Thinking Differently, Technology Goes to School

Stan, a virtual patient currently programmed to replicate a truck driver, is in poor health. He's sixty-one years old, overweight, drinks too much, and exercises too little. And on this particular morning in a treatment area at Duke Medical Center, he's about to suffer a far more serious problem. With the click of a mouse, he's given a tension pneumothorax—a punctured lung.

Lying on an operating-room table with a blue cloth shielding his plastic privates from view, Stan begins breathing heavily and the left side of his chest stops moving. His heart rate climbs, the blood pressure and oxygen level in his blood decrease, and he becomes short of breath. Before long, Jeffrey Taekman, a Duke anesthesiologist, steps in to do something. "That's a controversy, whether you should let someone kill the mannequin," says Taekman. "I don't think anyone has killed Stan yet."

At Duke's Fuqua School of Business on a recent morning, colleagues look up at an eight-foot-wide video screen that's part of Fuqua's Global Conference System. With the push of a button, another time zone comes to life as technology links Fuqua staff to counterparts in Frankfurt. "Guten tag," they say, and their life-size images beam from the wall and their gaze meets at eye level, as if seated inches across the table, rather than halfway around the globe. The audio is so realistic you hear a car horn honking from hidden speakers—in Deutschland or in Durham?Stan's a sophisticated, computerized simulator designed to mimic a real patient in a variety of scenarios. He's a hands-on teaching tool at Duke Medical Center, where hightech touches include a $750,000 Human Simulation and Patient Safety Center that opened in April and a student auditorium incorporating a dazzling array of technological advances that are perhaps the most forward- thinking on campus.

Meanwhile, at the law school on a recent afternoon, students aren't studying contract law from oft-dry, three-inch-thick law tomes. Instead, via computer laptops, they're immersing themselves, in video and audio vignettes with discussions from nearly fifty high-profile legal scholars, practitioners, and judges as part of a groundbreaking, DVD-ROM multimedia teaching tool conceptualized at Duke.

All around the university system, the move to "smart" classrooms is changing the way students learn and professors teach. Internet access, including wireless applications, other technical features such as patient simulators, SMART Board interactive whiteboards, sophisticated Duke-produced webcasts and DVDs, "telepresence"—all are just a sampling of a technology arsenal being deployed in recent years.

Duke Medical Center's training areas are full of heads and torsos, arms and legs. In med-school lingo, the noncomputerized body parts are known as "task trainers." But none match the sophistication of Stan, a $170,000, computercontrolled, life-size mannequin and control tower that exhibits symptoms and reacts to medicines and interventions like an actual person.

The medical center bought the high-fidelity patient in February 2001 from Medical Education Technologies Inc. (METI) of Sarasota, Florida. Housed in the Human Simulation and Patient Safety Center in Duke South, Stan has three "parents": the medical school, the nursing school, and the anesthesiology department. The Simulation Center also houses a pediatric patient simulator, aptly named Baby Stan.

The adult Stan—one of about twenty-five METI simulators in existence—is powered by a Mac G4 hooked up to a Linux computer controller and is run largely by pneumatics and electronics. His output is vital signs, including body temperature, pulse, and cardiovascular and pulmonary parameters. His pupils dilate and his vocal cords can constrict to impede attempts at inserting breathing tubes. He routinely suffers cardiac arrest, drug interactions, anaphylactic shock, and more complex conditions. A fluid system allows him to urinate and to give students the opportunity to tap chest fluids. Stan's eerie sounds give a sci-fi feel to a room when his breathing and heartbeat play through hidden speakers.

Taekman, who directs the center and is also assistant dean for educational technology and an assistant professor of anesthesiology at the medical school, says the simulator is an important technological teaching advancement. Not only does it help promote real-life hospital dynamics and teamwork, but it also reduces the need for students to do laboratory work with live animals. "The simulator is good for what-if scenarios," Taekman says. "There's a set way of treating most disease states, so you can't look at what happens to a patient if you try a different therapy. For example, you can't give a patient an overdose of a medication to see what happens. You also can teach a rare event in simulation, since we can have it happen commonly."

The simulator reacts to "pretend" intravenous drugs, which are administered via barcoded syringes filled with water and scanned to determine what drug is being injected. It can model either gender as young, old, healthy, or very ill. Switch out a few plastic body parts, and Stan becomes Stella. Stan also can be programmed to portray a number of cases the manufacturer has configured. Besides "Truck Driver," there's "Mr. Outta Joint," an orthopedic case; "Una Goodeye," an ophthalmology patient; and "Dr. Iven Fast," a combative, inebriated male who was just in a car accident.

In April, Stan moved into the new Simulation Center, modeled after a similar center at the Bowman-Gray School of Medicine at Wake Forest University in Winston-Salem. The center incorporates wireless capabilities, videotaping equipment, and a debriefing room complete with a SMART Board where students and faculty can share impressions following training. Video can be fed live to nearby lecture halls. "It's in the fiber-optic backbone of the hospital, so we can ship our scenarios anywhere in the world via the Internet," says Human Simulation Coordinator Gene Hobbs.

Taekman says he hopes to expand simulation to take full advantage of the technology. "We've got a group of about twenty faculty members who have committed to teaching over here," he says. He plans to use humanfactors engineering, with a combination of psychology and engineering, to study human performance in different scenarios. These studies could look into such variables as human- machine interface with the simulator and team interaction, considering such issues as what would be encountered in an emergency.

The Simulation Center is one of numerous high-tech teaching areas at Duke Medical Center. The 150-seat amphitheater classroom, where first-year medical students have most lectures, has laptop ports, power supplies, and built-in microphones for students; video cameras, CD, and DVD technology, and touchscreen displays for faculty; and a staffed control room. Like contestants on Who Wants to Be a Millionaire, students can respond to an instructor's questions via a hand-held remote keypad, rather than with a show of hands. Statistics are immediately tabulated and projected at the front of the room. Faculty can poll students with mini-quizzes to get an idea of their understanding of a concept in the middle of a teaching session. The keypad also can be used by the students in the auditorium who are observing and helping call the shots—via video—of a scenario in the nearby Simulation Center.

"We'll get them to a decision point, and then you're not putting the four or five people [in the Simulation Center] on the spot," Hobbs says. "Instead, they're making a decision as a group."

Across West Campus at the Fuqua School of Business, telepresence is one of the hottest topics, and it has nothing to do with television psychic Miss Cleo. Telepresence is high-performance videoconferencing used in Fuqua's Global Conference System, a high-speed, cross-continent video connection using Internet2, the next generation Internet, which features much faster data transmission through a bigger pipeline. The system allows Fuqua staff and faculty to meet, as needed, just by walking into a conference room linked to Frankfurt. In March, a virtual "ribbon cutting" was held to celebrate Fuqua's achievement of being the first institution—academic or corporate —to use Internet2 for telepresence.

"This is exciting stuff, and the future use of this is going to be powerful," says Nevin Fouts, associate dean for information technology at Fuqua. Eventually, Fuqua hopes to expand telepresence into the classroom for presenting guest speakers and other education programs.

On a recent demo of the system, Fouts began speaking with Felix Mueller, director of marketing and operations for Fuqua Europe; and Falko Friebe, IT coordinator in Frankfurt. The benefits are apparent. Both men appear relatively life-size and at eye level. It doesn't feel much different than sitting down and speaking to someone across the table. "This is a very useful tool because it allows us to sit down face-to-face," says Tim Searles, director of multimedia services for Fuqua. "You can't do that in a telephone call."

Smiling across the table from Germany, Mueller concurs. "One challenge, when you add distance, it means you have to add tools to bridge the distance. We cannot fly to Durham every week."

Fuqua's Telepresence: a video conference with Frankfurt Germany.

Telepresence is just one of the many Fuqua technology firsts over the last two decades. In 1983, it was the first business school in the world to integrate the personal computer into its curriculum and, in 1994, the first to do the same with the Internet. In 1996, Fuqua was the first business school to launch a new M.B.A. program, the Global Executive M.B.A., which combines international residential experiences with Internetbased learning.

In 1998, Fuqua was the first top-tier business school to deploy a high-speed local area network (LAN). Called FuquaNet, it was the first production gigabit Ethernet LAN in North Carolina and one of the first worldwide. Five years ago, Fuqua began deploying virtual learning to support its distance-based programs, and the school is currently deploying the fourth generation of these environments, says Fouts.

More recently, Fuqua is taking part in a pilot study investigating a new generation of computing devices that Fuqua leaders hope will extend the Fuqua experience beyond anywhere a traditional desktop or laptop can be used. "We have a lot of world-class technology that we want the people who come to Fuqua to experience," Fouts says. "We believe our technology and our environment are not only world-class, but as good or better than anything our students have experienced anywhere in their global corporate environments."

In 2001, wireless capability was deployed in all student areas at Fuqua, including classrooms. The school has some of the latest technological innovations in nine classrooms, seven seminar rooms, a studio classroom, and a large auditorium. Features include a mix of touch-panel controls of projection, lighting and computer systems, digital overhead systems, and a wide range of other technologies, such as DVD and CD players and wireless remote controls. Specialized classrooms also have SMART Board technology and plasma-display systems to augment traditional projection equipment.

Fuqua also has a multimedia production facility and can do live classroom webcasts. Other innovations include Learning on Demand, which captures classes for executive education and lifelong learning for alumni and executives; and Monday Morning Message, a weekly video-on-demand that highlights recent accomplishments through Fuqua's intranets, FuquaWorld and Alumni- Link.

Much of the classroom systems' design and installation are done by Kontek Systems Inc., a Durham-based firm founded fourteen years ago by Frank Kohnhaus '80 and Wes Newman '78. The company has done more than 200 installations on the Duke campus.

In a pilot Duke Law School program that began this spring, the first-year contract law textbook is being replaced with a multimedia, DVD-ROM called The Contracts Experience. A project of law professor John Weistart J.D. '68, the DVD features case re-enactments and analysis with video commentaries and discussion from forty-three high-profile legal scholars, lawyers, and judges, including consumer activist Ralph Nader, federal appellate judges Richard Posen and Frank Easterbrook, and contracts scholars Richard Epstein, Melvin Eisenberg, and Richard Speidel.

"It's the most significant project we're doing right now and a radical change in how you teach law and how the material is presented," says law professor Thomas Metzloff, who has been involved with many of the law school's other technological innovations over the years.

The DVD offers more than eight hours of video designed to help students find meaning in full-text versions of the Uniform Commerce Code and the Restatement (2d) of Contracts. It also contains fulltext versions of those legal resources, which are consistently underutilized by first-year law students.

The project is being led by Weistart and two other law professors, Duke's H. Jefferson Powell and Georgetown University Law Center's Girardeau A. Spann, with assistance from two editor/producers, Christopher B. McLaughlin J.D. '96 and Denise

E. Thorpe J.D. '90. It involved filming more than sixty hours of interviews in six cities— Washington, D.C.; Chicago; Atlanta; Denver; San Francisco; and Durham—and twenty additional days filming "hypotheticals" and case re-enactments. More than 250 first-year law students are using the beta DVD in three classes at Duke and Georgetown.

A typical contract-law book has about 800 pages of text with, at most, a few blackand- white photos or illustrations. Students can run the DVD directly on their laptop or install it on their hard drive. It has a list of all the chapters, just like a traditional textbook, and navigational tools that guide students through text and video elements.

"I love the DVD because it appeals to more than one sense," says Patricia Festin J.D. '04. "It's visual, it's auditory, it's interactive, and it just makes the whole experience of transferring information about a certain subject more three- or even four-dimensional. It just totally comes alive."

Festin likes the dual reenactments of some cases. For example, "they'll do the exact same facts of the case in a different context, maybe a young woman versus an old woman. They'll change things that are not implied and set in stone in the case, so it totally changes your perception of what you think the outcome should be and it really teaches you to do an analysis. It's not just 'what you see is what you get.' And that's what learning law is all about, that analysis."

"I really liked the noted authorities," she adds. "It's really good to see people who are actually practicing the law and how they struggle with the same questions students have."

With the DVD, Festin says she takes many more notes than she would just reading from a casebook. "I have the text and the video on my screen, and I can just open Word and take notes as fast as they're talking as to what's relevant. I don't really take those kind of notes when I'm reading from the casebook, but with the DVD, I take notes on everything." The team plans to revise the DVD based on reactions and expand it to other law schools.

The Contracts Experience is just one of the pioneering uses of instructional technologies at Duke Law. "The law school has long been recognized within legal education as a leader in technology," says Richard A. Danner, the law school's senior associate dean for information technology. "We operate on the theory, 'If you build it, they will come.' We've always tried to put as much technology as we could in all of our classrooms. It's just a natural part of the teaching environment."

In March 2001, The National Jurist ranked Duke's the number-two "Most Wired" law school in the U.S., and Syllabus, a magazine dedicated to exploring the newest and best educational technology, has twice cited the school. All student areas of the law school have wireless access, and there are plans to make the entire building wireless. In recent years, the school gutted its upper floor to create a new courtroom and renovated classrooms and a teaching auditorium to include the latest technology. All classrooms have Internet access and power ports for student laptops; most have wireless touch pads and projection equipment for faculty and a full complement of audio and video equipment. Three of the school's seminar rooms have SMART Boards, while the futuristic Moot Court Room marries legal presentation with similar high-tech enhancements.

Stan the mannequin:a computer-controlled "task trainer".

"It's not just a modest inclusion of a few technology tricks," the school's Thomas Metzloff says, adding that technology must be integrated with room architecture, seating, and lighting. In a seminar room, he turns on a SMART Board linked to his laptop and begins a rapid-fire display of material available with the touch of his finger. (SMART Board is a product of SMART Technologies Inc., based in Calgary, Alberta, Canada.) With the computer image projected onto the whiteboard, Metzloff presses the touch-sensitive surface to access PowerPoint and Web materials for case law involving the

McDonald's hot-coffee case, the Exxon Valdez oil spill, and the Dalkon Shield IUD case, to name just a few. Using a SMART pen, he shows how effortlessly he can take notes or highlight important information for students.

This spring, the law school launched an International Career Videoconference Series. The program gives students in Durham the opportunity to speak "face to face" with alumni working overseas in Germany, Hong Kong, and Switzerland for advice on careers abroad. And last year, Metzloff led distance-learning efforts when he taught, from Durham, "Distinctive Aspects of U.S. Law" to students at Tsinghau University Law School in Beijing. The project used videoconferencing, the Internet, and CD-ROM, along with on-site lectures and classroom discussions.

"I don't think for a minute that I've always excited all of my students," Metzloff says, "but I'm definitely known as the anti-chalk person."

The projects at the medical and law schools and Fuqua are cutting-edge, but if Mike Pickett has his way, they'll eventually be seen as run-of-the-mill. Pickett, special assistant to the provost for academic technology and Duke's associate chief information officer, led much of the academic information technology planning for the university's $700-million, five-year, "Building on Excellence" strategic plan, which was adopted in February 2001 by Duke's trustees. A total of $25 million has been set aside for technology initiatives.

"There's an awful lot happening; some schools are way ahead and some schools are just starting to dive into it," Pickett says. "As part of the academic strategic plan, there's a goal to increase and improve the way we use technology in everything we do."

One major initiative is the Computer and Information Technology Intensive Environment program, also known as CITIE. It has a steering committee with members from each of the schools and is exploring new modes of teaching, learning, and research using technology.

"It's kind of an overarching organizational project that tries to help the whole university create an environment where teachers and students and learners have the tools at their fingertips to use technology to improve teaching and learning and research," Pickett says. "One of the important concepts for all of these tools is we don't believe technology is important for technology's sake. We think its importance comes in what it does to allow us to be better and more effective teachers, learners, and researchers."

Other early efforts include mass data storage for research, student technology train ing, and the use of Blackboard, a Web-based course management system that allows access to course material outside a traditional classroom. Depending on what an instructor chooses to include, a Blackboard site can have a syllabus, readings, and presentations; a "virtual classroom" where students can chat with the instructor and other students; links to websites related to the course; a digital drop box for assignments or other documents; and automatically graded quizzes and fast access to grades, among other options. Pickett says more than 600 courses throughout the university can now be found on Blackboard.

"Duke has made significant technology strides in the last five to seven years," says Lynne O'Brien, director of Duke's Center for Instructional Technology. "We're doing some very ambitious things across the board." In addition to fostering on-campus initiatives, technology leaders at Duke meet about three times a year with peer institutions to discuss challenges and various technology initiatives.

"We get together regularly at different levels with the Ivy League schools and a few others, and struggle with the same problems in general," Pickett says. "In general, when we meet with our peer schools, I think we find we are very often in similar boats. Some schools will have pushed ahead in some areas and others will have pushed ahead in others."

For one, Duke has joined such universities as Stanford, Michigan, North Carolina State, Dartmouth, and Pennsylvania in the Open Knowledge Initiative. The OKI is a multimillion-dollar educational technology project from M.I.T. that brings the schools together to develop the kinds of software that are useful in academic settings and to share that broadly, O'Brien says, "so that we are not pigeonholed or forced to teach based on what commercial software developers give us."

"To a great extent," says Pickett, "we have all been trying to figure out how to provide online education for our undergraduates and graduates. However, of the number of schools that are our peers, most are not trying to provide an undergraduate degree using online technology, but are using the technology to enhance the undergraduate experience. What we will continue to do, and this is where we may be behind, is to become more experienced in how we want to use these tools to accomplish our teaching, learning, and research effectively. Where some other schools may be ahead of Duke is they may have had more time to use these tools and may be a little more advanced in how they are using them."

In the final analysis, Pickett says, Duke's technology plan is not aboutplaying catch-up, or about having the hottest and newest toys. Instead, it's about putting technology to work for the educational mission of the university. "We want to make sure we're not throwing away money or just doing technology for technology's sake. That's one of the reasons why Duke has been careful," he says. "We don't want to throw our resources away and we don't want to waste people's time. This is not about image. It's about effectiveness."

Babcock is a freelance writer living in Morrisville, North Carolina.