Lights, camera, medicine

Academic rigor meets social media — UF residents launch a peer-reviewed video medical journal

By Czerne M. Reid

A venerable piece of apparatus known as the copper kettle revolutionized anesthesia in the early 1950s by turning liquid anesthetic into rapidly and precisely delivered doses of fumes. Although the copper kettle has been replaced by newer machines, its operating principle is key to anesthesia administration, and so it makes frequent appearances on board examinations anesthesiology residents must take to become licensed to practice.

To help residents grasp the concept more readily, UF chief anesthesiology resident David Edwards, M.D., Ph.D., and his faculty mentor Mark Rice, M.D., chief of the liver transplantation and general surgery sections in the department of anesthesiology, created a flash animation and video tutorial that showed the kettle in action.

Their animation was of such good quality they wished they could publish it in a peer-reviewed journal.

“When you put a certain amount of work into something that’s comparable with any kind of written publication, that in itself is an academic accomplishment, and you feel like you should get some kind of academic credit for it,” Edwards said. “But it’s an animation, so where are you going to put that kind of stuff?”

The usual places are DVDs taped into the backs of textbooks or videos uploaded onto file-sharing websites. But Edwards and fellow chief resident Neil Ellis, M.D., who both recently finished residency at UF, felt there needed to be another kind of academic forum for such materials.

So they created a medical video journal.

The newly launched Journal of AudioVisual Medicine publishes peer-reviewed scholarly multimedia medical content, such as medical animations and surgical demonstrations as well as computer applications that allow users to customize the way they use the journal. The free open-access journal with the catchy nickname “JavMed” combines the rigor of peer review with the power of social media, allowing general users to rate videos and upload their own content.

JavMed’s advent is well-timed for a period in history when many people turn to the Internet as their first and often only source of information, and when technological advances and affordable mobile computing devices and social medial platforms make high-quality videos and animations possible and accessible. Those advances, in turn, feed an appetite among consumers for richer multimedia.

“There’s a huge need for a journal like this,” said UF’s André Pierre Boezaart, M.D., Ph.D., a world authority on acute pain medicine and a branch of anesthesiology called regional anesthesiology, a pain-relief strategy that involves numbing only the parts of the body involved in surgery. “A lot of our procedures are really technical, and you cannot really describe it in words, but you can describe it very well in an audiovisual presentation.”

JavMed already features video content from notable anesthesiologists and has issued a call for submissions. The journal plans to extend its reach beyond anesthesia to cardiology, radiology and other medical and surgical fields.

A new type of journal

Medical and other academic journals have ventured into the realm of modern media over time, but for the most part that has only meant allowing readers to view text online or download PDFs. Now, journals such as Science offer multimedia portals with podcasts and videos produced by authors of papers that appear in the print journal. But those materials are still separate from the journals’ peer-reviewed sections. Anesthesia & Analgesia and other leading journals have gone a step further, offering enhanced images online so readers can, for example, see the pulsing of an ultrasound image. The Journal of Visualized Experiments, or JoVE, goes the furthest, offering an entirely peer-reviewed video journal dedicated mostly to laboratory research.

JavMed, which specializes in clinical practice, offers a twist, not only by making text secondary and putting videos in the spotlight, but also by combining traditional journal standards with web tools that harness the potential of social media.

“We’re of the Harry Potter generation — we want to see the pictures moving,” said Edwards, JavMed’s editor-in-chief.

For that, many medical students and physicians turn to videos produced by companies that sell equipment or services, or to online health professionals networks.

Or to YouTube.

But there, medical content lives alongside work of questionable substance and quality —videos of piano-playing cats and videos in which ’80s pop star Rick Astley suddenly bursts onscreen singing “Never Gonna Give You Up.”

“On some level it kind of takes away from the seriousness of the work,” said Edward Nemergut, M.D., an editor of Anesthesia & Analgesia and editor-in-chief of its affiliated medical education website OpenAnesthesia.org. “I think a lot of scientists and physicians will roll their eyes and say ‘I don’t care how many views on YouTube you have, but if I have an outlet that’s serious and controlled and peer-reviewed I might be more likely to share the things I’ve created.’”

JavMed provides that outlet.

The project has drawn interest from luminaries in the field of anesthesiology, and Edwards and Ellis have assembled a scientific committee and editorial team to tackle the setting of standards and reviewing of submissions. Boezaart is the editor for regional anesthesia and acute pain medicine. Nikolaus Gravenstein, M.D., the Jerome Modell professor of anesthesiology at the UF College of Medicine, is the general anesthesia editor. Johan Reyneke, B.Ch.D., M.Ch.D., Ph.D., a world leader in corrective jaw surgery, is the editor for maxillofacial surgery.

Reviewers will evaluate entries on two fronts: scientific rigor and technical quality.

“We’ll very seriously peer review the submissions and make sure they’re of a very high standard,” Boezaart said. “We would expect a very high technical standard of practice and of production — it’s not just someone taking a picture with a cell phone and saying ‘This is how I do it.’”

That said, the journal does have room for cell phone videos in its non-peer-reviewed section, although many hospitals, including Shands at UF, have strict policies forbidding the use of personal phones to capture images or video inside the hospital. Users can upload self-made videos, rate other people’s videos and leave comments. The journal’s three-tier ranking system gives greatest weight to materials that have been peer-reviewed. Next is content given favorable ratings by viewers who are physicians or other subject matter experts, then comes content that has gotten the thumbs up from general users.

“The community of peers is the best peer review,” Nemergut said.

O Canada!

Edwards became interested in computers at an early age while growing up in Edmonton, Canada. His first personal computer was the Commodore 64, introduced in the 1980s. During his senior year of college, after hearing that he had been admitted to medical school, he promptly dropped all his biochemistry classes and signed up for animation courses instead.

Ellis, who is also very computer savvy, grew up in Toronto, Canada. While in college, he lived in California’s Silicon Valley during the dot-com boom, soaking up the Internet startup vibe.

The two met at UF while foraging for snacks in the residents’ lounge late one night when both were on call. They soon realized they were from the same country and shared many interests, such as martial arts, adventure snow sports and water sports.

Their love of the outdoors took them from Gainesville to Tampa and Orlando for kiteboarding and wakeboarding adventures. Their love for computer technology led to the hatching of many ideas during the long drives back and forth.

“We would just sit in the car for hours and think of things we could do,” Ellis said.

With the help of Edwards’ brother in Canada, who is a computer programmer, JavMed became a reality.

The young inventors fit right in at the UF department of anesthesiology, which has a strong culture and long history of invention.

Current and past faculty members in the department now helmed by F. Kayser Enneking, M.D., are leaders in medical invention, with innovations such as the first machine widely used to provide breathing support for babies born prematurely; a universally used set of emergency tools for quickly creating a breathing hole in the throat of patients whose airway is blocked; shoulder pads that prevent football players from overheating by funneling cool air onto the body; a widely used tool that allows long-term infusion of anesthesia into nerves deep in the body for profound pain relief during and after surgery; and the Human Patient Simulator, a lifelike teaching-tool mannequin that mimics patients’ reactions — and the list goes on.

 JavMed in education

Simulations eventually will feature prominently among JavMed’s offerings. One project in the works is an app that gives students the sensation and “experience” of using a special probe used in diagnosing heart disease.

Extending its reach, the journal is partnering with OpenAnesthesia.org to allow users of that site to upload and share their multimedia work. JavMed also has a big focus on providing teaching tools that allow compilation of top-rated videos on a given topic into virtual textbook “chapters” for tailored courses. In this way, a course’s instructors need not all be from the same institution. In addition, physicians can earn continuing medical education credits by viewing recorded sessions on JavMed from accredited meetings, such as the anesthesia workshop called GatorRAP, held in Gainesville.

“That’s the real power of having a credible set of collected resources online,” Ellis said. JavMed is more than just a database, it’s a tool.”

JavMed also has textbook and testing apps for smartphones and the iPad. One sure-to-be-popular app called ITE Master helps anesthesia residents prepare for an “in-training exam” that they take as a dry run before their board certification examinations. The app has a textbook section, a built-in bank of questions and a “test me” function that lets students see how their performance compares with that of other residents. Coming updates include in-app streaming videos and a “teach me” tutorial function.

“It’s taking the textbook out of the library, off the shelf and making it more mobile,” Edwards said. “When I first came to UF they used to give us textbooks — now they give us iPads; I can take the whole library with me.”