The 10th International Scientific Conference

eLearning and software for Education

Bucharest, April 24-25, 2014
10.12753/2066-026X-14-008

OBSTETRICS ELEARNING: THROUGH THE USE OF VIDEO AND OTHER

MEDIA TO ENHANCE LEARNING STYLES IN OBSTETRIC STUDENTS.
Donnchadh COFFEY, Dr. Sabin TABIRCA, Prof. Richard GREENE
University College Cork, Department of Computer Science
Cork, Ireland, Department of Obstetrics and Gynaecology, UCC.
d.p.coffey@umail.ucc.ie, s.tabirca@cs.ucc.ie, r.greene@ucc.ie

Abstract: This paper presents an insight into the use of eLearning in Obstetrics Education and its
advantages for practical application. The content available to existing obstetrics students attending
practical and theoretical classes are established as the paper progresses into beneficial factors of video
and eLearning as a source of valuable subject matter for these students as well as scope for new media
interaction. Interaction in edifying methods promotes learners' efficiency, motivation and cognitive
efficacy. A well designed e-learning programme can motivate learners to become more engaged with
the content through assimilating cognizance, skills and postures more expeditious. E-learners have
been shown to demonstrate incremented retention rates and ameliorated utilization of content, resulting
in a more preponderant achievement of objectives.

Keywords: Obstetrics, Education, eLearning, Video Technology.

I. INTRODUCTION
Technology is an integral part of society today. Advances in technology are apparent in every
discipline a few more acute than others but ultimately most have some technologic application. The
field of medicine tackles an array of technological sources and there are advances in every field of this
study. Video technology has been used universally in medical education.
The use of video in medical education encourages teaching and learning in an array of
different environments. Video Technology is a widely used medium for demonstrative, training and
educational purposes. Video has been used in medicine since the 1950s providing a signal reference
for CRT (cathode ray tube) technology. As video is a more viable and obtainable technology resource,
it is used extensively in medicine. Video is now easily compiled and distributed through the means of
online support making it an accessible interactive type of learning for medical students. Medical
education has adopted video technology as an essential learning resource next to online learning,
online learning tools and video tutorials are more prevalent in the curriculum of major Universities.
The need for visual demonstrations are essential in medicine, operations and surgical skills
must be taught but are constraint to theatres and practical classes. Along with these constraints a
consent for surgery review is undertaken; this practice can be dearly time consuming giving students
insufficient time for reflective learning. Video technology with the collaboration of online resources
give students an outlet for additional learning of uncommon visually documented procedures. These
uncommon procedures could be taught to students using video with additional audio narration and
textual information. The benefits of these web based video tools stretch to further assist students
studying online e.g. online courses and general revision. Alongside video, eLearning grants a user the
capability to access a broad range of learning styles to strengthen the users knowledge and skill. The

addition of eLearning in medicine promotes learning not solely being an outlet for knowledge
distribution.
Student learning research has shown that visualisation with elegantly designed visual tools can
result in students learning in a shorter time and can foster long term learning (McClean, Johnson et al,
2005). In obstetrics training simulation techniques has been used extensively. However, the
visualisation of the movement of a baby through the birth canal is something that cannot easily be
captured on film. Equally other procedures are not easily captured. Therefore the introduction of a
multimedia learning tool to aid the understanding of the birth processes for students without placing
the mother or baby at risk was suggested by a consultant obstetrician involved in the education of
medical students at UCC (University College Cork).
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and
their children during pregnancy (prenatal period), childbirth and the postnatal period.
Elearning tools have the added advantage of moving forward or backward during the learning
process eradicating static boundaries of learning. Learning experiments carried out by researchers such
as Richard E. Mayer have shown that multimedia learning works because adding animation to the
usual form of teaching through text had positive effects on students understanding (Mayer, 2005).
Studies have also shown that memory retention is improved compared to traditional teaching methods
(Vernon and Peckham, 2002). One would most likely remember a pictorial observation more so than a
written document. Sources of obstetric video material for students take the form of video lectures
including 2D still image representation of deliveries and procedures. Online platforms such as
Youtube offer some tasks involved but miss the narrative elements needed to educate an Obstetrics
student. Online resources such as OBGYN-101 (Brookside Associates Medical Education Division,
2008) offer videos and tutorial presentation slides for students but at a price.
II. METHOD
A study on the teaching of Obstetrics through the use of an eLearning platform was carried in
the Medical University of Bialystok (Pljanowicz et al, 2012), there were positive results for the
platforms usage with Obstetrics students. The results are as follows:
Accurately arranged teaching materials placed on virtual platform boosts the opportunity to
prepare students for the credits and final examinations in their individual field of knowledge. The
organization of classes in both forms (eLearning and traditional) was highly rated by students
engaging in the study.
From this study it is clear that eLearning is a beneficial approach to obstetrics education
providing a simple accessible means of viewing practical material without being physical present. This
allows students to avail of material in their own time and have ease of access. In University College
Cork, Obstetrics is taught to a great degree from its basic principles to materal and fetal medicine that
provide workshops and practical assessment of students. Clinical, Surgery and Delivery skills are
taught with practical observation and step by step tutorial guidelines with 2D still renditions of
procedures and deliveries. Students keep clinical logbooks of procedures and are counted towards their
final result of each module.
The introduction of eLearning resources are an asset to present-days contemporary student. An
influx of this format to University College Corks Obstetric Department would generate a positive
development in the way Obstetric students consume information for practical classes. The preferred
online eLearning resource for these Obstetric students would primarily be a hub for video content
hosting narrated video complemented by other contributory media (textual information, interactive
imagery, etcetera). This resource provides Obstetrics students with a platform that offers videos of
procedures and deliveries that would be readily available as opposed to viewing the same type of
deliveries at a set time. Practitioners and lecturers could be able to add comments to these videos and
attach online assessments in relation to individual aspects. The prospect of an online assessment would
shorten the timeline of a Obstetrics course giving freedom for both students and lecturers to
concentrate on practical coursework and placement orientation.
Online eLearning resources have endless possibilities, connecting students and lecturers with
tools that bridge formulaic processes that consume time in practice. Simple tasks conducted in
coursework can be distributed online and completed online instantly. With the access to an online
resource with an array of capabilities an Obstetrics student can view deliveries and exams that would

possibly be a rarity to view in practical circumstances. Unusual deliveries including twin birth
deliveries can be a rare process to view as student. When documented and filmed practices like the
twin delivery can be visualised on the eLearning tool and freely accessed
III. CREATING THE ELEARNING CONTENT
The first milestone in creating the eLearning tool is capturing the footage needed to display on
the online resource. When filming deliveries and supplementary procedures like Caesarean sections or
placenta exams and removals consent is needed to film/photograph a patient for non-profit use
(educational). This action is processed by the patients authorization through the use of a patient
consent form. Once this form is approved by the patient preparation for filming can be conducted.
When filming a delivery, care is needed to not obstruct the practitioners in process and position of
lighting and cameras in appropriate stations within the delivery room. When choosing the type of
lighting conditions needed to produce a visible image, directional lighting and back lights are needed
to eliminate shadow and focus on the focal point of the video (the patient).
The camera would be adjusted to adhere to the lighting conditions, as the delivery rooms
lighting levels are high with the additional lights provided. The ISO settings in the camera determine
how sensitive the image sensor of the camera is to light. Noting the lighting conditions in the room the
ISO levels are moderately low to complement the image. A wide frame is used to view the full
delivery and to lessen the necessity for camera viewpoint changes. Changes in viewpoint consist of
close up and extreme close shots for c-sections and placenta examination/removal (Figure 1).

Figure 1: Lighting and Camera positioning

Each delivery and action when recorded would then be edited to suit the suitable online formats. Clips
are cut to shorten the period of delivery for continuity between each video clip as each deliveries
timeline may vary. Narration of each step of the delivery or procedure is added along the clips timeline
through the use of video editing software (Final Cut Pro). Before preparing the individual video clip to
be added to the learning tool each video clip is converted to a web friendly format.
The creation of the resource application itself involves both interface design and
programming. Adobe provides an application that tackles both design and programming in a compact
manageable process (Flash). This applications output is also connected to a content management
system (CMS) developed through web development tools using hyper-text markup language (html)
code. The web developed structure acts as a container for the Flash developed learning tool. As the
web developed structures output is in a format developed for online capabilities it is the sole platform
of the eLearning resource application. Other features collaborating with the video clips are its online
assessment section held within the CMSs interactive layout. These assessments are displayed and
students received feedback instantaneously once completed. This action has further capacity for
development.

3.1. eLearning tools Structure

The eLearning tool is created to hold fully interactive actions, all content tabs and video player
activators animate and react with the users input. The video player developed gives the student the
option of switching between different videos and textual information provided with the procedure
involved.

Figure 2: The eLearning tool Structure

The eLearning tool has its own navigation separate to the CMS navigation. Processes within
this navigation include the switch view action within the video player and the activation of separate
media involved in the narration of the videos content. The design follows a clinical look making the
navigation easy to use and instructions clear. The animation gives each action an interactive feel and
these differ between various processes to establish a labelling of roles.
The CMSs navigational structure adheres to webpage orientation lining tabs horizontally
above the eLearning tools content place holder. The style of the CMS matches that of the eLearning
tool to create a seamless blend of the two separate entities. Other navigational hotspots contained
within the CMS are the mentioned Assessment pages having their own separate page for processing
students input. A survey page is also connected to receive feedback from students about their
experiences with the eLearning tool.
With the creation of a multi-purpose video/media player, media aside from textual and image
orientated examples can be shown to coincide with the videos displayed. The introduction of 3D
simulated videos of deliveries presents the process from an internal point of view, displaying the
correct position of the child and the movements it generates as it is delivered. 3D can be adapted to
show multiple deliveries including normal, ventouse and twin deliveries. This enhances the eLearning
tools ability to teach students a thorough practice in Obstetrics, giving students a visualisation of a
highly documented process to further support their progress within the course
3.2. Players Implementation
The eLearning tool implements one particular programming language while the CMS utilizes
three more. Actionscript 3.0 (as3) is the language used in adobe flash, like most programming
languages it generates events and functions to run applications.
The functions primarily used in as3 enable the videos imported into the program to swap and activate
when clicked. This generates multiple media interaction as the tabs reveal narration, commentary and
visuals. The CMS used a combination of html5, css, javascript and php to create its functioning layout.
Javascipt and php act as the CMSs main functionality processing the navigation and relevant pages
including its Assessment page. All content is stored on a server including the source files (php,
javascript, html5), video and textual documents. Each individual content is provided with a folder that
relates to a structured directory for easy access and content to code synchrony.
IV. USABILITY TESTING
The first stage of testing involved the online learning resource. Using Adobe run software
Dreamweaver, the site was opened server-side and code checked before the Build/Run option was
opted for. Red markers and warnings appear after line segments of code if they have incorrect syntax
or if code is placed in the wrong methods. This projects code ran smoothly and did not show any
markers or warnings. This reassured the developer of the functionality of the site. This method was

also used in the publishing of the flash made learning tool where markers and warnings aid the change in
incorrect action script code.
The next step was testing the site compliance with W3Cs markup validation service
(validator.w3c.org). Two warnings appeared which were not threatening to the usage of the site i.e. the
Doctype hadnt been declared and it was unable to determine a parse mode. The reason for these
warnings was that the validation compared itself to standards involved in html4.0 which are
unnecessary in html5.
A group of students were asked to navigate the eLearning tool and complete three simple
tasks, after doing so the students were asked to complete the survey listed on the site. The students
were supervised during the tasks as follows:
1. Navigate from the main eLearning tool to an internal video page and back.
2. Interact with a video and open its related media.
3. Navigate to the assessment page and complete the exam.
All three students were able to navigate through the tool with ease, interacting with the videos
and its related media (3D or textual information) was unanimously positive. In respect to the
last task all students found the assessment page each achieving individual results in the online
exam.
The survey page provided as content on the CMS side of the eLearning tool platform assessed
the performance of the eLearning tool in the students perspective. The following figures represent the
results of the survey and selected questions:

Figure 3
This results in Figure 3 reveals the lack of interaction with online learning resources Obstetric
students have. The willingness to adapt to an online learning style was apparent clarifying the need for
more interactive web-based material in Obstetrics coursework
V. CONCLUSIONS
There is a future in Obstetrics eLearning, we have established the online tools on offer today
and presented a means of eLearning on an online platform. The online eLearning tool embodies the
potential of Obstetrics eLearning generating user-friendly interaction, new styles of learning and
introductions to new obstetric scenarios (3D simulation and device interaction). Possible future
developments of this resource include adaptation to other medical, science or health education
requirements.
References
[1]
[2]
[3]

McClean, P., Johnson, C., Rogers, R., Daniels, L., Reber, J., Slator, B.M., Terpstra, J & White A (2005). Molecular
and Cellular Biology Animations: Development and Impact on Student Learning. Cell Biology Education; 4(2),
168-179.
Mayer RE, ed. (2005) The Cambridge Handbook of Multimedia Learning. New York, NY: Cambridge University
Press
Vernon, T and Peckham, D (2002) The Benefits of 3D modelling and Animation in Medical Teaching. Journal of
Audiovisual media in Medicine, 25 (4), 142-148.

[4]
[5]
[6]

Wiesaw Pjanowicz, Robert Latosiewicz, Sawomir J. Terlikowski (2012) The results of teaching of subject
Obstetrics, gynecology and gynecological and obstetric nursing with the use of e-learning platform at the Faculty of
Health Sciences, Medical University of Bialystok in 20092012, 26(3), 191.
University College Cork Book of Modules (2013/2014), Obstetrics and Gynaecology http:// www.ucc.ie/modules/
descriptions/page079.html
C.P. Obando, J.Maurer, G. Plantegenest (2011) Creation and use of online blended modules for third-year medical
students in the Obstetrics and gynaecology rotation.