Educational video created in a medical simulation facility.

Context and setting Although health care professionals frequently struggle with communicating technically challenging information to an increasingly videoand computer-savvy audience, video media remain under-utilised. There may be advantages to using simulation environments for videotaping. Several medical centres have developed programmes and facilities for simulation-based education, which faithfully replicate the dynamic nature of critical care medicine. Why the idea was necessary Health care professionals require on-demand education to learn or review a treatment modality prior to providing patient care. Although written and web-based text plays a central role in education, many people are visual learners and are able to assimilate information better by observing images. The technique of concurrent continuous renal replacement therapy and therapeutic plasma exchange (CCRRT + TPE), which has been described in the treatment of fulminant hepatic failure, is not intuitive to most health care professionals. The technique is difficult to describe using words, but may be demonstrated in a straightforward fashion by video. It was postulated that a medical simulation facility could be of value in creating a CCRRT + TPE video. What was done Prior to filming, a story-board was developed to outline the scenes and filming sequence. PrismaCRRTandCobe centrifugationplasmapheresis machines (Gambro BCT, Lakewood, CO, USA) were run by dialysis and apheresis nurses familiar with the procedure. Fluids representing blood and 5%albumin were formulated using normal saline and dye powders. An infant manikin (Rescusici-Baby Laerdal NRB 1000; Laerdal Medical, Wappingers Falls, NY, USA) was selected to represent the patient. Numerous pan-tilt, remote-control cameras and highly sensitive microphones located in the ceiling allowed multiple camera angles and clear recording of verbal interactions and machine alarms. All activity was captured on a digital recording deck before it was transferred to a CD-ROM disk in Windows Movie File (WMV) format. A total of 35 minutes of video was needed to demonstrate the storyboard sequences. The final video was created using Microsoft Movie Maker (Microsoft Inc., Redmond, WA, USA). Evaluation of results and impact A 6-minute video was produced for a plenary presentation at a national conference. The video was subsequently placed on an institution intranet website, where it was reviewed by dialysis nurses and doctors. The video was uploaded to YouTube (http://www.youtube.com/watch?v= ARi-61nIcjQ) and has induced several inquiries. Gambro representatives also use the video to teach the technique. This project demonstrates that videotaping a novel, infrequently used technique in a medical simulation facility is possible, given current technologies. The advantages of videotaping in a medical simulation facility include a video-friendly environment, the elimination of competition between filming and patient care goals, the ability to schedule videotaping at a convenient time, and the fact that consent and ethical approval are not necessary. The costs associated with videotaping include costs for the simulation room (typically $50 per hour) and simulation staff who perform the filming and set up the manikins, and costs for disposables. Additional costs include those incurred by moving machines and hourly nursing costs. Compared with didactic lectures, a web-based video provides worldwide viewers with a low-cost, on-demand educational experience that affords the opportunity to review scenes that are of particular interest.