=Paper=
{{Paper
|id=None
|storemode=property
|title=Collaborative Visual Annotations For Knowledge Exchange in Practical Medical Training
|pdfUrl=https://ceur-ws.org/Vol-1047/paper2.pdf
|volume=Vol-1047
|dblpUrl=https://dblp.org/rec/conf/ectel/BockleSN13
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==Collaborative Visual Annotations For Knowledge Exchange in Practical Medical Training==
https://ceur-ws.org/Vol-1047/paper2.pdf
ECTEL meets ECSCW 2013: Workshop on Collaborative Technologies for Working and Learning, Sept. 21, 2013, Cyprus
Collaborative Visual Annotations For Knowledge
Exchange in Practical Medical Training
Martin Böckle1, Svenja Schröder1, Jasminko Novak2
1
Humboldt-Viadrina School of Governance, Social Innovation Lab, Wilhelmstraße 67,
10117 Berlin, Germany
2
University of Applied Sciences Stralsund, Institute for Applied Computer Science (IACS) /
European Institute for Participatory Media, Wilhelmstraße 67, 10117 Berlin, Germany
{mboeckle,sschroeder@humboldt-viadrina.org,j.novak@eipcm.org}
Abstract. This paper presents an approach to applying a visual annotation sys-
tem for informal learning through knowledge exchange between physicians in
post-graduate training in general medicine. The system is part of an online plat-
form for creating and sharing physician-generated medical cases from their
work practice. Collaborative visual annotations of medical images are used to
support knowledge exchange through online discussion and cooperative crea-
tion of medical cases. First results suggest that this can provide valuable sup-
port for informal learning through knowledge exchange in this specific domain.
1 Introduction
Knowledge exchange in practical medical training plays an important
role in connecting theory and practice. After obtaining their degree
physicians go through a period of post-graduate education of five to six
years to specialize in a given medical field. An important part of this is
practical training through independent work practice supported by ex-
perienced physicians. During this specialization, general physicians run
through different medical institutions, which are geographically dis-
persed and functionally not related (e.g. hospital, general practitioner’s
surgery). Thus, it is a challenge to keep their peer-network stable and to
use it for informal learning through peer-based exchange. We present
an approach to support such settings by building specific tools for facil-
itating problem-oriented knowledge exchange in work practice. We
focus on the use of collaborative visual annotations within a communi-
ty platform for the creation and sharing of medical cases between gen-
eral physicians in post-graduate training (the KOLEGEA project1).
1
http://www.kolegea.de/
Copyright © 2013 for the individual papers by the papers' authors.
ECTEL meets ECSCW 2013: Workshop on Collaborative Technologies for Working and Learning, Sept. 21, 2013, Cyprus
2 Collaborative annotations of medical images for physicians
2.1 Related work
Current research on knowledge exchange through user-generated con-
tent in medicine has largely addressed patient portals and online medi-
cal communities. Solutions for knowledge exchange between physi-
cians have been little addressed. Several community platforms for phy-
sicians exist (e.g. DocCheck, Coliquio2) but they largely offer general-
purpose solutions, with forum-based support for discussing patient cas-
es. Little work has considered how to support physicians in specific
medical domains. In this context, we have been investigating the appli-
cation of collaborative visual annotations to support work-related
knowledge exchange in practical specialization in general medicine. On
one hand, this builds on current research in collaborative visual analyt-
ics and CSCW that has explored new kinds of collaborative comment-
ing and analysis (e.g. Willett et al. 2011) for knowledge exchange. On
the other hand, previous work on collaborative learning has also shown
the usefulness of collaborative annotations for engaging users in learn-
ing-related behaviors such as showing support, self-reflection or inter-
nalization (Gao et al. 2013). In addition, healthcare professionals are
increasingly accessing visual information from the Internet such as
medical images (Carro et al. 2006) to support their work-related prob-
lem solving and continuing education. This points to increasing im-
portance of visual support for knowledge exchange in medical practice.
2.2 Application concept and design
The KOLEGEA1 platform supports the creation and sharing of medical
patient cases from the daily practice of general physicians. A core con-
cern is the design of tools for cooperative creation and use of patient
cases. These cases are conceived as visual artifacts combining a medi-
cal structuring with multimedia information (Novak et al., 2013). A
patient case is presented as a slideshow (Fig. 1) organized by phases of
medical consultation (examination, diagnostics etc.). Different types of
media like text, video, audio (e.g. voice memo) and image files (skin
2
http://www.doccheck.com/, http://www.coliquio.de/
ECTEL meets ECSCW 2013: Workshop on Collaborative Technologies for Working and Learning, Sept. 21, 2013, Cyprus
eruption, injury etc.) can be uploaded through mobile devices (tablets)
or the web.
Fig. 1.0 Visualization of a patient case / cooperative visual annotations
The cases can be linked to medical guidelines (best practices) and
tagged with symptoms, diagnosis keywords or counseling purposes. In
order to stimulate peer-exchange the author adds an initial question to
state his motivation for posting the case (e.g. asking about unusual
symptoms). Physicians can discuss the case through plain comments or
by using the special visual annotation tool. The latter allows them to
highlight a region of interest in a case image and add a comment (“Can
this skin eruption be a side-effect of the furosemide medication?”) as in
Fig. 1 (left). Medical discussions often revolve around specific details,
such as direct observations of patient symptoms or diagnostic infor-
mation (e.g. EEC diagrams). Linking comments to specific parts of
visual material could improve the quality and precision of knowledge
exchange among the physicians and increase the motivation for partici-
pation under time pressure of work practice. Such annotations could
also help gain new insights in complex cases that might be difficult to
recognize otherwise. By stimulating collaborative analysis and discus-
sion of problems from practice they could increase the effectiveness of
informal learning in the workplace and connect it with problem-based
learning in formal medical education (Ziebarth et al., 2013).
3 Preliminary evaluation results and discussion
To evaluate the practical suitability of our approach, we conducted a
formative evaluation of the patient case application in two sessions of
ECTEL meets ECSCW 2013: Workshop on Collaborative Technologies for Working and Learning, Sept. 21, 2013, Cyprus
1.5h each with 5 participating physicians (in total). The participants
performed typical tasks that would occur in practice: creating a patient
case, sharing it with their learning group and discussing it online with
their peers and a mentor. To assess user acceptance we applied selected
elements of the UTAUT model (Venkatesh et. al 2003) elicited by a
Likert-scale questionnaire. All users perceived the application as useful
for their medical training (“strongly agree”) and all but one perceived
that it simplifies their medical training (“strongly agree”). Regarding
the functionalities for visual annotations, the participants found the
possibility of marking regions of interest on medical images and com-
menting them directly very useful (four out of five “strongly agree”).
The same result applies to adding free comments and linking them to
an entire image. The usefulness of the related knowledge exchange
through peer-based and mentor-assisted discussion also obtained the
same level of agreement (four out of five “strongly agree”). Such find-
ings indicate that the specific functionalities of collaborative visual
annotations for case discussion could provide appropriate support for
stimulating knowledge exchanges between the physicians in this specif-
ic domain. Accordingly, this suggests that visual annotations could
provide specific support to improve the process of informal problem-
based learning through peer-based knowledge exchange in workplace-
based training and related settings. This explorative hypothesis will be
investigated through further work and evaluations, such as a planned
real-world (longitudinal) pilot study.
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