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220 POSTGRADUATE MEDICAL JOURNAL April, 1965
HERXHEIMER: I just wanted to ask how many of the
general practitioners in^ Ipswich used^ the^ library
compared with the number^ that^ attend^ the^ Friday
meeting, because^ I^ think^ one^ experience has^ been
unfortunate. I have^ heard of a^ Library in Texas
which is very munificently endowed whidh was used
by about 2% of the practitioners, and is empty most
of the time. I was just wondering whether this should
be designed primarily for hospital doctors with G.P.s
being, of course, welcome to use it and invited to use
it but not designed primarily for them.
PAULLEY: I am^ sorry to hog this machine but my
answer is that still not many of the practitioners who
come to the Friday Club are using the Library. We
believe that in the long run more will do (^) so, par-
ticularly if they start to produce papers for the
Friday Club^ or the^ Clinical^ Society they will have
to use the Library. When they do, a glance at the
Library attendance book always reveals it a week or
so before the meeting. But I don't really think the
practitioners are^ going to use or properly appreciate
libraries until the Medical Schools start to teach them
how to do so, as I have said already.
THE GLASGOW POSTGRADUATE MEDICAL
TELEVISION PROGRAMME
DAVID JOHNSTONE
Producer (^) of the (^) Programmes (^) for Scottish (^) Television
THESE programmes originated in a Glasgow
University conference^ on^ TV^ in^ education, at
which it became clear that the desire of Scottish
Television (especially of its director, Dr. Noel
Stevenson) to^ see^ an^ expansion of educational
television chimed with a desire of the Glasgow
Postgraduate Medical Board (especially of the
Dean, Dr. A. C. Fleming) to find a way of
reaching doctors^ who^ could^ not^ attend^ ordinary
meetings and^ courses.^ Fifteen^ monthly pro-
grammes have^ now^ been^ transmitted:^ they have
been much appreciated, and are now being
used by more than half the commercial TV
companies in^ the country, and may soon be
seen abroad. Though aimed uncompromisingly
at doctors, many others listened to them, es-
pecially members of the^ associated^ professions.
They have demonstrated that^ good specialist
television educational programmes can be pro-
duced relatively cheaply; the fact that S.T.V.
were a commercial company has proved no real
obstacle. The necessity of avoiding peak viewing
hours was a disadvantage, but there is no ulti-
mate solution apart from the opening of a new
educational TV channel.
THE GLASGOW POSTGRADUATE MEDICAL
TELEVISION SERIES: PRODUCTION PROBLEMS
ON THE MEDICAL SIDE
BERNARD LENNOX, M.D., Ph.D., F.R.C.P.(G), F.C.Path., M.R.C.P.
Department (^) of Pathology, Western (^) Infirmary, Glasgow.
KNOWING that conferences on medical education
have a sad reputation for consisting mainly of
long dull^ lectures^ on the necessity of not giving
long dull lectures, I resolved to stick to a
strictly practical account of^ some^ aspects of
the work of the medical production committee
for the Glasgow series. Today's conference
has, of course, not deserved that reputation, but
I propose to hold to concrete description never-
theless. Though our own programmes have not
reached Kent yet, B.B.C. 2's version will soon
be here. Even for those with no prospect of
taking part, it^ adds^ to^ the^ interest^ of watching
such a programme if you know something of
the problems involved.
I want first to expand a point already touched
on by David Johnstone. These programmes
April, 1965 LENNOX:^ Glasgow Postgraduate Medical^ Television^ Series^221
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i.·i.. (^) !ii..,.-~ '.i ## FIG. 1.-Reproduced with the permission of Scottish Television, Ltd. differ more (^) fundamentally than (^) you might at first (^) suppose from such familiar series as the B.B.C.'s "Your Life in Their Hands" which cater for a mass (^) audience, and however much useful information (^) they may convey inciden- tally, are^ fundamentally entertainment.^ This means, of^ course, that^ a^ great deal^ more^ money can be (^) spent on (^) them, but (^) quite (^) apart from that the role of the (^) professional television producer in them^ is^ very different. Since^ what goes out must^ be^ comprehensible to^ the^ general public, it^ must^ be^ comprehensible^ to^ him. Since he understands it he can (^) take full (^) res- ponsibility for^ it.^ Once^ briefed, he^ can^ write the (^) script and decide (^) just how everything is to be done. In a (^) postgraduate programme, we can (^) say with (^) certainty that if what we want to (^) get over can be (^) totally understood (^) by our (^) producer, we're (^) under-shooting our (^) mark; we're (^) wasting our time and our audience's time on (^) explanation of (^) elementary stuff. And this (^) applies not (^) only at the obvious level of (^) producing the (^) script and deciding what^ is to be said and what can be left out. It (^) applies at (^) such (^) apparently technical levels as the work of the director and his cameraman while (^) actually shooting. So (^) long as we stick (^) exactly to a (^) script, the director can follow it and knows from (^) experience of the rehearsal what is wanted. (^) When, however, anyone deviates from^ the^ script, or in^ any period (^) of free discussion, the director is apt to lose the thread of the (^) argument simply because it isn't his (^) language that's (^) being talked. One effect of this is to enforce the use of (^) a completely scripted programme. It^ is^ possible to (^) avoid this if those (^) taking part understand the director's difficulties and do a little self- direction, (^) contriving to (^) give him the (^) necessary hints (^) as to what is (^) likely to be wanted next: but (^) this needs (^) experience. I (^) don't want in the least to diminish the contribution of the (^) television side. All we know we've been (^) taught painfully by David Johnstone and Ian (^) Dalgliesh, our (^) director. But I want to emphasise that whereas^ (to use the current jargon) in^ most^ television (^) programmes, even medical (^) ones, the (^) television side (^) supplies not only all^ the^ hardware^ but most of the software too, if (^) you are involved (^) in a (^) programme that really sets^ out^ to teach^ doctors as distinct from entertaining them, you will^ find (^) you have to supply a^ good half of^ the^ software (^) yourself. This (^) side of the (^) Glasgow programme has been in the (^) hands of a Television Production Committee of (^) five. Four are medical-two physicians, one^ surgeon and one (^) pathologist, all (^) young to (^) middling consultants, and all with academic connections. The fifth is a medical artist with some (^) experience of (^) filming. His role has been a most (^) important one. (^) Doctors themselves, or medical artists (^) without (^) special POSTGRAD. MED. J. (^) (1965), 41, 223 DISCUSSION ## Chairman: DR. GEOFFREY TEMPLEMAN; Opener: DR. IRVING MERRILL, Director of Television Research, San Francisco Medical (^) Centre, University of (^) California; Participants: A. A. G. LEWIS (^) (London), J. R. ELLIS ## (London), A.^ HERXHEIMER^ (London), B.^ LENNOX^ (Glasgow), J.^ W. PAULLEY (Ipswich), M. SIM (Birmingham), ## D. BECKER (New York), A. WILLIAMS (Oxford), D. S. CHILVER (Boughton); Concluding Remarks: J. R. ELLIS ## (London). ## MERRILL: We have been using two methods of ## broadcasting in^ the^ States for continuing medical ## education. I might say that I use the words 'con- ## tinuing education'^ to make sure they mean that of a ## practising physician of some kind either in general ## or specialised practice, as distinct from graduate study ## which would be part of what we call a residency. ## Two methods of broadcasting have been very popular ## in the United States. One was pioneered by Dr. ## Frank Woolsey at the Albany Medical College where ## viewing was in^ a hospital, and a group of anywhere ## from 10 to 40 physicians and house staff members ## would gather to receive it. Another method, which ## was popular in the West, was that of the University ## of Utah where (at the time our study was designed) television was used for (^) reaching the (^) physician in his ## home, and the question arose: which one of these ## would be preferable? The physicians seemed to like ## both kinds and so the result might very well turn on (^) which was more effective from an educational ## point of^ view, that is under which situation people ## learned more. Briefly, in our study, we did use a Greco-Latin-square design which^ enabled^ us to^ use ## television stations in three different cities, and use three (^) different types of (^) subject matter, varying the ## order of presentation in each of the cities, and we ## also used various feed-back and response devices and ## we had three of those, and we varied them in the ## same way. We did not use physicians in this study ## but instead used 120 staff nurses who were currently employed in a general (^) hospital. So, conservatively, ## I cannot say that I know that the results of that study will be identical for (^) physicians, although I ## must add I suspect that they will be. These three programmes lasted over^ a^ period of^ six^ weeks.^ At the end of (^) that time we called all 120 nurses in for ## an evaluation session. One of the things we did was ask (^) them whether (^) they attended or (^) not, and the next thing we^ did was to (^) give them a little (^) examination, a 60-item (^) test which was (^) prepared (^) by the same (^) people ## who prepared the programme; we had checked out ## this test ahead of time so that we were quite sure the results were reliable. We then went into the evaluation (^) session and let them contribute ideas that they had^ to^ mention. When we had (^) analysed the ## findings we^ found out that those nurses who had left the (^) hospital or (^) who, just prior to (^) going to the ## hospital, had^ viewed this^ programme at home, had ## learned far more from the broadcasts than those nurses who had (^) gathered together as a (^) group at a hospital. Our (^) interpretation of (^) these findings was a hopeful sign for the use of (^) open circuit (^) broadcasting ## as a means of continuing education in the health sciences. We are not (^) prepared to (^) say that (^) under all conditions this would be true but at least we (^) did ## have some pretty solid evidence that there was no real (^) reason for not (^) going ahead and (^) using open circuit (^) broadcasting to reach these (^) people, and I think that (^) this is a (^) heartening sign for the efforts (^) of Scottish television in the (^) North, and it (^) seems to ## indicate good possibilities of success for the pro- gramme that the B.B.C. is (^) going to be (^) doing here in the Southern (^) part of (^) England. I think (^) that's as ## much as I'd say at the time. Reference ABBEY, S. (^) C., BoYD, V., DECK, E. (^) S., SHROCK, J. G., ## and MERRILL, I. R. (1964): Television in Health Sciences Education: Home (^) and Hospital (^) Viewing ## of Continuing Education Broadcasts Under Three Presentation-Response Conditions, J. med. Educ., 39, 693. ## LEWIS: At the recent A.S.M.E. conference Dr. ## Charles Fletcher made a most valuable suggestion, which was that if we are going to have television ## programmes there might be certain ones of a revision ## nature, as it^ were, which could be linked with local courses of (^) instruction in (^) certain areas, and that there might be^ some^ advance notice of this (^) given out. I wonder whether (^) anybody would like to comment ## on that as a possibility? ELLIS: I think I (^) could help a little with the (^) question ## Dr. Lewis has asked. In regard to the B.B.C. 2 programmes which^ will go out from (^) January onwards in collaboration with (^) A.S.M.E., we shall see that all ## who can receive do get information as to the nature of the (^) programmes, and we (^) will, before (^) they start (^) to ## go out^ be^ in^ touch with the regional postgraduate advisers of the (^) relevant areas (the (^) Metropolitan areas and the (^) Birmingham (^) region) so that we can col- laborate not (^) only in (^) sending out (^) information about the (^) programmes and (^) getting back results (^) of our enquiries as^ to^ their effect, but also I (^) hope collalborate together so^ that in the areas of the (^) country and ## postgraduate centres we can combine our efforts with television and what (^) goes on in the centres. ## HERXHEIMER: I should like to ask Dr. Lennox and ## Dr. Ellis what arrangements there are for feed-back from listeners and viewers to these (^) programmes so that there (^) is audience (^) participation. I think that Dr. (^) Graves's talk showed (^) very much (^) how important ## audience participation is and how much more efficient it makes (^) learning; Dr. (^) Paulley has (^) very much emphasized this^ and^ I^ wonder in what (^) way this can be used (^) effectively with (^) television (^) programmes. LENNOX: (^) Well, we (^) have, I am (^) afraid, done (^) ver little on this. We did do (^) one (^) questionnaire fairly early and^ got very encouraging results. The (^) majority of the G.P.s who (^) replied, and there were I think 800 or 900 from the (^) Glasgow area, approved of what we (^) had done and (^) thought we were (^) hitting the (^) right kind of (^) level. Since then (^) simple questions of cost-- it is an (^) expensive business-have (^) prevented us (^) doing more, but^ with the (^) help of one of the (^) drug firms we are (^) embarking on another (^) questionnaire in the (^) very POSTGRADUATE MEDICAL JOURNAL ## near future. Some of our own people who attended the Tunbridge Wells conference came (^) away with the view that it was possible to (^) pay too much attention to feed-back and (^) research, and that there was (^) a danger of (^) paying more attention (^) to the research and the feed-back than to (^) getting a (^) decent programme to start with. When (^) you are (^) dealing with a new medium and you haven't (^) very much (^) experience of it, you may be better advised (^) to behave as an artist rather than a scientist and (^) try, first of all, to put out what seems (^) subjectively to (^) yourself to be a good programme. Once you have (^) reached the stage where you think you can (^) play about with the technique you may then experiment (^) and undertake research into the results of (^) your experiments, but I think it can be a mistake to (^) apply too much research to your first childish efforts in (^) the medium. That, at least, was our feeling. LEWIS: May I (^) speak about audience participation? The best example of this which I found in America was in fact at Dr. (^) Merrill's own school, The University of California, where (^) telephone lines are linked to the medical centre after an (^) F.M. broadcast and a two-way conference (^) can then be held with participating hos- pitals. Now (^) in Maine, after the Bingham Associates Fund television they are gong to hire (^14) telephone lines from the Bell Telephone Co., which will be linked (^) up to the panel in the studio and a (^) two-way discussion for half an hour can then be held between the (^) studio panel and the audience. Now this is not yet, so far as I know, possible with our wonderful telephone system but private companies in America are only too glad to arrange a hook-up for a con- ference. Business firms think nothing of (^) hooking-up for half (^) an hour at 12 o'clock on a (^) Wednesday right across the States for a conference on (^) privately hired lines. PAULLEY: Dr. Lewis really said what I wanted to say and I did ask this question in Manchester: would it be possible to use, as it were, (^) existing methods, particularly by encouraging say a free (^) period of questions at the end of the programme, and encourag- ing doctors to 'phone in questions; (^) in other words, have somebody sitting there (^) taking in (^) questions and trying to make, as it were, a small (^) discussion at the end which is alive, even with (^) our existing resources? LENNOX: The first (^) programme that (^) you saw, the one on the immunization (^) programmes, had a studio audience of just two (^) general practitioners who asked live questions. That's one (^) possible way of doing it. It worked fairly well. It didn't liven up the programme as much as you'd think but (^) it did help to some extent. We have (^) certainly never (^) tried using telephone questions. We are (^) starting a (^) magazine for five minutes on (^) programmes, and part of that is going to be devoted to postal (^) queries, if we get them. SIM: There is just one (^) point I'd like (^) to make which hasn't been stressed, and it's really (^) to reinforce what Dr. Merrill said, and that is that we (^) cannot divorce education from the culture into which it (^) is received; it is (^) very difficult to try and draw conclusions from educational methods, e.g. in America, and (^) try and translate them here. Education or (^) learning is (^) very largely a^ matter^ of^ reinforcement.^ As^ we^ know, ## anxiety is^ probably the^ most^ potent factor in that ## reinforcement, especially the^ anxiety that derives from ## full responsibility. I am thinking of the responsibility the American doctor has in his office surgery, where ## he can really work up the patient to a degree which ## the British general practitioner, especially now under ## the Health Service, is almost incapable of doing. ## As well as improving our methods of education we have (^) got to make (^) sure that our students have (^) got ## the cultutral conserve which will reinforce that ## education, and^ produce the anxiety which will allow ## them to effectively improve their knowledge. As ## things are^ at^ the moment there is a danger that we ## will keep running refresher courses without providing the motive (^) power, but if we can alter the structure of the service (^) to allow the doctor the facilities for the ## full work up of his patients, then we are really ## making a^ positive contribution to learning. ## BECKER: I think it pertinent to point out that much of (^) the success of the newer methods (^) that were (^) presented today depend (^) upon a re-examination of the (^) content of the material that is (^) presented, and an (^) examination of the (^) objectives that one is (^) attempt- ## ing, or^ re-thinking of^ the^ behavioural^ characteristics ## that one hopes to achieve in teaching, so that the process of^ preparing material^ itself^ appears to be one of the most (^) important elements (^) to the success of (^) teaching. I think (^) perhaps the (^) emphasis on the ## new methods will also help the old method of teaching, where^ it will^ emphasize a^ little more what goes into^ it and^ encourage us^ to think about that aspect. ## WILLIAMS: There is a small group of doctors meeting in Northampton once a week (^) who are taking (^) part ## via telephone in a seminar in London-a joint ## exercise-and they have had to design some special instrument which I don't understand, but it sounds ## as though it oughtn't to be too complicated to produce (^) it, and use it more (^) widely. CHILVER: I would be (^) interested to hear from Dr. ## Lennox or Dr. Merrill, or both, whether the lay public in this (^) country or (^) in America listen to these open programmes, and^ if^ so whether they use them as rods for the backs (^) of their doctors who are unwise enough not to (^) have seen them themselves. LENNOX: Can I (^) just say that we worried about (^) this terribly when^ we^ started. We know a lot of (^) lay people do^ listen-I^ know my own barber (not (^) a barber (^) surgeon either) greeted me with joy after (^) the first time I (^) appeared on television-but we have had no (^) specific complaints at all about any (^) unpleasant reactions. One (^) thing in which we find (^) ourselves inhibited is (^) cancer; we haven't talked much about that (^) yet. Also we (^) didn't, though we were (^) very tempted to do (^) so, go ahead with a demonstration of how to take a mid-stream (^) specimen of urine. That kind of thing is difficult, but (^) on the whole it has caused a (^) great deal less (^) trouble than we (^) expected. 1 think Dr. Merrill has had exactly the same thing to (^) report, based on a good deal (^) more experience than ours. MERRILL: That is correct. (^224) April, 1965
