

J

iron the tniversity of California medical Center in
1

diabetes"
oan Jrancisco.

Color television at the 1958 Annual meeting of the

 

Aherican heuical Association.--Color television was utilized

 

at the Anericen LeciCal ASsOCiation Annual meeting in San
Francisco, in 1958, to denonstrnte the currently aoiroved
techniques for surgical frocedures frequently yerforned by
the Lenoral practitioner. The proiran of surbical panels
and clinics originated from the San Erancisco hospital.2

Organization of the Council on Medical Television.——

 

As an outgrowth of a conference on "Television and Postgradu-

/‘

ate hedical dducetion," held in the early spring of 195; at
the national Institutes of dealth and sponsored by the Insti-
tute for advancement of hedical Communication and the Aneri—
can Academj of Ceneral :ractice, the Council on heuical Tele—
vision was organized. "The consensus at this meeting was
that there existed a need for a continuing body to stucy,
stinulate and facilitate the use of television at all levels
of medical education and research."5

The first-tine linking of five hajor necical schools

 

1

a; color television.--As an exterinent in medical education,

 

five major neoical schools were linked for the first tine by
closed circuit color television in harch and April of 1959,
at fhilacelphia. lroduceu n; the medical Service Unit of
Smith, hline and french, the five one—hour telecasts on fo—
rensic medicine, OTiQiHRLEC in the hegical nxahiner's office

and were transmitted to some 1190 stutents who watchec on

 

 

1"Crand Rounds at A.H.A. Convention," Overflow, June,

F-A
\
K'TW
(1
T3
f\)
P)
\1

2J1 A, April 19, 195‘, Do 2327'
3Council gnu Metical television, Status Resort: June
1’ 1963, Jo lo

 

 

..‘Q ‘)_

4 x 6 foot screens in their own schools. "ieaction was booe
at tne schools. Generallb, it was felt that this is a po—
tentially useful technique for highly stecialized tocics in
which the availability of ex;erts is iimitca."1

An qgen circuit exgerinent.—-A fifteen—minute show
consisting of a feature story and a round—u; of the latest
neuical news was Cesi¢nec by its syonsor, the Ciba Comrang,
as an attemgt to us‘ ogen circuit transnission, while Cis-
courging unintended viewers from watching the protreu. It is
believec that the strictly neeical terminology that is used
will tend to eiscourpe leg-viewers who will have difficulty
in understanding the show. The program was tested in a
"gilot" broadcast between seven and eight in the morning in
singhamton, miani, Dallas and hansas City.2

Television facilities at ueuical schools: a 1;:3
survev.—-The Council on hecical Television sent a question-
naire to the deans of 86 medical schools in an attempt to

0“,

survey televisi n facilities at metical schools. based on
returns, it was founu that:

Sixteen schools indicated that they presently have some
tyre of television installation. About one-thire use
their facilities for UHL€T¢T9du9t€ eeucetion only,
whereas two—thiros have both UHQBTLTHLU?te an: post-
nraeuate TV teaching programs. An equal number of
schools signified that trey have definite plans to in—
stall facilities within the next two gears....

lostLraeuate courses b3 oten circuit television.—-ln
June, 1959, Wayne State University fresentec the first of a
ten-week series of telecasts on "lsychiatry in neeicine" on

UHF Channel 56, Detroit. The series was CCSiLfiEC to acquaint

 

1C.S. Cameron, "jive bcnools Linked Together for TV
Teachina," Journal of Medical neucation, 34 (fiovcmber, 1953),
pp. 1677-51.

2Council on heeical Television, Newsletter, Spring,
1859, p. 3.

3ibio., Fall, 1959, p. 3.

 

 

_¢1_
gractitioners with psychiatric princiyles ans while no at-
tengt was made to make the grograms understandable to inci—
dental lay viewers, there was no unfavorable oublic reaction.
The series was organized in conjunction with the hichigan
Academy of General Bractice and the Detroit ieceiving Hessi—
tal's Qeyartnent of Psychiatry and took the form of a panel
eiscussion anong aporopriate specialists.1

The University of Utah, after producing ogen circuit
postgraduate courses on a commercial channel in 1953 and 1954,
presented a series in the fall of 1959 of thirty-minute week—
ly programs over the facilities of Utah's eeucational tele—
vision station keen, vnr Channel 7.2

hygronanfor both the medical and general audience.-—
The danger signals oflung cancer-—possible causes and ferns
of treatment-—was the subject of an hour—long presentation by
the Upjohn Con>any for the Annual meeting of the American
College of Chest Physicians at Albuquerque, new nexico, in
October of 1359. T ansnitted to a physician-audience in
Dallas, the proLram was also viewen by general audiences in
both Albuquerque and Dallas.3

New York University meeical television Qroject.-—Tne
laeuical Television tnit of the Jew York University-Eellevuc
medical Center had completed the filming of its first three
television programs, by early 1960, and projected additional
prograns to be made soon thereafter. Designed for the con-
tinuing euucation of the general practitioner and to give the
faculty experience in teaching with television, "...the three
programs range from essentially verbal comnunication to pre-

<moninantly visual."4 Iroaraa l, a lecture on "New Oral Drugs

 

 

F)‘ -' i ' ‘. . \ _, 1 .~'
¢"meelcal bp601al event," CVerflow, necenoer, 1959,

\r!
C‘.

.A.T., Eewsletter, fiebruary, 1960, p. 4.

 

I

 

—o2—

in the Ire turn it of Diabetes," uses charts and graphs to
present part of the verbal informftion. trogran 2 is an 11-
lustr tee lecttre on "Clinical Implications of tnc iiolopy of
the Skin Surface, lart 1: a)3arricr zone; b)owcat aid lirids,"
employs a: experi ental niocottre to show tne barrier zone, a
cenorstration of a patient with defective sweating, and 35 an
SliC.GS of unusual ca s: s. Progr 8m 3 is an ucetioral tele-
vision proL:uction, "Self—help Devices for latients with Ar-
thritis," which communicates nest of its infornation by show-
ing patient cisahilities and how they can be nininized by the
use of self-he p devices.l

Twenty—sixth nccical school adds television.-—The
Jefferson hecical College in lillacclpn a, one of tne nost
recent adCit iOJIS to the roster of schoolszentloj1no television,
increasec to twenty-six the nunber of mecical schools usi;:p
television by 196$. at Jefferson hecical Collepe, ”...the
e uipncnt is used in the histolojy, embryolon, anc neuro-
anaton; laboratories to GXQGCitG orientation of student Lroups

in microsCOpic preparation techniques and for the ViGWiflp of

d Utncr cep artnents

motels and other macroscogic materials.”
in the colle e are considerin¢ the purchase of accitional
equipment.

I

A proposes postgraeuate proLra1.-—The Aaerican Acade-

 

my of General Practice, in association with the iublic Af—
fairs Division of the national BroaCcastinb c01 any, has con-
tcnplated the procuction of an Open circuit television series.
As presently envisioneo, the pregrans woule oritinate in Lew
lork anc would be resorted on tape two to three weeks prior
to their actual presentation. This plan permits procuction
scheculcs to meet tle convenience of phvcicians appearing on
the preprans, and also allows the programs to be shown at

viewing tines that are desirable in e52ch of the time zones.

 

"'

llbid. 2ioiu., September, 1960, p. 3.

‘7

4—.

‘w-r

C\
\_)J

’

Botr the content of proprans in the series and tLe content of
tnc stonsor's messages woulc he uncer tLe authorit; cf the
co-ogeratinc aecicel organization garticigeting in the amiss
of grograms.l

The concern of the Acacemy of General fracticc for

provioinb proLrams of continuing ecucetion to its MG$CGTS has
resultec in its interest in television as a nenns for the ac—

COLEliSLiH; of tnis goal.

...The Aceteiy *equires that its menters contlctc one

hundrec fift; hours of continuctign stud; ever; thTEC

years to neintein tueir mentorsnip. The Qomnission on
doucntion is resgonsible for the Levelopment and con—
cuct of contin*rticn stucy groérans of benefit to...
members. Television is consieereo a gotentinl necium
for makint educational probrams available to Academy
nesters. Tnis is the motivation for considering the
NLC television groérzm.‘

She grogoseo series, "LGCiCine in frogress," would be
telecast at en early hour on sundey mornings-—a time pre-
ferred by most yhysiciens.3 The current "Continental Class—
rogm" series, which gresonts college level courses for cretit
in pn¢sics ane cnenistry, woulc serve as a groto-type for tne
be .A;- , .. 4
new neoical series.

A videotqie librerg of gostgracunte medical irogrems.
——Presently uncer cevelopment is a stereo videoteie library
for postéracuete neuical education. The ViCBOtRLES, LPCG
Lossiole by a grant from the fill Lilly Comgeny to tne Council
on mecicel Television, are to be procucec curinb lSol, and
tested late in the gear.4

1c ,

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L‘OPQ'V. Lb.bllc [Iii-LVllS L'Jer'fai t..i§7.lt)’ A.b<1l\/lllc 111 JLI'J'“

 

 

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The meeical ielevision fixgerience
The total medical television exocricnce, viewed in
lQol, covered a Span of less than twenty Jeers. Just fifteen
yecrs hao passec since the to; in 1946 when the Director of

tne fiuresu of health doucation oi the nmericsn neuicel Assoc}

‘\
A

ation eggearcc on pioneer Chicego television stoeiqn waist to
uiscuss the nutritional values of food--anu to make that was
grobatl; the first neCicnl telecast. Only thirteen years

had elagseu since Trinble ant Jesse, cissotisifieo with the
inaeeguate View observers Loo of the ogerotinc field and the
contaninntion these observers brought into the operating room,
utilized television at Johns honkins University to circunvent
these cifficulties——anc made the first spylication of tele-
vison to the oemonstration of surgery for a group. still, in
1361, enough exyerience had accunulated to make possible the
planning of an early morning, open_circuit,series of post—
nrauuate telecasts for o"ncticin¢ physicians across the
country--thet would bring instruction to the phgsicians in
their homes.

The sgplicetions that have been moce of television to
genicine have closely gerallelec the technical acvoncenents
that have been made in the neuiun itself. In the earliest
necicel epglicstions, television served to electronically
amplify human vision. lt servoC to make visible to numbers
of vieWers simultaneously whet only a few had previouslg been
atle to see inoiviouolly. Later, as transaission facilities
developed, television extencec vision so thst viewers at a
sistance could see whet only those who were inneeiately
present had been able to see before.

Television's neoical agglicstions at first were mono—
chromatic. nomevcr, these early so,lications schce to ’enon—
strote the need that existec for color television. amen

COlor became technically Possible, its cenonstration in meci-

—65—

Cal arplicetions was oranatic. it the Annual session of the

Anericnn Leeical Association at ntlantic City in 1343,
thousanus of oh5sicians first vieweu color television on
small picture tubes of the special receivers.
Tne sheer novelty and excitement of being able to
witness a close-up, fairly accurately colored image of
a surgical yroceCure then in progress createc an unde—
niable impact and evoked discussions in which the tern
'imneuiacg' epitomized the contribution of television
as contrastea with moti n oictures.L
Television became a tool for the teaching of meticine
in mecical schools, when it was installed at the bnivcrsity

of kansas Medical School in l943--the first monocnrone,closei

A.

circuit, installation on a germanent basis to be made at a
necical school. lwo years later, the same school again pio-
neered with the first color television systes to be installec
in a medical sch cl.

suite early, a trend CCVClJfCM toward the use of hie—
vision for ;resent¢tions to large audienc-s. ns technical
eevelognents meCe it possible, antical television s,annee
greater anc ¢reater cistences; eventually the entire countr;
could be unitec for seeieel yro;raas. 1o insure trivecg,
closec circuit transmission gas most often eagloaed for medi—
cal telecasts. The LevelOdeht of large SC‘een frodection
television in color, afforcec viewers in large audiences a
moon introvec View.

dith added exgerience, groduction techniques 16erg€
more refined. The single gresehtation of an operative site-—
a characteristic of early gresentations——was replaces with
more CDHQliCFtEC anc effective yrogram formats. Visual de-
vices and methods were addet to creete greater visual inter—

‘

est, and greater enphasis was ylecec on makinr

0 television
more than just a viewing device.

As time LESSGC and the novelty effect of television

 

ldlson and doll, p. 1551-

'3

u? “...—n... in- .-

u‘!
z
..
‘~

-56..

facet, it was founc that Lnere it tad been thcuzht trxst phy—
sician-audiences would decrease, it was actually founc tnat
more pn sicians were viewing netical television presentctions.

when, in 1953, oLen circuit television w.s first useo
to carry courses to practicing physicia ns in Utah, a mile—
stone in postgraduate meuical enucation lac been reacneo.1fig;
sicians who hao seen unable to leave their practices to at-
tenc courses, coulo watcn courses on their television sets in
t eir own noses. Tue successful telecasting of postgrafucte

net ruc ti1n has been continued t; the University of btah Lei,

*4.

col School, and has also been initiated t; other meCical
scioo ols

for arch of its more e secrete closec circuit exgeri-
ence, mccical television has nad the patronage of several
pnarnaceutical manufacturers. Smith, Kline eno french pio—
neerec in the field--both in programing and in the designing
of equipment. The first mceical school installation of tele—
vision was an outgrowth of the work done b3 Smith, hline and
french. The use of color anfl large screen projection in nee}-
cel television, also wcs pioneerec by the sane firm.

Tne {cries of tin e that res ela -sec since the first
applications of television to cedicine is a relatively short
one. still, it has proviceo time for experiment and some ex—
rerier ce in the use of the new mediuu. Television has ampl;
demonstrated to the necical profession its ability to enhance
hunan vision; to circumvent 01m tacles to span distances; anc
to telesc0pe time. however, in performing these miracles it
has often been regarded as something of a novelty and its
potential as an effective channel for metic al communication
has not received the most serious consiceration. Accorcinily,
tne areatest potential of nedical television, it would seen,

is still to be alize eo.

m.’ . 1‘ - W‘._aj

CHAPTER V

TELEVISION AND THE ELEEENTS OF THE
PROCESS OF EEUICAL COMMUNICATION

Introduction:
A Channel Concept of Television

 

I
|
Some concepts of television.-—Television, when con— E
sidereo electronically, is: "The transmission and reproduction I
of a view or scene by any device which converts light rays 9!
into electrical waves and reconverts these into visible light I
rays."l educationally, it can be said "...that in a sense
television is a master medium. Many other teaching media and
Operations can be channelled through television."2
In medicine, television has found applications to
meet the requirements of both concepts of television. It has
been an electronic extension of the human eye, making visible
what the eye could not otherwise see; it has served as a
medium of communication, presenting simultaneously what other
media had done individually. Television has been a master
educational medium, bringing other educational media and tech-
niques to the physician. It is in this latter concept that
television will be considered here.

A channel concept of television.--Television, when

 

considered as a medium of communication presents some rather

 

1Webster's New Collegiate Dictionary, (Springfield,
hass.: C. & C. Merriam Co., 1959Y, p. 873.

 

2C.d. Carpenter, "Thoughts on Instructional Communi-
cation: Common Denominator Problems of Fields and Media,"
Council on medical Television, Report of the First Meeting,
p. 11.

—67—

_\

-5g-

special considerations. In this context, television becomes
in itself a quite neutral entity. "...The medium of tele-
vision, of itself, noes not make education Eommunicatiofl good
or bad. Television is no better and no worse than what is
put into it...."1 Like a blank page, a sheet of newsprint,
the empty airwaves, or a length of unexposed celluloid, its
potential is realized only when it is impressed with aummsaga

As a conveyor, television is nondiscriminatory--it carries

3.?

messages of all qualities with equal faithfulness. It is
probably this attribute of faithful reproduction that pro-
vokes the designations of "good" or "bad" for television. It
would seen that the medium is criticized, when the message is

the culprit in this instance. However, the important con-

N‘. : m-uuwr— _—
I ‘-

‘W
_..\

sideration is that television transmits whatever is placed
before its cameras, and accordingly is a medium,or channel of
communication.

Implications of the channel concept of television.--
When television is allotted the place of a channel in the
process of medical communication, it cannot be abstracted
from the other elements that constitute a process of communi-
cation. Therefore, the herlo "S-M-C-R“ model2 of the process
of communication will be utilized to relate the elements of
the process: source, message, channel, and receiver to the
process. All elements will be considered as inter-related
elements of the communication process.

for the purposes of this study, the elements of the
model are related to medical communication, and are defined
as follows: The source--the originator of a message, or its
vocalizer, who will most often be the communicator of pro-

fessional medical information; the message——the medicallycndy

 

1Local Education Commission of Atlanta and Fulton
County, Georgia, fieport to the Commission bygits Education
Council, (Atlanta: The Commission, September, 1960), p. 12.

2berlo, pp. 30-39.

-69—

ented product of the source, chiefly medical television pro-
grams; the channel——the medium for conveying the message from
source to receiver, especially television as a channel for
medical communication; and the receiver-~the recipient of the
message, especially the practicing physician, but also, the
medical student, or the general viewing audience.

While by definition the concept of process is such

\

that the process is on—going, and cannot be halted,1 for the

purpose of analysis, the elements of the process will be con- r?
sidered individually. The treatment of the elements follows i
an arbitrary arrangement that has been chosen for convenience i
of discussion. It is recognized that properly the elements i
of the communication process must be considered in their 5;
ti

proper dynamic perspective--interacting and affecting each
other, and having no point of origin or conclusion in the
process.

The dimensions of the message.——While the medical

 

messages that are of the greatest concern to this study are
those designed for the practicing physician, it is quite
natural that an overlapping of televised medical messages
should exist. "Televising health 'shows' for the public and
televising medical matter for the profession require differ-
ing approaches, but are based on the same fundamental re-
quirements. Either must be useful; either must be interest—
ing; either must be technically adequate."2 Both forms of
televised messages will be considered within the dimensions

of the medical message, as treated here.

A Consideration of the Source
in Medical Communication

The role of the source in communication.--The source,

 

as the originator of a message or its presenter, plays a most

significant role in determining both the design and even the

l

 

, A a. . fl
oee Berlo, p. 23. ‘W.fl. Bauer, in Warren, p. 4.

-73-

direction that a message will have in its effect upon an
audience. While he may not necessarily be the creator of the
message, still the source imparts a Specific effect upon the
message as its vocalizer. So influential is this role of the
source, that the same message presented by two sources who
differ in certain characteristics, can produce diametrically
Opposite effects upon the receivers of the message. Because
communication is effective only to the extent that it pro—

duces a response on the part of the receiver; because the

‘3

source plays such a vital role in determining the character
and effect of a message and the response it elicits, it be-

comes axiomatic that a message can be no more effective than

'r &- 'L—I. “W‘sn'mm

the source is effective in its presentation.

hecause the source is such a vital determinent to the

pulp

effectiveness of communication, the identity of the source,
essentially Egg it is that communicates becomes vital to the
effectiveness of the communication itself. Therefore, the
communicator by choice would be the one most skilled in the
techniques of effective cemmunication. Actually, it appears
that this is true more in theory than in practice--for cri—
teria other than those of effective communication seem to
apply to the choice of a medical communicator.

The recess by which people come to be teachers
of medicine Eommunicators is a very.interesting one.
many of them are chosen only for the length and quality
of their bibliographies in a very narrow and highly
Specialized area of research, other because of the back-
ground of their training in the general aspects of medi—
cine. The fact is that many times those peeple who are
defined as teaching professors of medicine need even
elementary instruction En the techniques of communi-
catiofl.

The technical expert as a communicator.--The step is

a short and natural one from communicating in the classroom

__

1Paul W. Shafer, in American Medical Association,
P oceedings of the Annual Congress on Medical Education and
L censure, (Chicago: American Medical Association, l955),p.58.

-71-
to communicating via the channels of medical communication.
the step is similarly short for the practitioner, who by
virtue of a background achieved through education, research,
or several years of medical practice, has attained status in,
his profession. While it is only natural that the profession
should turn to these people to communicate the knowledge they
have acquired, still this system may leave something to be

desired as a means for selecting communicators.

”'9

The pattern followed in the "natural selection" of
many medical communicators is not unlike that followed in the
determination of communicators for other fields. Specialized

eXperience is most important in the achievement of competence

'u"m-m'm
r ‘.

in any particular professional field. However, the suppo—

‘? .5. ' nO-.

sition that competence in an area of scientific knowledge can
be equated with competence in the skills of communication,
would seem to be as suspect as the suppostion that competence
in one discipline automatically endows competence in another.

It is the disparity between the attributes of the
connunicator's background and his ability as a communicator
that often presents a real obstacle to the effective communi-
cation of knowledge in the technical disciplines, such as
medicine.

New responsibilities for the communicator.--What has

 

been said thus far is probably applicable to centuries of
medical and other technical communications. With the advent
of television as a channel of communication, new responsi-
bilities have accrued to the technical communicator. Where
his ability as an essentially inter-personal communicator was
of concern, now his ability to utilize an electronic medium
effectively has become important.

In a discussion that touches on the very essence of
the problem of communicating via an electronic medium, Iago
Gladston states:

In the radio address and in television as well, does one

-72-

...primarily address himself to the listener, or does
one talk about a subject?...To address oneself ef-
fectively to a person, one must be competent to recog-
nize and deal with the psychOIOgical emergencies

arising during communication. But to address oneself

to subject matter requires no more than an adequate
knowledge of the subject and a competence to organize
that knowledge in an orderly fashion. To communicate
effectively with the living person, implies psychologi-
cally, to arouse curiosity, to enlist sympathy and to
lead to action, while he who talks to the subject matter,
so to say, sets out his stores and wares for him that
passes by to partake as he wishes. In these connections, F!
it is pertinent to observe that traditionally, the medi- ‘
cal man almost invariably addresses himself to his
subject. his mind is on the matter, not on his listen-

 

er. he Speaks of heart disease or diabetes or cancer. i

he is seldom anc little mindful of his listening audi- *

ence.l 3
Some methods for improving medical communication as 5'

 

it is affected py_the communicator.—-At least three methods

 

are available for the improvement of medical communication as
it is affected by the communicator. Quite obviously, the in-'
ept communicator could be replaced with a professional com~
municator--one especially trained in the techniques of ef-
fective communication. Equally obvious would be the plan to
train the medical communicator in the techniques of communi-
cation. While still another, and perhaps less obvious plan,
would utilize television to improve the communicator'sgnesen-
tation.

The employment of a professionalcommunicator in medi-
cal television programs would seem to enhance the opportuni-
ties for effective communication to occur. However, medical
audiences may well reject a message presented by a non-medi-
cal source. The credibility of the professional communicator
in the role of a medical communicator, unless it were obvious

that it wenea.role, would doubtlessly be quite low. Because

 

lIago Gladston, "What Have Radio and Television to
Contribute to Continuation hedical Education?" Journal of
medical Education, April, 1954, p. 29.

 

-73-
the influence of a communicator may be affected by the audi-
ence's perception of his expertness and trustworthiness, it
can be concluded that the use of a professional communicator
would generally be unacceptable in medical communication.

. Training the medical expert in the techniques of ef-
fective communication would, of course, be ideal. It would
combine the acceptability of the medical eXpert with the de-
sired qualities of the professional communicator. However,
the achievement of this ideal would be especially difficult
in the field of medicine, on more than a limited basis. The
time consuming demands of the profession must receive first
consideration, with the result that little time is left for
additional activities.

Demanding some effort from the medical expert, but
offering considerable communicative advantages, television
merits serious consideration as a means for improving the
presentation of the medical communicator. When television is
used, production techniques, audio—visual devices, and camera
work can all be used to focus the attention of the viewer on
the presentation. Tne communicative abilities of the medi-
cal expert can be greatly enhanced without placing undue de-
mands upon the communicator himself. At the same time, tele-
vision preserves the intimacy of live presentation that is
lost when a program is filmed.1

Some effects of television on the medical communi-
cator.--Medical television places requirements in addition to
effective verbal communication on the medical performer. The
demonstration of technique is a significant part of medical
communication, and has received considerable application in
the teaching of surgical skills. however, some objections to
this use of television have been made for reasons that bear

directly upon the the communicator. The live telecasting of

" 31'.

 

 

. lFor a_nore detailed account of television as a
channel for medical communication, see Chapter VI.

'1 L"(__1 .

1x=

-74-
surpical Operations seems to increase the tension present in
the operating room, and is for that reason considered as be—
ing undesirable by some surgeons.

Commenting on a televised operation to repair a

cardiac defect in a two year Old boy which was performed at
the Raymond Blank hemorial nOSpital, Des hoines, Iowa, in hay
of 1957, Dr. John Gustafson, one of the operating surgeons

stated: "...there was so much tension that I don't think we

want to do it again."1

In Detroit, the Wayne County hedical Society
asked members to stay clear of live surgical telecasts.
This request resulted from a proposal to do a live tele-
cast Of a Cesarean section....The Society felt that
participation in such broadcasts impose undue tension
on the surgeon.

The televised presentation of surgical technique.--
While little modification of present practices is required in
the teaching of operative surgery by television, Elsom and,
Roll have indicated some Of the changes that are necessary.

host surgeons apparently miscalulate the size Of the
surgical field visible to the television audience. This
is usually so small that only the actual site of the
Operation can be observed. The Spectators cannot at
once visualize the position Of the patient or the actual
location of the Operative site. It is important, there—
fore, for the surgeon to demonstrate any landmarks, and
to indicate whether the camera is placed at the head,
foot, or to the side of the patient. This orientation
of the audience avoids much confusion. The surgeon who
is accustomed to Operating before an audience seated in
an amphitheater has developed the habit of pitching his
voice to be heard by the audience and lowering it to
make remarks to be heard by the Operative team. On tele-
vision this habit can cause him some embarrassment until
he learns that the small microphone placed between the
layers of his mask picks up the slightest sound.
WhiSpered commands give an impression of nervousness or
irascibility on the part of the surgeon which is not
conveyed if he speaks in his usual voice. Actually, one

 

lNewsweek, May 13, 1857, p. 78.

ZCMT Newsletter, Fall, 1953, p. 4.

 

-75-

of the great attractions Of television to his surgical
conferees in the audience is the unrehearsed, unedited
informality with which the surgeon meets the vicissi-
tudes of the moment.

Many surgical presentations are slightly marred
by the inadequate demonstration of pathological speci-
mens removed at operation. These are frequently demon-
strated rt some distance from the site of Operation,
where the lighting is poor and the focus of the camera
must be changed in such haste that the spectators do not
Obtain a satisfactory view. If a towel is placed over
the incision and the specimen examined very deliber—
ately without moving it unduly, a good view is usually Ir:
assured. Since the television camera is placed 2 or 3
feet above the site Of Operation, it is inevitable that
the surgeon or his assistants occasionally obscure the
view for stort periods. when this occurs, an intercom-
nunication system permits the monitor to infoxm the
surgeon, who soon develops an awareness of the position
of the camera, which usually obviates the difficulty. .

...A running commentary by the surgeon should
keep the audience constantly oriented as to the details
of the Operative technique which is being Observed at a
given moment. This comhentary need not be continuous,
provided the audience is kept informed as to the purpose
and technique of some future steps which may absorb the
entire attention of the surgeon. If at some stage in
the operation time must be devoted to an Obvious step,
such as tying Off many hemostats, an Opportunity is pre-
sented for the discussion of unrelated subjects such as
the history, physical findings, indications for operation,
mortality statistics, postOperative care, and the like.
Use Of this time avoids such commentary at a time when
the audience would prefer to concentrate on watching the
technical procedures then being performed.

 

A Consideration Of the Message
in medical Communication

The design of the message.--Because communication

 

takes place with the receiver, it is the receiver who in-

fluences all of the elements in the communication process. If

one type of audience is to be reached, the program or message

will bear certain characteristics applicable to the interests

of the audience; if another audience is to be the receiver Of

 

leisom and 3011, pp. 1552—55.

-76..

the message, it will take another form.

medical programs reach two general types of audience:
l)professional, and 2)non-professional, or lay audience.ibth
types of audience require a Specific and different treatment
of program content, since the technical program suited to the
needs of the professional audience would not accommodate the
needs of the general audience. To be valuable to the phy-
sician, a program must present all significant medical in-
formation. However, some medical subjects may prove to be f“
objectionable to the lay viewer and therefore unsuitable for I
presentation to the general audience. Clearly, separate
programs would be necessary if the needs of both audiences
are to be met satisfactorily under such conditions.

Another consideration that occurs in planning tele—

 

577...;-

vision programs for both the professional and non-profession-
al audience, is one that relates to the audience's level of
medical information. Conceivably, a considerable degree of
misunderstanding could arise when a lay audience views a
program designed for a medical audience. The lay audience
simply does not have the background that is required to place
the medical information presented on a professional program
in its proper context. Again, separate programs, designed
with the audience's level of medical information in mind, are
indicated.

The medical program for the professional audience.——
;Further refinements are possible in determining the compo-
sition of the audience-—and therefore its requirements. The
;professional audience is largely composed of two groups: 1)
students in medical schools, and 2)physicians engaged inzmnhr
cal Luectice. because these professional audiences require
eui instructional program that differs in the level of subject
unatter, more than the nature of subject matter, the programs
reyyuired by these groups can, generally speaking, be consider-

ed together.

-77-

Structuring the medical program involves consider-
ations that differ from those in other forms of television
programing. There are seven types of format that seem most
adaptable to the medical program: l)straight narration: mono-
logue or single speaker, 2)back and forth dialogue: two
speakers with the question and answer interview, 3)trilogue:
the panel or symposium, 4)dramatic or re—enactmcnt, 5)docu-
mentary or essay form, 6)film, 7)a combination of all or any
of these formats.1 F

The choice of a format for a medical program is de-
termined by the theme of the program and also by the kind of
audience to be reached. Professional programs seem to divide t

quite naturally into two clinical categories: the surgical

 

and the medical. By its nature, the surgical program allows 5
comparatively little variation in a choice of format. It is
restricted pretty much to the confin s of the operating room
and the depiction of surgical procedures. In contrast, the
medical clinic, which is less restricted to a given area,
allows for a television treatment similar to that available
for non-medical subjects.
he surgical program.-—dithin the limited format that
is applicable to the televising of surgical procedures, it is
still possible to introduce some variations.

The surgeon can do a straight running narration as he
Operates. He can carry on a question and answer

session with a member of his operating team. He can
hold a round table discussion with other surgeons
watching the operation on a monitor located in the
studio who can discuss and demonstrate clinical material
pertinent to the operation.

The medical clinic pregram.--A greater choice of for-

;iat is available for the medical clinic than for the surgical

 

lWarren, pp. 40—41.

2"Medical Color Television: Story of Progress," JAhA,
November 21, 1953, pp. 1130—1101.

-78-
presentation. However, it is essential to consider the viszd
qualities Of a subject in planning the telecast of a medical
clinic, because a program that is not visually interesting
will soon lose its audience--and the Opportunity to communi-

cate.

Clinics proving of great interest because Of
their pictorial value have dealt with such subjects as
the administration Of shock therapy, biopsy methods,
cardiac catheterization of dermatological lesions,
fresh autopsy material....Presentations built around F‘
demonstrations with patients are almost uniformly suc-
cessful, whether they show, for example, the classical
facies in endocrinological disease or depend on inter-
views in which Eeficallfl interesting histories are F
elicited or the patient's reaction to certain forms Of '
treatment...are discussed.

 

Blsom and Roll have cited some clinical presentations E5
that have been particularly successful, such as those con-
cerned with the develOpment Of methods of speech following
laryngectomy; the results of ACTE or cortisone treatment in
cases of rheumatoid arthritis; the results of ileostomy in
cases of ulcerative colitis; the care of a colostomy patient;
the postoperative results in operations for congenital heart
disease. It was pointed out that patient participation has
served to add interest to the clinics in each of these casesfiz
The utilization Of visual techniques.--Particular
attention was given to making programs visually interesting
and stimulating when the American Cancer Society and the CO—
lumbia Broadcasting System presented "Telecolor Clinics."

For the purposes of identifying anatomical structures,
explaining Operative procedures, demonstrating tech-
niques of radiation therapy, and illustrating diag—
nostic methods, plaster anatomic models were used.
Sponge rubber models, having all the advantages of
plaster models, with the added quality of flexibility
that permits the insertion Of instruments or an ex—
amining finger, were used to demonstrate the Special
techniques of proctoscopy or bronchoscopy. While the
flannel board and the magnetic board proved worthwhile

 

W

leisom and Roll, Ibid. 21bid.

 

0]. vi .. ..
csoft$ ‘.

.
c . t
. g .. .

“ .0. .lM . -

 

-79...

visual aids, it was found that the chalkboard was un-
satisfactory because erasures left the board clouded.
The problem of long lists, that did not compose well
within the 3:4 ratio of the television screen, was
solved through the use of a revolving drum.

The medical_program for the general audience.——hedi-
cal subjects on television shows for the general viewing
public have attracted sizeable audiences. In 1957 there were
at least eight medical—line network shows telecast weekly,
with a combined national audience of some 50 million.2 By
comparison, the preceeding year had averaged only two medi-
cal programs a week and attracted only about 10 million
viewers.3

Independent radio and television stations in every
region of the country, co-operating with local medical
societies, are finding vast and eager audiences for
medical shows woven in such varied formats as: music,
interview, drama, panel discussion, question and
answer, demonstrations and individual reporting.

Audiences found programs that utilized a panel Of physicians
with a lay moderator to be the most appealing.5

There has been a considerable degree of success with
medical programs that originate on a local level.

Local medical societies achieve the warmest 'personal'
touch in television authenticity. You feel it as a
member of the Medical Society of the County Of new York
features real patients before live television cameras
making a real diagnosis and prescribing real treatment.
You sense it as the Winnebago County Medical Society in
Rockford, Ill. televised mass visual eye tests for
school-age children. Doctors of the hedical Society of
hilwaukee County let their WThJ-TV viewers peer through
a microscOpe, watch electrocardiographs in Operation,
and examine detailed sections of the body through the
use of an anatomic mannikin.

 

1A.I. holleb and B.f. Buch, "Color Television in Medi-
cal Education," JANA, September 25, 1954, pp. 299-300.

2"how Authentic is Medicine on Television?" JAHA,
Xuay 4, 1957, pp. 48-51.

31bid. 41bid. 5Ibid., p. 5o. 61bid., p. 51.

 

 

fii

 

-. ‘7‘.

“an .

 

 

—80-
The concern that the medical profession has expressed
over the medical prograns produced for lay audiences would
seem to be justified in terms of the results that some medi-
cal programs have produced. In Luffalo, five doctors offered
to answer questions for a television audience on the dangers
Of Obesity and nearly 18,090 calls flooded the station satch—
board. When the first American telecast of surgery for lung
ancer was made in Louisville, Kentucky, in 1953, an unprece-
dented voluntary demand for chest x—rays developed in the F1‘
perioc of a few weeks. Blood donations increased and people I

who had been hesitant about reporting for routine physicial
l

\ .' k)~

examinations, went to their doctors.

As a television viewer, the layman has been witness

 

to the process of birth, to heart surgery, and tO numerous
other medical and surgical procedures, once confined to the
experience of the physician. The layman has had the Oppor-
tmmtytoconsider various health problems and to learn more
about himself. Television, as the medium of communication,
has been significant as the factor that has enabled the lay-
man to acquire greater insight into an important area-~medi-
cine.

The treatment of "sensitive" subjects.——lnherent in

 

the production of medical programs for the general audience,
is the problem of presenting the "sensitive" subject. The
"sensitive" subject is found in those areas of medicine which
some feel may serve to Offend some lay viewers. In general,
eXperience has shown that audiences are much less sensitive
than imagined, and that the technique of presentation of
such subjects Often determines the nature of their reception.

The pioneer program, "Johns HOpkins Science Review,"2

 

l"Medicine's Fifty Million 'Fans'," JARA: May 4:
1957, p. 53.

4For a detailed account of this program see: Leo

Geier, Ten Years with Television at Johns Hopkins, (Balti-
more: The JOhns Hopkins University,‘l958TT

a. . . . 3 I: -... OH- - .
. ...vr 1]“! ..hi}..!.. ..
. u ( ...

Vx -..

‘I \c\|
f Pf;

 

 

-81—
did much to diSpell what was felt to be an artificial atti-
tude toward televising the "sensitive" subject.

While producers, sponsors and performers of other net—
work programs were rapidly entwining themselves in
taboos brought on by unfounded fears, the hopkins
program stood alone in proving them wrong. Hepkins
scientists, particularly in the field of medicine, re-
fused to recognize these taboos. Through their daily
contact with people these men knew that mid—Victorian
attitudes toward the body and unpleasant physical situ-
ations were a thing of the past....These scientists,
and the program's producer, felt that medical termi—
nology and disease situations should be used factually
=and without embarrassment, and that they would be ac-
cepted in good taste by viewers. Their contention was
dramatically proved when the "Science Review" produced
a series of three programs on cancer. Ehe series was
an early one exploring unusual topics of interesfl. The
programs involved a frank discussion of the breast and
cervix, using all the necessary anatomical terms and
drawings usually seen only in physiology class....The
program had been opened with these remarks, 'We are go-
ing to discuss tonight a mature subject every woman,
and girl, too, should know.‘

The audience reaction to the frank, mature, and
honest programing concept of the "Science Review" producers
"...was overwhelming. Letters poured in. Jone were criti-
cal."2

Other experience with "sensitive" subjects.--EXperi-
ence in educational broadcasting at the Chicago Junior
College has also shown that the message and its manner of
presentation are more influential in determining public ac-
ceptance of programs dealing with sensitive tOpics, than the

ature of the topic itself. "Sensitive materials can be pre-
sented on open circuit television, for example, race re-
lations, evolution, and human reproduction have been discuss-
ed. Sound scholarship and a professional attitude on the

part of the instructor are vital in this connection."3

 

lGeier, pp. 37-38. 21bid.
P. Hasiko, Jr., "What Research Tells Us About Teach-

”h

ing by Television," Junior College Journal,.kpunU£,lflx>,gulf.

 

 

 

 

deceiver helated Considerations
in Medical Communication

The significance of the receiver.-—Circumventing the

 

channel, the next element in the process of communication to
be considered is the receiver. The significance of the re-
ceiver to the communicative process cannot be overestimated.
It is, after all, for the receiver that the entire communi-
cation process is initiated, and it is with the receiver that
the ultimate success of a communicative endeavor must be de—
termined. If a breakdown in the communication process oc—
curs at the level of the receiver, then all the intermediate
elements from the source to the receiver become worthless.
Medical television and the receiver.--As a subjective
index of the effectiveness of television as a means of medi-
cal communication, some audience evaluations are available.

...A survey of...physicians Ettending the Missouri State
hedical Association in St. Louiglwas conducted to de-
termine their opinions of the effectiveness of color TV
in postgraduate teaching of surgery. Of 116 physicians
who answered the questionnaire, 9 % preferred to watch
surgery on color television rather than from an oper—
ating room amphitheater, and 52% preferred to observe

an operation on color television rather than from a
place beside the Operating table.

...Avsurvey conducted...during the annual session of
the American College of Physicians in Boston...although
not recorded statistically, indicated that the great
majority of fellows desired an expansion of the tele-
vision portion of coming programs.

...A recent television broadcast illustrating cardiac
surgery met with all sorts of diverse comments, mostly
of a condemnatory critical nature....ln the realm of
closed—circuit, television programs in which Operations
were televised, the students and resident staff felt

that they got very little from such programs. Of course,
certain specialties, better than others, lend them—
selves to television, but these have not been defini-

 

lJAMA, december 15, 1251, p. 1553. 2Ibid.

 

 

V . q.
.’ ‘I p
.v C. K. .
.. ....lt.- . .
O‘..I.‘ .‘opj.~c .

I .u I... .OHI'U . o . . . .Y . ..o .‘90

 

 

~83—
tively explored.l
Smith, Kline and Frencn Laboratories has presented
1138 clinics and 705 surgical procedures on television over
a period Of seven years.2 A survey conducted by the firm
comprised Of a thousand questionnaires sent to physicians
showed:

...98.4 per cent of televiewing medical doctors favor
including TV in the meeting program; 81 per cent prefer
color TV clinics to platform (or auditorium) clinics;
84 per cent prefer to view surgery on color TV rather
than from an amphitheater; and 70.5 per cent prefer to
watch televised live Operations rather than color film.

While it was initially considered that the novelty
effect Of television had much tO do with drawing physician-
viewers to demonstrations at medical meetings, experience has
shown that rather than the size of medical audiences de-
creasing, they have increased as time has passed. To some
observers this has been "...gratifying testimony to the place
medical color TV had won in the estimation Of physicians no
longer impressed with its 'newness.'"4

Objective evaluation and the receiver.--Objective
evaluation Of televised learning is an area that is still in
need Of further research.

We do not know enough about the assessment of learning
gains which result from the use Of television. Particu-
larly, there is an acute need to develop better methods
for assessing complex learning. It should be possible
in the medical fields to make extensive use of per-
formance tests to evaluate the effects Of mediated
learning on performance skills. Also, there appears to
be great possibilities for using film tests or exami-
nations along with television tO assess the achievements
even Of geographically dispersed audiences Of learners.

 

1Letter from Cornelius H. Trager, Editor, Medical
Radio System, New York City, August 18, 19¢).

 

2Paul A. Greenmeyer and Paul C. Schmidt, "How Ska?
Uses Color Television," Closed—circuit Television Appli-
cations, RCA Publication, July, 1957, p. 2.

Blpig. 4"I-ledical Color Television...," p. 1101.
5Carpenter, p. 12.

i1

-.—» ‘

 

...-

.12

 

 

..84—
In considering the evaluation of open circuit tele—
casts, a "model Plan" proposed by the Council on Medical
Television states:

4

Unlike closed—circuit telecasts, the effectiveness OI
postgraduate teaching by TV in the practitioner's home
or office cannot be evaluated a priori. A arefully
designed pilot—scale trial is indicated....

Some of the features that would be included in such a plan
are:
(l)Preview testing of prerecorded program "cores" at a F‘?
postgraduate medical center.
(2)8ample survey testing in various types of medical com-
munities: a)metropolitan b)mixed urban-rural and ohms—

dominantly rural, of audiences composed of 100 phy- *

 

.

sicians in each group. b;
(3)A cooperating postgraduate medical center, in or near

the test communities would arrange to handle questions

from the local audience and conduct seminars or teach-

ing rounds as required.
(4)A set of self-administered objective tests given'mnOre

and after the course would be used to estimate the

subject matter learned as a result of the course. Code

numbers selected by participants would serve to identi-

fy the test papers for purposes of comparison and would
assure anonymity.2

Evaluation in an actual situation would be more

ccnnplex than that done with the relatively small test audi-
erlce, but would, of course, be more realistic.

Factors, such as, the influence of formal registration
upon the consistency of viewing and the amount learned
from the course, and the percentage and characteristics
of the physicians who regularly take advantage of the
educational Opportunities afforded by these courses,

lch, Report of the First Meeting, p. 44.

21bid., pp. 44-45

 

 

-85—

either ty informal participation (occasional viewing) or
formal registration for the course, can be assessed.
Accurate information of this type is needed to provide
a solid foundation for all efforts to make TV a truly
effective tool for postgraduate education.
A special problem: the unintended receiver.——In—
herent in the design of a message is the concept of a spe-

cific receiver, or set of receivers, for whom the message is

intended. "The communicator intends to affect the responses
of a particular person Er group of personfl other than himself. Ffih

 

However, his message may be received by the person for whom

it was intended, or by persons for whom it was not intended,

 

or both."2 What is important is that a message nay have an i

undesirable effect on the unintended receiver or may result ,_;
.‘ -J

in his unjustified criticism of the message, irrespective of 25
a

the fact that the message was not intended for him.

No where is the problem of the unintended receiver
more acute than in the use of open circuit television for
medical programs. Open circuit, with its readily available
facilities and uncomplicated viewing characteristics (as com-
pared with closed circuit and "scrambled" image television),
offers a most desirable means for telecasting medical tele-
vision programs. However, the same viewing characteristics
that make the open circuit program available to physicians on
their home receivers, also make it available to the general
public. When the prOgram is one of a professional medical
nature that has been designed for a physician audience, lay
viewers who would happen to watch the program would consti-
tute unintended receivers. The advice has been given that
‘planners of medical programs't..must always think of the
.public as a Peeping Tom, looking over the physician's

shoulder as he views the broadcast meant for him."3

 

llbid., p. 31. 2Berlo, p. 15.
BCMT, Report of the First Meeting, p. 28.

 

 

 

-85-
The use of open circuit television and the resultant
consideration which must be given to the unintended receiver
pose some specific questions:

(l)Do the restrictions imposed...limitations on the use
of clinical materials, inhibition of candor, exclusion

of realistic mortality and morbidity statistics, etc.,

reduce the educator's effectiveness in teaching clini-

ggl subjects to clinicians?

(2)How broad are the areas in clinical medicine that can
be effectively covered without offending public sensi—

 

bilities of producing iatrogenic effects? f‘
(3)Does the lack of overt complaints mean that no harm g

is being done?

(4)How many lay viewers watch the program even though .
they understand it only partially, if at all? And what 1

impressions do they actually take away? .

(5)Can proper choice of broadcasting time limit the lay L,

audience without affecting the physician audience?

Some possible solutions to the problem.--Several tech-
niques have been devised for resolving the problem of the un-
intended receiver in the use of open circuit for medical tele-
casts. For a series of weekly open circuit telecasts by the
University of Utah,

...program schedules are mailed to physicians only.
Program time is 10:30 P.m. At 10 P.h., the ETV station
(Channel 7, KUED) announces the completion of its broad-
casting activities and a 30 minute period of 'dead air'
follows. It is felt that this interval substantially
reduces incidental lay viewing.

Wayne State University in a series designed to ac—
quaint practitioners with psychiatric principles, made no at-
tempt to make the programs understandable to incidental lay
viewers and used the facilities of a UhF channel which it was
believed would "...substantially reduce the possibility of
public viewing." The result has been that "...neither Wayne
State nor KPEC—TV has received any unfavorable reactions from
the public."3

 

lIbid., 2GMT Newsletter, December, 1959, p. 3.
31bid., Fall, 1959, p. 3.

 

 

-87—

Ciba Pharmaceutical Company has developed a program
format for Open circuit transmission that consistsof azfimumre
story and a round-up of the latest medical news. "Strictly
medical terminology is used, and the laymen who happen to
see the show will have difficulty in following it. In this
way it is hoped that anyone other than the intended audience
—-physicians--will be discourged from viewing it."1

Supplementary techniques for supplying restricted
information to the medical audience only, while the general
audience receives the non—restricted information, have been
suggested in at least two forms. Program booklets distribufiXi
to physician viewers to accompany the telecasts, "...can.sane
an additional function-~that of supplying information not de-
sirable to broadcast, e.g., mortality and morbidity statunncs,
or prognostic considerations."2 Dr. Frank Woolsey has sug-
gested the use of two sound tracks with each telecast. Track
I, prepared for lay viewers would be troadcast with the
picture as is usual; track II would be for physicians only,
and would be transmitted on a different wavelength.3

When several problems inherent in the proce s are re-
solved, "coded" transmission may well prove to be the most
feasible plan for securing privacy for medical telecasting.4
Involving the use of "scrambling" devices, the coded process
makes it impossible to receive an intelligible picture on a
television set not equipped with a Special "decoder." Escause

the system is essentially the one that is utilized for sub-

 

llbid., Spring, 1959, p. 3. 2ch Report, p. 3o.
31bid., p. 32.

4Several methods Of "coded" transmission are awfllable.
In one type the signal is encoded at the transmitter, and re-
ceifinars equipped with special decoding devices are used. An-
other involves "multiplexing," which permits one channel tote
lised fer two simultaneous broadcasts. This would permit one
prxugram for the public and a second to physicans transmitted
viii "coded" technique. At the present state Of multiplexing
scum; reduction in the quality of the picture has been noted.

. ‘1‘: ... 3

 

‘ . -
.
n
.o'
‘;

 

 

-88-
scription television, its implementation must await a favor-
able decision by the Federal Communications Commission that
would permit "coded" transmission.1

The problem from another perspective.--While the use
of Open circuit transmission has been considered from the
point of view of providing privacy for the physician-viewer
and eliminating the lay-viewer, there is also the lay-viewers
interest to be considered. The medical program may not always

be acceptable to the lay viewer. The detailed views of an

aria-1

Operation, necessary for the physician-viewer, may well not
be pleasant for others to view. As Mr. William J. he Donell,

of the Federal Communications Commission Field Office in Chi-

 

cago, has pointed out to a medical audience:

rs
l'...

...a considerable amount of programming going on through
the last few years in connection with medical television
...was on our regular broadcasting stations, or on edu-
cational stations. If the functions of those stations
were to be continued, it might not be possible for Ehy-
siciana to share the facilities with them, particularly
where you have the type of picture that you have shown
here today. In some cases, of course, the pictures
would be educational to the public. In that case,
programming would probably be allowed. But obviously
where that type of picture would be satisfactory to the
public ...it would not be satisfactory to you Es phy-
siciang because you want to get down to studying unre-
stricted medical material.

Research applicable to the problem.—-Over a two year
period the Division of Postgraduate Medical Education of the
‘University of Utah, has presented weekly half-hour open.cinmnt

telecasts designed primarily for the general practitioner. A

 

1Representatives of the Federal Communications Com-
mission who were present at the first meeting of the Council
on Medical Television, stated that until such a time as a
concrete proposal for private telecasts to physicians was pre-
sented to the FCC, no opinion could be given as to the diSpo-
sition of such a request. For the present, such proposals
could be made by a station which would ask for a waiver on a
short term, experimental basis, of existing regulations.

2Proceedings of the Annual Congress..., p. 69.

 

 

-59-
research study Of an eight week course on Diabetes Mellitus
considered among other things, the number and reactions of
lay viewers. It was found that: "...assuming thoughtful se—
lection and presentation of subject content, there seems
little danger Of Offending the public or generating undesira—
ble patient-doctor feedback."l

 

lch Newsletter, September, 1960, p. 4. The Utah
study was conducted by an independent research organization
and the final summation was based upon: l)physician audience
measurements, 2)physician viewer attitudes, 3)depth inter-
views with physicians who had, and had not, seen the tele-
casts, and 4)number and reactions of incidental lay viewers.

In evaluating the results of this study, a pertinent
consideration would seem to be that the subject, Diabetes
nellitus, may be more acceptable to lay viewers than some
other medical subjects would be. However, the conclusiontkms
tend to support experiences of the Johns Hopkins "Science Re-
view" and also of the Chicago Junior College in the area of
the presentation of sensitive subjects.

Similarly, when Wayne State University presented a
series designed to acquaint practitioners with psychiatric
principles, no unfavorable public reaction was received. lflus
is especially interesting because the programs were presented
during a prime viewing period and via Open circuit. The
series was seen on a UhF channel from 8:00 to 8:30 P.h. on
Friday evenings. Subjects covered included: Introduction;
Use of Drugs in Alcoholism; Narcotic Addiction; Facilitiesfcr
the Alcoholic and his Family; Depression; The Suicidal Patnmn;
Isychiatry of Invalidism; Emotional Problems of Children;
Psychiatric Emergencies; nd Psychotherapy in hedicallkactkw.

 

mfi “in: 73-?

*.‘.; 2113”“;
4

 

 

CHAPTER VI

TELEVISION AS A CHANNEL IN THE PROCESS
OF MEDICAL COMMUNICATION

Television in Medical Communication:
A Consideration

The significance Of the channel.--In purpose, the
channel1 serves as the carrier, or medium, for conveying the
message, and all messages exist in one or another form of
channel. Most significant in the consideration of thecfiwnnml
is that "...the choice Of channels Often is an important
factor in the effectiveness of communication."2 No whereckes
this concept seem more applicable than it does to medical communi-
cation. The apparent hiatus in essential medical communi-
cation--the probable result Of the employment of inadequate
channels for contemporary medical communication--is made evi-
dent by an examination of the existing process Of medical omn-
munication.

The traditional activities: reading, personal con-
tacts, professional meetings and intra-mural postgraduate
courses, have become the accepted techniques for communi-
cating available medical knowledge. When medical knowledge
was relatively limited in scope and the physician's mode of
practice less complicated, these techniques were apparently

satisfactory. However, changes in the dimensions of medical

 

1Having considered the other elements in the process
of communication in a proper sequence, the consideration of
the channel was omitted from the sequence for special con-
sideration in this chaper because of its particular relevance.

2Berlo, p. 31.
-9o-

““1
;’ J

:1. _-‘_

 

1C" -11 fi-
4“;

 

 

-91-
knowledge and the nature of the physician's practice make
these inadequate and ineffective.1

rhysician-Oriented communication.——The postgraduate
medical course offers the most competent source of medical
information that is presently available in a comprehensive
treatment. "The increasing demand for refresher and other
special short courses reflects a desire on the part of practi-
cing physicians to receive well—organized, systematic presen-
tations Of new medical knowledge as well as review of basic ffi‘
principles and techniques."2 t

Still, for all their merit, postgraduate courses are
deficient in this respect: they are teacher-oriented, not phy-

sician oriented. The physician-student must travel to the

 

teacher-~a factor that may keep some physicians from attending pt
such courses.3

Physicians in both urban and rural areas find it diffi-
cult tO absent themselves from their practices to attend
postgraduate courses without curtailing the effective
medical care they render to their communities, to say
nothing of the economic losses they may incur through
loss of practice and the expenses of travel and mainte-
nance while away.

In an endeavor to eliminate the need for the whencian
student to travel to the teacher, various attempts have been
made to bring the teacher to the physician-student. There
are extramural postgraduate courses Offered--about one-third
of the available courses Offered are held outside of medical

schools and their hospitals.5 "In some rural areas...visiting

 

lDarley and Cain, p. 33. ZJAMA, January 1,19aip.41.

3Travel was considered a considerable deterrent tO
_physician attendance at postgraduate courses in the Vollan
study. However, the more recent studies have shown that phy—
sicians travel more to attend courses than had been assumed
;previously. See: Glen H. Shepherd, "History of Continuation
Funiical Education in the United States Since 1930," Journal
<of Medical Education, (August, 1960), p. 756.

4JAMA, Ibid. 5Shepherd, p. 755.

 

 

-92-
teaching teams from medical schools Effer 'circuit' courses
or regional hOSpital affiliation programs."1 In Utah an
"Audio—visual Seminar Kit, including a recorded medical dis-
cussion, a set Of 35 mm slides correlated to the discussion,
a table top slide viewer, and a script of the discussion, has
been developed for use by the physician in his home or in his
Office.2 The kits, prepared by the University of Utah dnlcge
of Medicine, met with considerable success; more than one—
third of the physicians in the state used the kits in a six-
month period.

Aural techniques have also been utilized in the at-

tempt tO bring information to the physician. A two-way radio

 

system between community hospitals and the Albany Medical
College was established in 1956 as: "...an effective means i;
for Obtaining participation in postgraduate medical presen-
tations without undue eXpense, End ta save travel time for
both faculty members and physician-students."3 Tape—recorded
abstracts of medical literature have been made available to
physicians on a bi—weekly basis by the California Medical
Association, since 1954.4
TO varying degrees, the measures just described do
carry postgraduate programs to the physician, and with some
advantage over his being required to travel to a remote course
However, the extramural courses and the two-way radio system
still are group activities necessitating that the physician
travel to a central location to join the sessions. Also, ex-
tramural courses "...put an additional strain on the already

limited teaching resources of undergraduate medical schools;5

g

lJAMA, Ibid.

2Robert 8. Warner and John Z. Bowers, "Program of
Postgraduate Medical Education," JAhA, April 14, 1956, p.
1307.

3Shepherd, Ibid. 41bid.

5Thus affecting undergraduate medical education.

 

-93-
since the burden of travel is simply shifted from the many
students to the relatively fewer teachers."l What has been
accomplished by these methods is the shifting of postgraduate
instruction from a teacher-orientation to a group-orientation.

More physician—oriented are the "Seminar Kits" and
the "Audio-Digests" that can be used in the physician's home
or Office and at his convenience. Still, slides cannot de—
pict motion or convey "immediacy;" audio—tapes and two-way
radio cannot present the visual. In the critical consider-
ation of the liabilities of these devices, the assets of an-
other method for conveying medical knowledge become apparent.
What slides and audio-tapes cannot do, the medical motion
picture can do. Medical subjects can be brought to the phy-
sician in color and motion, and with sound, by means of the
motion picture. However, films require projection facilities
which are more apt to be found in a group, rather than in an
individual situation--so must be considered as being a group
oriented activity. At best, films can reproduce, but cannot
convey the immediacy Of a sudden surgical emergency and the
surgeon's efforts to retain control of the situation. When
surgery is filmed, the audience knows that the film editor
can rectify what the surgeon cannot.

The counterclaim can be made, of course, that each Of
the devices named has a specific merit in a specific situation,
and that it is unfair to expect a device to do more than it
is designed to do. Yet, to concur with this pointcfiwnew'hsto
acknowledge an entirely unnecessary restriction in the use of
such devices for they are often capable of much wider appli-
cation. -

Television: a master communication medium.--Utilizing
television as a channel of communication gives an immediate
extension to the usefulness Of those techniques and devices

which formerly received much narrower application.

 

lJAMA, Ibid.

 

 

 

 

—, -
,/

...Nith adequate confidence we can assert that in a
sense television is a master medium. hany other teach—
ing media and operations can be channelled gfi through
television. That which we can accomplish e ucationally
with sound motion pictures can be accomplished also by
film projected through television or in some cases by
TV used alone. The same applies for lectures, lecture
demonstrations, graphics, audio-recordings, print, etc.

The relationship is a symbiotic one: television extends the
applications of the techniques and devices which in turn en-
hance the messages carried by television.

The common denominator problems.-—Carpenter has desig-

' .‘_._..3

nated as "common-denominator" problems those problems which
"...are basic to the unique characteristics of the media--

radio, films, television, print, and other instructional ma- J
terials."2 ,j

What are some of the major fundamental problems which
must orient and guide our planning and developing of

new instrumentation and new methods to meet the mounting
requirements of education, including advanced profession—
al education?...There is a complex of common problems
involving the analysis of the characteristics and capa—
bilities of the audiences of learners, be they students
in schools and universities or practicing lawyers and
doctors. We must analyze in detail, if our educational
Operations are to be successful, the needs to know, in
relation to what is known by those who would learn, and
in relation to available knowledge or information. Then
we need to determine, with far more precision than is
usual, the information, intelligence, or performance
skills which must be communicated.3

 

r:-

 

However, these are not the only problems that obscure
the way to the ultimate goal. There is the problem of how to
bring "...information into effective interaction with men who
have, or should have, the need and motivation to learn."4
More must be learned about motivation, perception, and
learning; about the structure or organization of information

which is to be communicated; about the assessment of effects,

 

lCMT Re ort, p. 11. 21bid., p. 10. 31bid.
41bid., p. 11.

 

 

-95-

the measurement of net learning gains, including the im-
provement of performances.1

Instructional television research.--At Pennsylvania
State University research has been carried on for more than
eight years on sound motion pictures "...to explore their
possibilities for extensive, rapid mass training of a mili-
tary character...these research findings have direct bearing
and significance for improving instructional television com-
'-..-1unications."l Additionally, five years of research have been
done oh using closed circuit television in university anuses.
hany of the basic findings and theoretical results of this
research are applicable to important aspects of broadcast
television when employed for advanced professional training.2

The effectiveness of a means of instruction, such as
television, cannot be considered properly without also con-
sidering the characteristics of the learner. "Learning de-
pends equally, as much, or more on the active characteristics
of the perceiving person as on the characteristics of the
stimulus materials or 'message.'"3

Effective instruction can be successfully re-
moted by means of television. Space or distance can be
Spanned either on the input or output sides of the system.
This proposition holds for a very wide range of subjects
however they are classified, subjects which range from
logic and mathematics through the science to the arts.
This also includes complex learning such as the mastery
and applications of principles, understanding complex
concepts, restructuring of attitudes, and appreciation
of aesthetic qualities.

Research done at Pennsylvania State University has
shown that, with adequate television systems, competently
maintained and Operated, the three groups of factors or de-
terminants which most importantly affect the amount and the

quality of learning include:

 

lIbid. 21bid., p. 9. 31bid., p. 11
41bid.

 

 

 

 

 

   

  

9...... ...-12.... . u

ohm-... I: ..If.

-95-
(l)the instructor and his competencies and performances,
(2)the subject matter, and (3)the student or learner and
his characteristics relevant to the required learning.
The role Of television, then, is to make possible
create, and intensify the interactions within and among
these three clusters Of basic determinants.

 

 

If it is true that television is, and only can be, a
medium of communication, it would seem that if there is to be
any improvement in instruction by television it must come in
those areas affected by the teacher, the subject matter, and
the learner. "The real problem becomes that of how to improwa
the teaching performances Of instructors; how to improve the
selection, organization and presentation Of subject matter or
content, and how to engage and motivate a capable learner to
increase his learning."2

Some areas where further research is needed.--Many
very significant areas Of experience still require extensive
exploration before television can become a totally effective
instructional medium. The comb'nation of different media and
learning resources in order to produce summated effects which
approach maximum learning, is little understood.3 "...Wermmd
tO know how to combine media for maximum effectiveness, and
we need to know how the media alter or Change the information
channelled through them."4

We need to know, particularly on the operational
levels Of instructional television, how to counteract
Parkinson's Law Of progressive complication. How do we
keep our systems Of equipment, staffs, and associated
production Operations adequate but not unnecessairly
complex and expensive. We need some realistic standards
tO guide our judgements and decisions, and these standards
must be appropriate tO instructional television and not
network television. The standards must relate to the
efficiency Of instruction and not to entertaining peOple.

 

...We need to know a great deal more than we do
about mobilizing the resources that are needed tO support

 

 

 

llbid., p. 12. 21bid. 31bid., p.'12-13.
41bid., p. 12.

 

 

 

 

-97-

instructional television programs. How do we get our
best teachers, best and most important courses and
program made available for television? Then, how do

Je arrange for the availability of the needed distribu-
tive capacities Of television to meet the needs Of medi-
cal education? Must we provide a fourth national network
dedicated to significant educational purposes?

The Television Medium

Attributes Of television.—-Television has several

 

attributes which serve tO especially recommend it as a.channel
for medical communication. David Sarnoff has provided an im—
aginative description that illustrates graphically how the

attributes of television can be used to serve the medical pha-

fession. Mr. Sarnoff has said that:

 

...Anything the human eye can see can be transmitted
by television in true color.

The details Of an Operation or the appearance Of
a lesion can now be sent tO any desired point for exami-
nation. Any malfunctioning area can be studied without
the examiner actually visiting the patient. We can en-
visage a time when the individual patient, in a hospital
or at home, can be viewed and advised by a physician
from any distance. Microscopic slides and x—ray pictures
can be studied at places remote from their physician lO-
cation. Any picture in motion--let us say Of an Oper-
ation in progress--can be viewed directly, in normal size
or greatly enlarged, at any desired point of reception.

Panels of specialists hundreds or thousands Of
miles apart can consult about a case. Fully illus-
trated symposiums can be held in many hospitals or
meeting halls in widely scattered Cities at the Same tin;

The living record of an Operation or Of the tdsto—
ry Of a medical case, moreover, can be put on magnetic
color tape for leisurely viewing and study in the future.
In the hospital, a skilled supervisor at a central con—
trol station can literally 'see' the entire institution
without moving from his seat, dispatching nurses and
doctors to points where they are needed.

Elosed-circuit televisiofl...means that vital in—
formation and skills in one community have become readily

 

1.1..b._i_(.i.‘.' ’ p' 130

 

 

(

available to the rest Of the country. It means that the
genius Of an outstanding teacher or specialist, hither-
tO confined to one university or hospital, can be made
accessible to interested men and women anywhere. In a
period when significant new medical knowledge and tech-
niques are constantly being unfolded, this electronic
ability to disseminate them widely and rapidly should
prove Of unestimable value.

Television in teaching, research, and medical care.-—
Medical school faculty members, "...as the source Of the
teaching program, are the essential fabricators of any compre-
hensive plan for the use of television in its five audience
areas: medical students; practicing physicians; Specialists;
dentists; nurses and allied scientists; the lay public."2
Television can provide the faculty Of a medical school with:

l)A mechanism for inter—departmental cooperation. A
television demonstration Of thoracic surgery, for ex-
ample, might call upon the departments Of anatomy,
physiology, pathology, anestheOlOgy and medicine for
contributions, in order to deepen the meaning Of what
otherwise might be primarily a demonstration of surgi-
cal technique.

2)An experimental field for pedagogic techniques. There
is general agreement that course boundaries tend tO
vanish in the clinical subjects. However, the problem
remains Of how to recall to the minds Of clinically ori-
ented students the basic science foundations Of clinical
practice, how to present the complexities Of doctor-
patient relationships and the contributions Of other pro—
fessions and of community agencies, and how to develOp
the civic as well as personal maturity demanded Of the
true physician.

3)Aid in the solution Of burdens Of postgraduate in-
struction.

Television teaching for some specific audiences.-—

Television Offers advantages for meeting instructional needs

 

lDavid Sarnoff, "Color Television and Biology," JAHA,
August 2, l958, pp. 1781-82.

2V.E. Bazilauskas, h.V. Dyer, and D.S. Ruhe, "medical
Education and Television," Journal of hedical education, July,
1951, p. 246.

31bid.

 

 

 

 

for some specific medical audiences.

Television teaching for medical stucents.—-The
intearation and correlation of courses within the school
of medicine has bec0me a kind of holy Grail sought by
most educators and found, if at all, by a rare few. It
is precisely in this area of correlation that television
probably can make its greatest contribution by;gnmitfing
the teacher to lead the student freely throngh time and
Space, and interchangeably from clinical to basic sciences
and even into the social sciences

 

Television teaching for practicing physicians.——
Faculty members fully recognize the obligation to engage
in lectures and discussions with practicing physicians.
hut they deplore the time-consuming—-even debilitating£-—
aspects of travelling frequently over many miles for two
or three hour meetings. Television would permit the
burdened Specialist to teach many practicing physicians
without ever leaving the medical center. He would not
only save a C«,reat deal of time and effort, but he would
be able to call upon a wide range of ancillary, illustra—
tive, and demonstrational materials which he can take
with him to distant meetings only with the greatest dflfii—
culty.

 

Conversely, busy practitioners would not have to
Spend disprOportionate amounts of their free time travel-
ing to metropolitan centers to participate in discussions
and lectures....

Television teaching for dentists, nurses, and al—
lied scientists.--Allied medical fields can be given
practical avenues of communication through television in
the same manner ttat television crosses departmentalldnes
in medical schools.

 

 

Television applications to research.--To theLMXJ—
cal researcher television can offer several advantages:
(a)the light sensitivity of the television tube means
that fluorographic screens can be visualized in virtual
darkness; (b)clinical material can be telecast without
the special and distrubing lighting required for motion
pictures; (chsychiatric patients can be studied and
kineSCOped without obtrusive and expensive studio
lighting; (d)the development of small picture tubes will
find use in endosc0py; (e)special sensitivities of tele-
vision tubes lend themselves to 'electronic stain' tech-
niques——useable in telemicroscopy.

 

Ibid., w. 247. 21bid. 31bid.

 

 

 

 

 

—1oJ—

The liabilities of television.—-Jhile television

   
   
 

 

offers many advantapes as a medium of communication, it also
has some disadvantaées. In general, television's disad-
vantages may be considered as being either channel related,
or use related. Channel related disadvantages would be those
that arise from the limitations of the channel, while use re-
lated disadvantages are those that become obvious during the
employment of the medium.

A channel related liability.——An essential part of
the communication process is the feedback, or response, that
occurs between the receiver of a message and the source of
the message. "Feedback provides the source with information
concerning his success in accomplishing his objective. In
doing this, it exerts control over future messages which the
source encodes."l

In inter-personal cohouhication, there is no problem
in obtaining feedback: the communicants are in a relationship
that permits direct action and reaction. however, where the
communication channel that is utilized is an electronic one-—
such as television-—there is ordinarily no provision for the
occurrence of feedback. Therefore, television is essentially
a one-way communication medium, and the part that it can play
as a total channel of medical communication is accordingly re—
stricted.

While the inherent inability to provide feedback is
a serious limitation of the television medium, still it does
not rule out the value of television to medical communication.
An ameliorative factor in postgracuate medical education is
the considerable use of teachinp techniques which require
little or no stucent participation. Didactic methods,
sometimes modified by the addition of a question period, seem

to be the most prevalent form of postgraduate medical edu-

 

lBerlo, p. 112.

 

 

 

-lQl—

cation. Vollan concluded that there was a "...diSprOportion-
ate prevalence of didactic methoos in postgraduate Eedicafl
eoucation....l A study by the Council on Medical education
and Hospitals showed that "of...1054 courses, only 149 or 14
per cent used anarcly didactic, nonparticipative nethoos--if
the opportunity for question periods (regardless of the size
of the size of the group) was considered to make the course

participative."2 (Italics mine.)

 

While the preponderance of courses using didactic rq,
methods in postgraduate education is not considered ideal——
and should be rectified through the introsuction of more par- g

. 1 t
tiCipative metnocs3--"nevertheless, didactic methods have a E

 

larger place in postgraduate education than in undergraduate ;
medical education, since the physician-student has foundations *3
upon which to anchor the knowledge he receives.”4
Because didactic methods are widely used and because
they do have a place in postgraduate medical education, it
would seem that televised didactic presentations would have
an effect that would be no more adverse than when didactic
methods are used in a face-to-face presentation. Various
methods of augmenting television with provisions for feedback
make it possible to use the medium for postgraduate medical
education with no greater a lowering of the standards of edu-
cation than is found in the utilization of face-to-face di-
dactic presentation, followed by a question period.
In the attempt to provide feedback for televised medi-
cal courses, several techniques have been devised to permit
viewers to comnunicate with the instructor. Physician-viewers
of Open circuit programs in Utah, have been provided with
special phone numbers so that they may call the station after

the program and question the participants.5 Another plan, the

 

lVollan, p. 93. 2Shepherd, p. 755. 3Vollan, p. 93.

4Ibid. 5th Newsletter, December, 1959, p. 3.

 

 

 

-1J2-

TV "talkback" system facilitates participation in question-
and-answer sessions between points of program origination and
reception.1 The system uses regular telephone circuits and
reversible amplifiers that permit loudspeakers to serve as
both microphones and receivers. Two-way "round-robin" radio
hook-up systems have been used to provide feedback from a
limited number of viewing points--as have different types of
telephone connections. These techniques offer at least a
partial solution to the the problem of providing feedback for rfiq
televised courses. A

Color: asset or liability?——While color is very defi—
nitely an asset in many medical applications of television,

it can be a serious liability in others. Some presentations 1

- iw—v

42"..“

WOUlC be almost worthless, medically speaking, if telecast in

 

4' *iVl’
.!
4.

‘

black and white. Still, for instructional applications, the
complexity and cost of color television must be considered in
terms of the relative value of a color picture as compared
with a monochrome picture.

A single camera color System installed in a
surgical Operating room, for instance, might cost...
woo,o)o. 'his same amount of money, however, could
equip ten or more Operatinp rooms in a hospital with
monochrome cameras, with provision for automatic
switching to any desired Operating room from viewing
locations, and with provision for automatic kinescope
film recording facilities so that important or unusual
segments of surpery could be instantly recorded from
any of the operating rooms.‘2

Some additional problems.——Before television can as—
sume the role of an effective channel for medical communi-
cation, several problems that apply specifically to medical
teaching via television, and generally to all medical communr-

cation carried by the medium must be resolved.

 

1New York World Telegram, February 17, 1359, p. 12.

2ddward w. gird, (ed.), Medical—Dental Television
deference, Medical—Dental Television Workshop, Rational naval
hedical Center (Bethesda, Maryland, 1963), p. I-6.

 

 

 

 

...The trustees, deans, and faculty members Ef medical
schoolg will have to be convinced (l)that long—term
financial support will be available; (2)that TV will
provide a unique Opportunity to study teacning methods
and teacher skills; (3)that teaching time will eventu-
ally be saved and more students reached with better in—
struction; (4)that high quality progrwms are possible
without overburdening the faculty or interfering with
other intramural objectives; (5)that the programs will
make a significant contribution to medical education as
a whole; (6)that sufficient faculty members are able
and will use the medium.

Some econOmic considerations.--Assuming that in all
other reapects television may be ideally suited to serve as
a channel for medical communication, economic factors still
may serve as the determining consideration in the employment
of the medium. delatively high equipment and production
costs may well serve as the basis on which a decision not to
use television is made. however, a decision that is based on
a cost per viewer, and with consideration given to the unique
advantages the mediumoffers the viewer, would seem to employ
a much more realistic yardstick than the costs of equipment
and production alone would. The application of television to
intramural or extramural education, presents specific eco-
nomic considerations that can be TBSOlVbC only in terms of
the effectiveness of television, compared with other media,
in accomplishing he desired educational goal.

Finally, where the decision has been reached that
television should be utilized but there are economic obsta—
cles in the path of such utilization, some form of financing
may be available to resolve the obstacle. Some forms of fi-
nancing that are available include:

(l)the hational iducation Defense Act, Title VII;
(2)00nnercial sponsorship Ehere feasibla; (3)foun-
dations. And after the eXperimental phases are cow—
pletea...physicians enrolled in the television courses
for formal academic credit should pay all or most of
the costs....nn enrollment of 10,03) or 23,0JJ of the

 

lChT deport, p. 33.

 

Fir-.1"
in. ‘

-134-

F7 ,

country's estimated {3,333 general practitioners...
aninfl a old) for a year's course should meet
i.'I'O{_,I‘Eilh1Z.iIlg COStS o 1

Three methoes of television transmission.-—Ihere are
three forms of television transmission that have been found
to be adaptable to the requirements of medical telecasting:
Open circuit, closed circuit, and "private" telecasts.2

bpen circuit.--0pen circuit transmission has the very
practical advantage of readily available facilities, but
places restrictions on program content since the viewing
audience cannot be predetermined. The dinensions of the
latter problen may, however, be less than generally thOUght,
since "...in the opinion of some, Epen circuit cafl be used

for as much as 80% of the material in a well rounded post-

 

graduate educational propram."3 host appealing in open er

circuit transmission is the availability of educational tele-
vision stations; the availability of "fringe" time on com—
mercial stations; the ready access that physicians have to
television receivers in the home--all of which make possible
program transmission without the creation of special facili-
ties.

Closed circuit.--Defined as "...a program originating
from a central source and shown live at multiple outlets
simultaneously,"4 closed circuit transmission affords complete
audience control, and can be auénented with provisions for
feedback. however, limited viewing sites and the higher
cost of reaching a given number of viewers, must be considered
in the employment of closed circuit television.

"Private" transmissionrm—Broadcasts with reception
limited to specially equipped receivers, are technically
possible with either "scrambling" or "multiplexing" devices

and are known as "private" broadcasts.5 The technique is es-

 

Ibi ., 27—45. 31bid., p. 32.

llbid., p. 32. 2
41bid., p. 39. 51bid., p. a.

Q
*U
'U

 

 

 

 

 

 

 

-135-

pecially advantageous in medical usage because it pernits an
unrestricted choice of program content without the concern
of offending public sensibility or violatinb patient privacy.
Cost and the necessity for Special equipment, toasther with
the fact that utilization of the system is dependent upon a
decision by the Federal Communications Commission,1 consti—
tute disadvantages of private transmission.

Special equipment requipements for medical television.

 

--If television is to serve effectively in medical appli—
cations, the need for improved equipment must be met. At the
present time, most of the equipment in general use was de—
sipned for industrial or broadcast purposes, and does not ex—
actly meet the Specialized requirements of medical television.
A limited market and ill defined needs have been practical
reasons why manufacturers have not produced specially designed
medical television equipment.2 "Costs commensurate with edu-
cational budgets, simplicity, flexibility, durability, minimal
need for technical personnel, and instructor acceptance...Er§

some of the important requirements in designing equipment for

 

1The Federal C mmunications Commission indicated in
1959 that it would soon issue licenses for eXperimental tele-
vision broadcasts in which "scrambling" devices are used to
insure that no receiver except those eSpecially equipped can
receive an intelligible picture. Althouph these devices were
originally intended for subscription television, they also
can be used to gain privacy for LCGiCSl television broadcasts
received by practicing physicians in their homes or offices.

alJ station, fiJJf, Jacksonville, filorida, received

permission in gel from the E.U.C. for a one year trial of
scrambled-image telecasting as a part of the Jacksonville
HOSpitalS educational lrogram to improve facilities for gradu-
ate and postgraduate medical education.

2The first color television equipment designed Spe-
cifically for medical instruction and demonstration purposes
was installed in 1955-1956 at the Walter heed Army neeical
Center. Distinctive in the system is "...that it contains
the first medical color television camera for ceiling mounthg;
in operatinp and autopsy rooms. It also includes a specially
designed color television system of microscopy utilizing
standard instruments....for projection to large groups, SeVeP—

 

. A ...Yva

,o ”Math.-- uV... I..\ .f.“ .
3-1%

 

O r
_ . O '
. . .0 in. .c t v-
.., ....-f e.. -. ¢ r.
‘ c O n t l . . .
| M O I I ‘0 .(a.: ‘ JV .... . o . ‘ v or o .. O
1 o .9 ,. .. t Jfilu‘fixi. q ‘
. o .. u . a . ... ..xfi" .l.‘§ 5“. q“
..i n '1. .. .1 o
. . . .u .
.. L. tr... OJ. . . 4.
4. . . ‘ v
s . J7. .rt 9*.
.r t ’L. ‘
v .-

 

—136—
medical and educational television."1

The vidicon camera.—-Smaller and relatively less ex-
pensive than the studio television camera, the vidicon type
of television camera that is used for both direct viewing and
program origination, has found ready application in medical
television.

It is used for...1arge-group classroom viewing of small
objects or microscopic slices. Connected to a micro-
sc0pe, it can be adapted to scan fields of particles and
is an integral part of the Sanguinometer, an electronic
haemocytoneter which can do a blood count in l/3O of a
second. It can be used as an occult observer in the psy-
chiatric ward. With either a vidicon or standard TV
camera, fluoroscopy can become a shared experience in
comfortably lit surroundings for time periods of any du-
ration. The vidicon can be combined with an ultraviolet
light source to give electronic staining techniques.
Cellular elenents c.n be differentiated without the
'fixing' action of dyes and pigments and the interruption
of the living processes.

 

Some new advances in equipment.--New television
equipment, still in various phases of development, will, when
available, even further enhance the value of television in
medical applications. A new imase orthicon camera tube that

requires only five to ten percent of the light needed for

 

a1 newely developed color television picture projectors Eerg
installed. Ehe camera desigr "...uermits completely renote
Operation of its electronic characteristics as well as of its
mechanical and optical adjustments, such as selection and
change of lens and focus of the optical system. illustrative
of the Special designing required for medical use is thatfl
"...the suspension, the light and the camera are so designed
that at all tines the center point of view for the camera
coincides with the center point of view of the operating room
light." (halter need...Uses Color Television..., p. 3.)

A recent installation at St. ChristOpher's hospital
for Children, Philadelphia, features especially designed
equipment. The cameras "...are conpletely self-contained,2fll
transistorized and equipped with automatic Zoonar lens andnag,r
be used almost anywhere under normal hOSpital lighting con-
ditions...." ("Closed Circuit Television Aids in medica
Training," Philco Corporation News, hay 17, 1963, p. 2.)

 

 

llbid., p. 9. 2warren, p,. 18-15.

 

~197-

standard tubes, will serve to largely eliminate the problem
of special lighting and make color television possible for
everyday use in medical t‘aching, at such a time as reduced
cost and improved color fidelity make it economically practi-
cal.1 Image definition, essential to any medical application
of television, will be further improved by a new imageixflensb
fier, which will, when fully developed, show detail with roe}-
lution equal to a 600 to 700 line system.2

Radiologic diagnosis and teaching are already bene-
fiting from the use of an image-storage tube that makespmsst-
ble the immediate viewing of very short duration x—ray ex-
posures by any number of people for periods of up to two
minutes;j

Thermoplastic recording, still in develOpmental
stages, because it will offer the advantage of either optical
reproduction—-like a motion picture—~or electronic repro-
duction—-1ike video tape--wi11 find use in the recording of

medical programs for transmission or showing at will.4

 

lBroadcasting, December 7, 1959: p. 78.

 

ZChT Newsletter, December, 1959, p. 4.

 

3Ibid., February, 1960, p. 4.

k3

4Broadcasting, January 18, l 63, p. 110.

 

 

 

 

 

CHAPTER VII
THE ROLE OF TELEVISION IN MEDICAL COMMUNICATION

The Need for an szective hedium
of hedieal Communication

A need to know.-—Paradoxically, the greatest need in

 

contemporary medicine would seem not only to be the need to
know-~research--but also the need to know what is known--com-
munication. While this is not to say that there is no further
need for medical research because all that there is to know
has been revealed, it is to say that there would seem to be
little need for continued medical research if the results of
that research cannot be effectively communicated. If the
practicing physician does not have ready access to the bene-
fits of research; if he cannot apply the advances made possi-
ble by medical research to the welfare of his patients, then
there is little merit in continuing medical research. The
practicing physician cannot be expected to implement the ad-
vances in knowledge that results from research, if his access
to that knowledge is obstructed.

Obstructing the practicing physician's present needs
and desires to know, are the inefficiencies inherent in he
continued use of traditional channels of medical communi-
cation. While the traditional channels: medical reading,pro-
fessional contacts, professional meetings, professional organ-
izations, and formal posturaduate courses were once effective
in providing the physician of an earlier period with new
information, with little exception they do not adequately

meet the needs of the practicing physician today.

—108-

-.. ~I~ .5!

... (Q "~ 5"“? .u

 

3!
‘24.,

-139—

1t is he difference between the capabilities of the
traditional channels to provide effective communication, and
the communication needs of the contemporary physician, that
constitutes a problem as paramount to the future of the medi-
cal profession as any in the research laboratory. Like the
solution to the problems in the laboratory, the solution to
the problems posed by ineffective medical communication, af-
fect the welfare of all to whom the physician ministers.

A change in the physician's orientation.——Perhaps
fifty years ago, when the critical educational and research
processes were found in medical practice, the traditionalcxmk
munication channels were adequate for the needs of the pnmnfi-
cing physician. Even twenty or thirty years ago, medical
journals, scientific meetings, and societies were quite ade-
quate as sources of information; and postgraduate courses
served both remedial and instructional functions with a
considerable degree of proficiency. However, today the phy-
sician must base his practice on concepts that undergo steady
change at the hands of aggressive researchers. Still, to
find the information so essential to his practice, the con—
temporary physician must resort to the virtually unaltered
media of communication that were effective in another era.

The physician's enigma.--The attempts of the existent
media to perform functions beyond their inate capacities in
the attempt to meet contemporary demands, have only served to
heighten the physician's enigma. As research expanded medi-
cal knowledge, the journals multiplied in an effort to bring
the new knowledge to the physician-reader. Without a com-
mensurate increase in the time physicians have available for
medical reading, such efforts were predestined to failure.
Efforts to abstract and digest the information published in
journals at best represent a measure born of desperation, and
at worst an ineffective listing of article titles. lhy—

sicians have themselves adjudged hospital and medical society

 

 

-llO—
meetings as ineffective activities that they would prefer de-
voting e'en less time to than at present. Professional
contacts would, of course, vary widely in significance ac—
cording to the nature of the contact and the participants in—
volved. Postgraduate courses, while potentiallv the most
competent and comprehensive means for furthering the practic—
ing physician's knowledge, are not precisely oriented to the

5‘

physician in terms Ol contemporary communicative requirements.

Evidence of ineffective medical communication.--Tesmr

 

mony to the ineffectiveness of the present means of medical
communication is found in the existence of an anomalous souroe
that functions in medical communication. So ineffective are
the present channels in providing the physician with the
information that he must have to continue his practice, that
the opportunity has been provided for sources outside the
medical profession to usurp the communication perogatives and
authority that are rightly the possessions of the medical com-
municator alone. It is in an area as tantamount to patient
welfare as the communication of information about new drugs,
hat pharmaceutical manufacturers have been afforded the
opportunity to become the physician's source of information.
When a system of cemmunication permits the producer of a drug,
who is understandably its advocate, to also serve for all
practical purposes, as the sole source of information for the
practicing physician as to the efficacy of that drug, then
the validity of the communication must be questioned.

Receiver-oriented communication.—-Eecause the purpose

 

of communication is to in some way affect the receiver of the
message that has been sent by a source, the system of communi-
cation must be oriented to the needs of the receiver forlaaxt-
mum effectiveness. Medical conmunication does not today ade-
quately meet the needs of a prime receiver—-the practicinD
physician. dhile he desires tn practice medicine in accord

with current scientific developments and medical theory, the

 

 

 

—lll-
physician can only become frustrated in his attempts to co so.
Of the approximately four hours per week he can cevote to

ze physician would be exceptional if he

P'd

medical reaning, t
could scan, yet alone read the available medical texts plus
more than a few of the 53d) metical journals tint 810 putlnnn-
ed annually. He would he fortunate too, if his professional
contacts encompassed several bedside consultations with
Specialists, and if he hal the Opportunity to attend renote
postgrahuate courses. Yet, these are the activities that
constitute the physician's aeans for acquiring new knowledge,
and on which he must of necessity base his concept of medical
practice.

What is indicated, if the physician is to be afforded
the opportunity to practice medicine in terms of acceptable
modern knowledpe, is convenient access to essential new medi-
cal infornation. The provision for such access must be ori-
ented to the contemporary practicing physician. It must fit
the practice and the life of the physician and not require
that the physician adjus his practice and life unduly to fit
its demands. In addition to beinL convenient, the provision
for obtaininb infordatio must possess the facility of timeli-
ness, and it must have the potential for presentinb new infor—
nation with a minimum loss of time. It must have the validit;
afforeee only by sources within the medical profession; its
Sponsorship must cone from the physicians themselves. ECU?
cationally, it must have proven merit as an effective heans
of instruction.

Television as a channel of medical Comnunication.-4flue

 

provision for access to medical communication must be a con-
munication channel that encompasses the essential require-
ments that have already been described. When considered as a
communication channel, television possesses all of the attri—
butes of an effective means for the practicing physician to

gain access to new medical knowledge. In terms of‘convenience,

 

 

-ll2-
television is as accessible as the physician's home tele-
vision receiver; programs can be scheduled to fulfill the
choice viewing period of the majority. New information can
be presented as soon as it is feasible to do so and simul-
taneously to all parts of the country-—or recorded for delayed
broadcast to meet the requirements of the different time
zones. Presentations can be as effective as the most compe-
tent medical sources and the best ancillary techniques that
are available can make them. Self-sustaining sponsorship and
the resultant control of program content is feasible through
tuition fees from Viewing physicians. Research has shown
that effective instruction may be successfully remoted by
television.

Television does have some liabilities: the use of the
medium necessitates didactic presentation; the provision for
feedback must be provided on a supplementary basis; color is
not universally available; and television demands a possible
Change in both concept and technique of presentation. Al—
though cost is a worthy consideration, it need not be the de-
terminant of whether television should be used or not, since
methods of finance can be worked out.

Perhaps the most serious liability that must be con-
sidered where television is used, is one that originates not
from the medium itself but from those who employ the medium.

The advent of the first comprehensive medium of communication

 

—-one that embraces the abilities of all its predecessor ¢
media-~would quite naturally engender great hope for its uti-
lization. hepe, especially unjustified hope, can only lead
to disillusionment; in some instances television has been en-
ployec on a basis that could not be expected to produce the
hoped for results.

Over—endowed with revolutionary zeal, some enthusi-
asts have rushed into television and embraced it as theznedhrn

which would save their communicative endeavors. however, it

 

-115-

has been the experience of those who use television with this
eXpectancy to soon become disillusioned with the medium. The
abuse of television has been confused with its use; opinions
of the medium's effectiveness may therefore derive more from
its abuse than use. Because television is a channel for con-
munication, it can only serve to transmit messages. And it
transmits with equal fidelity every communicative effort that
-is placed before its cameras-—good or bad.

If there is one reason why television might fail as a
medium for medical conmunication, the reason for such failure
might well be found in the preceding consideration. Thebesis
for failure is a conceptual one: it is the difference between
what television can actually do and what some might imagine
that it can do. EXperience at the University of Kansas:wflnml
of Medicine serves to illustrate what might be considered as
being a conceptual liability of television.

...We did, however, fall into what we now regard
as an incorrect point of view, namely, that all that is
required for a successful program is to mount a tele—
vision camera above an operating table and let it run
continuously throughout the Operation, with commentary
by the operating surgeon. Our first program schedules
reflected this attitude in that we merely televised Oper—
ations from 8:30 a.m. to 12 noon daily, honday through
Friday....Soon, however, it became apparent to all ob-
servers that our program format was inadequate in re-
Spect to long sustained interest. Just as the student
finds it boring and wasteful to stand at the operating
table for hours, holding retractors, when many more
challenging opportunities present themselves, so did our
students gradually spend less and less time in the
elective television clinics, thouth they were quick to
admit that they could see much more of the operation in
the television classroom than they could when standinp
in the fourth position at the operating table....

Thus, we came to the position that television
to be employed most effectively had to be used in short
sequences and had to present the salient aspects of
tepographic anatomy, regional anatomy, normal and ab-
normal physiological processes, gross pathological con-
ditions in situ, and certain details of the Operative
procedure itself....0ur prior experience with monochrome
television was convincing on the point that several hmns

 

1......
|

 

-114-

of disorganized, uninspiring television could not be
expected to capture an elective student audience.

While the experience at the University of Kansas has
been in the utilization of television for instruction in a
medical school, the results of that experience are applicable
to extramural applications of television to medical communi—
cation. It was concluded at kansas that "...unimaginative
and unsuited television proLramminé such as we first attemphxi
will obviously lead to lack of acceptance Ef televisiofl."2

Another important consideration in the utilization of
television is the choice of an effective communicator to ap-
pear on programs. It was determined at lennsylvania State
University, that one of the groups of factors that most im—
portantly affect televised communication is the instructor
and his competencies and performances.3 At Kansas it wascwn-
cluded that one reason why television might fail being ac—
cepted in the undergraduate medical school curriculum is "...
that teachers generally are characterized by an unwillingness
to change their familiar teaching methods."4 Unless cogni—
zance is given to the particular requirements of the tele-
vision medium in the choice of a communicator, and unless the
communicator himself understands the medium, effective com-
munication cannot be achieved with television.

Still, television's assets more than compensate for
its liabilities. In realistic appraisal there is no other
convenient means of communication available that can bring
into focus the knowledge to be communicated, the communi—
cative medium, and the individual need of the physician-re-
ceiver, with the clarity that television can do so. The only

'bounds that are encumbent upon the effectiveness of tele—

 

lPaul w. Schafer, "The Kansas Television Experiment,"
(Reprinted, with additions, from) JAMA, 152 (June 6, 1953),
pp. 2"}.

2Ibid. 3See page 96. 4dchafer, p. l2.

 

~115-

vision, assuming technical competence, are the capabilities

of the communicator and the design of the message, or prxgram.

Considerable research and experience have accrued in
both postgraduate medical education and in the use of tele—
vision as a medium of education. The requirements of post—
graduate medical education for meeting the needs of the con-
temporary physichna are evident. The capabilities of tele-
vision as a modern and effective means of communication are
now known. It is apparent that postgraduate medical edu—
cation and the channels of medical communication must be re?
oriented to fit the mode of life of the contemporary phy—
sician. Television offers the most effective and compre—

hensive means available for facilitating the reorientation.

 

 

§f4tt an _- '

BlELICCdALHI

Berle, david K. The Process of Communication. hew York:
holt, nhinehart and Winston, 1960.

 

Geier, Leo. Ten Years with Television at Johns hopkins.
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Klapper, Joseph T. The effects of mass Communication.
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Schramm, Wilbur. (ed.) The Process and Effects of mass Co:-
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Siepmann, Charles A. TV and Cur ochool Crisis. new York:
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Warren, frank. Television in Medical Education. Chicago:
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dribht, Charles Mass Communication. New York: dandom

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P. Pu

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Bloomfield, Arthur L. "The lroblem of Keeping Up With Medi—
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Cameron, C. 3. "five Schools Lin ed Tepether for TV
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"Color Television at Los Angeles A. h. A. Convention,"
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775—92.

 

 

 

-ll6-

 

~ I I n -0 .-c.. \ ..
0 0| . . I- 'I‘ 0 e I. .I .
.. .L-a.\. t 3 tax a.m..wifs. - ...YVI? 5.
_< ..s. . 4&2 w.’\. ..o .5 ..-». -nd. .\ b... _. . .
..I I.‘ 0‘15... . J..~’.‘ ‘Jw. O. ‘t . . i . . .... . . . . . . .
. . . . . . . K . c . ...
. _. .- .2. ._ ...... -3.

 

I
u ‘4..- _ '

 

‘:Wt / . 9.. ..
. .7 v I o 1. L1 4d
. . I . I u . «h : D . .
\. I . 'r . t 0 . . . . . . .

O - O o ’ . O: o ' .
n O o O - pi I 0 | l‘ . I
t 0. 4| . ..ob ‘Q. \ . . . 0 . a

.- . .. 1

 

—117—

Darley, Ward, ant Cain, Arthur 5. "A Troposal for a national
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r0!
1

Medical Education, ,5, (January, 1361), 35-57.

 

Delp, m., dieing, J. D., and Nelligan, d. D. "University of
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"now Authentic is Medicine on Television?" Journal American

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"Intrusion on the Insane," Newsweek, 5Q, (August 5, 1957),
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"medical Education in the United States and Canada," Journal
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—1ie—

Association, 164, (may 4, l;57), #7,

Jr

\4

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jfio

 

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—l20—

' . ‘r‘ i A. ~,‘ 0 ‘, ) ‘. I 'w I «f. NVY " " "L ‘ ' "“ r."
meclgul Jehogls. u irtllilhu jeoori. Inbtltute 1Jr

.-_._.

 

..-. ..-- _,

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AneriCFn neCiCal Association, 1355.

N#

 

Unpublisnec haterial

Jouncil on heuical Television, Institute for Advance ent of
medical C04munication. newsletter. new York, Jgring,
1959. (nineograghed.)

. fall, 1959.

. necenber, 1959.

 

. February, 15o).

. 118,3; , 12".“).

 

. beytetzdmm, 19%)).

'L’, m ,.
Luger QQUFLSS

Cnarles n., Assis ant director,fne‘Anerican Acaueny
of General lractice, kansas City, mO., personal
letter to Jack J. Frank, January 17, lgcl.

Auhe, David 3., a. J., nirector, negartnent of Aucio—visual
scucntian, Universit; of hansas hedicel Center,
kansas Cit), hanses, yersonal letter to Jack L. Eran.,
January 13, 1561.

prayer, Cornelius n., L. 3., Ccitor, Lecical naoio system
(service of daoio Corporation of America, national
:roaccasting Congany), Hew York City, personal letter
to Jack 2. frank, Aucust 1C, lye).

 

 

 

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