Hi, everybody. Thanks for having us. Today's our topic is teaching everywhere, changing the teaching paradigm. So actually my faculty today, my two dearest residents, oh no, fellows, and actually Amy Tenelia is our Senior Pediatric Rehabilitation Fellow at Columbia University Irving Medical Center and Weill Cornell Medicine. And Ray Stamford is a former, my Pediatric Rehab Fellow. Now he's heading to Phoenix Children's Hospital. And Dr. Kentaro Onishi is our colleague at University of Pittsburgh School of Medicine. He's currently Assistant Professor and Director of PM&R Sports Medicine Fellowship Program. So I'm trying to, okay, so this is our disclosure. And I bet all the people who are on this National Grand Rounds, you guys all feel that we needed to improve our skill on remote teaching. But before this, we also feel that we need remote teaching more than before. I was thinking about that, why we need to remote teaching nowadays. There's a lot of changes in the healthcare system. The hospitals are merging all the time. Therefore, trainees and faculty, we all have to go around out of our main hospital. So we are working or rotating at many different off sites. Therefore, we are not able to get together. We are not able to study together, or even hands-on training have been very, very difficult. So we have to learn how to teach them from far. And the other one is a pandemic has been teaching us so much in different ways, but especially education part has been drastically changed because of a pandemic. And there's a lot of spacing issues. So we are focusing on remote teaching nowadays. But still, we haven't been doing it. I was able to participate a lot of international meetings and education meeting, conference and workshops through these different platforms. And then even I was able to continue the missionary work. For example, this is we are actually sharing cases at orphanage in China with our hospital therapist and myself. We're doing case review and then we are formulating the treatment plan. So after we give a talk and then physiatrist in China is translating. So as you can see, still a lot of education never stop. Education never stop. It's still going on. But we are not really equipped to, or we are not very familiar with all different platforms. And we are not very skillful either. We just push the link and then we just continue the talk. That's it. But we can be better through this grand rounds. I'm trying to go to next one. Okay. Now this is who I am and who I was in the past. So this is crazy. It's very hard actually. Just clicking the Zoom link is not sufficient for me to teach efficiently. So my young fellows are teaching me how to help them out. So especially we have a huge problem with the live demonstration. Thankfully, I met Dr. Kentaro Onishi through another conference and he was teaching us that we can do live demonstration through Zoom. So I start to learn how to do this live demonstration. And then now I have my YouTube channel. I'm teaching my fellow and resident through YouTube channel. And then I have even my library for those live demonstrations. So this library material is readily available and this is free. So funny thing is my resident called me one day and he said, Dr. Kim, now I'm reading same PowerPoint lecture five times on the train, on my bed. So you can imagine these young people, they want to, everything has to be very readily available for them. Otherwise, we cannot really approach our young fellows to achieve their learning goals. So now actually, since we are doing this YouTube remote teaching, we did a brief survey with our fellow Dr. Ray Stanford and Amy Tenelia, we did together. And then we didn't include graduate, the senior doctors. So we have only N15, PGY2, N3. Our question was, what barriers for coming in person for ultrasound practice? Mostly, their problem was rotation was off sites. 80% of people had trouble. And how many times have you watched? At that time, we had the 10 times live demonstration. They watched the five times. And then do you watch the YouTube live or later? About one third of our residents were participating live demonstration, but the 100% of residents, they were actually watching, recorded one. And then how is the image quality of the videos? It was great. Actually, good was 80%. Okay, was 20%. And is supplemental material PowerPoint slides, it was helpful. There's 100%. They were helpful. Actually, if you look at my YouTube video channel, they like to watch PowerPoint slides than live demonstration. And the YouTube is not set up for two-way video chat like Zoom, as you can imagine. So is text to chat sufficient? 50% of residents were okay, but about half of them were actually asking for real time chat to have a conversation during live demonstration. So now I'm going to introduce our lecture. So Amy Tenaglia is going to talk about Zoom and Ray Stanford is going to focus on YouTube. And Dr. Kentaro Onishi is going to talk about his experience on remote ultrasound, the teaching experience and its challenges. And today's learning objectives. Upon completion of this study, participants will be able to state the benefits of remote teaching and describe how to utilize the features of Zoom and YouTube to create effective lectures and describe how to set up your personal computer and ultrasound machine to use for a remote live demonstration. I'd like to invite Dr. Amy Tenaglia to talk about Zoom settings. So Amy, oh, I'm sorry, I was, where did it go? Dr. Kim. Are you on it now? Yep. Good. All right. Hi, everyone. So I just wanted to talk a little bit about some of the basic features of Zoom meeting. And this is just to help give you the most effective and the most interactive lectures, as this is a pretty common platform that we're all using right now. So we'll start with basic things like how to set up a lecture and send out an invite, and then go over some of the features like screen share, polling, breakout rooms, and things like that. Just a disclaimer, I am not a Zoom expert. But like many of us have been using this more and more frequently over the past year. And then Zoom also has their website with a lot of great resources and tutorials that go through how to use a lot of these features. All right. So the first very important step is how to set up a lecture. So you're going to go to the main Zoom login page, zoom.us. You'll log in on the upper right-hand side. And then you'll come to, now this is also another important point. This is for somebody who is an account member. So if your organization belongs to Zoom, this is what your account will look like. You'll likely be taken to your profile as the first page. You'll click down under meetings. If you have meetings that are already set up, you'll see them here. If you want to schedule a new meeting, you'll go in the top right corner to schedule. You'll then be able to put in the details of your meeting, the lecture, the time, the date. Two things I want to point out that maybe some people skip over. You can actually require registration for your meeting. If so, the participants or the lecture rather, the participants will put in some of their information like their name, their email address. And this will allow you to keep track of who attends if you'd like. Another important feature is the personal meeting ID, which sticks with you and your Zoom account. It's like your personal room. And you do actually have to click this and enable using your meeting ID to be able to use a lot of the features that we're going to talk about. So I would actually recommend clicking this meeting ID so that all the features are enabled. Another important point about some of these features is that your account from your administrator actually has to be set up to enable a lot of these features. So if you're not seeing something or something isn't right, that could also be a potential problem. Okay. So once you've selected your features and you can click through all of these things, you're going to obviously save your meeting. And then when the time comes, you'll go back to the same tab, you'll hit start your meeting or your lecture, and you're good to go. All right. Once you're actually in the Zoom meeting, this is a screen that you'll see. Much like the screen you're probably looking at right now. These will be all of your features. A couple things to point out. The top left, this little green shield, great place to get a quick link to share the link to the lecture if you want to invite somebody to join. Top right-hand view, you'll have your view and you'll be able to pick which view you'd like to see. You can also, as AAPM and our staff actually mentioned, Install My Thunder, you can click the three dots next to participants and you can select features there like hide non-video participants or mute this participant or other features. So I encourage you guys to look at those. Another, and then we'll go through actually all of the features one by one across the bottom. So one important point again to bring up before we start is that their settings have to be enabled to use these features. So again, if you log into your Zoom, you come to your profile, you click down to settings, and there's a whole bunch of options here that anything you think you might want to use, you have to make sure is enabled. Polling, breakout rooms, a passcode, whatever the case may be, make sure this is toggled blue so that you'll be able to use it during your meeting or during your lecture. All right, first very important feature down in the middle of your screen in green, screen share. You're going to click that, going to click whatever content you'd like to share, the desktop, a PowerPoint. I do recommend for these two bottom buttons here, if you're going to have something with sound or with a video, actually clicking both of these buttons as it will make the best experience for the participant, the sound and the video quality. So clicking these two things, keeping that in mind. And then as you click through, of course, you'll get this message that you're screen sharing, and then when the time comes, you can either stop share or you can share something new with either of these buttons. One important thing I wanted to highlight for screen share is you could actually screen share a whiteboard, which I don't know if is used commonly, but if you screen share a whiteboard, this brings just a normal whiteboard that you can draw things out, you can write things out, you can type, and you can even allow your students or your participants to add and draw on the whiteboard as well to make it a more interactive experience. So that's something to keep in mind as a nice feature. You just, again, like all of these features, have to allow these things in that settings tab. Another great feature is a poll to poll the students and keep it interactive. This you do have to set up in advance. So you'd go to that same website, the meetings tab, scroll all the way down to select your meeting, and then scroll all the way down to that meeting. To the very bottom, you'll see where polls are. You'll select create a poll, and then you'll be able to enter whatever you'd like, the title, the question, the options, anonymous or not, save that information. And then when the time comes, when you're in your meeting or in your lecture, at the very bottom of the screen, you'd hit polling. And then any polls that you have created in advance will pop up here. I happen to just have one in advance, so this is what would pop up. This is the one I want. I would hit launch poll. This is what everyone would see. I'd be able to see how many people have voted. And then when I was ready, I would be able to end the poll. If you kept it anonymous, this is what you would see. If you wanted to see participants' names, for example, if it was a quiz in a lecture, at the end of the lecture, you actually have the opportunity to go into Zoom and download a poll report, if that was something you wanted to do. Another great feature are breakout rooms. If you wanted to break a lecture into small groups, or I know this is a feature we used during interview season for virtual interviews during COVID, but again, you'd click at the bottom of your screen. You'd see breakout room. You could choose whatever options you'd like, however many rooms. And this you could do right in the meeting as it's ongoing. You can assign the participants to the room with many different options. And when you're all set, you'd hit create. You'd see however many rooms you chose. You could assign members to the room. And then when you were ready, you'd open all rooms. And then you'd see everybody in there, however long they were in their rooms. If you wanted to give a warning, like five minutes remaining, you could scroll down to the bottom or click down broadcast message to all and write five minutes left. And everybody would see that as a message across the top of their screen. And then once that time was up, the rooms would close and then everybody would be invited to join back into the main lecture. And you would close all rooms. Nonverbal feedback. We all know emojis very well, I'm sure. But I would encourage lecturers to have participants use these so that, again, it's a little bit more interactive. You don't have to unmute yourself, but you can give feedback with the emojis. With the raise hand option, I think we've learned that you can hit raise hand so that the lecturer knows you have a question, but you actually have to hit it again to unraise your hand. So that's just a good tip. Otherwise, your hand will stay up. And then one of these will show at a time, whichever one you'd like. The chat, another feature that I think we know well. You click down at the bottom. The toolbar appears on your right-hand side. You can send it to the group. You can send it privately. But it's important to note that the host can actually choose the chat setting features. So if you wanted to give a lecture and you didn't want private messages, you have that option. For a live transcript, I think another great feature, you can, there's three different ways you can have a live transcript. If you assign somebody to type, if you have the opportunity to use a third-party service, or if you just want Zoom to sort of auto-transcript itself, it will, if you click that option, it will sort of put out words on the bottom of your screen as you're talking with a decent accuracy, which is a nice feature too. Virtual backgrounds, which I'm currently taking advantage of. This, different than all the other features, something important to notice, you actually have to sign into Zoom desktop as opposed to that website. So for me, I have an Apple. So I was able to find my Zoom app. I logged in. And then once you see this page, when you log in, you'll actually go to your initials in the top right corner. You'll see settings. You'll highlight that. And then you'll scroll down and you'll click background and filters. So, and then you'll have all these options to choose from. Some are pre-populated by Zoom, some pre-populated by your organization. Ideally, you want to be wearing a contrasting color to your background. I did not do that here, but that's a good tip so that you stand out and the backgrounds are less choppy. You also want to hit mirror my video, especially like in this case, if you have words, although they appear backward to you and I, when they're actually using the filter in the meeting, they appear correct to other viewers. So that's something to keep in mind as well. And then once you've selected your background in this setting, it'll actually stick with you when you join other meetings. But say you're in a meeting and you want to switch your background to something different. In the meeting, you would find the start video button on the bottom, hit the little up caret, and then choose virtual background. You'd get the same screen that I just brought up, and then you can select a different background if you'd like, or none at all. And then additionally, if you have, I think the most recent version of Zoom and your organization enables it, you could also choose blur your background. I don't happen to have that option, but that is something you could do as well. And then this website, if anybody wants to check it out, is from Zoom and actually is a collection of lots of different virtual backgrounds that you could use. All right, to record a lecture, this you do right before the lecture starts. Again, down at the bottom of your screen, you'll hit record. You can choose where it's recorded to, either your personal computer, your device, or the cloud. I would recommend the cloud because it makes it very, very easy to then share the lecture once you're completed with students or other participants. But regardless, you'll click your option. You will see this notification, like you can currently see right now that the lecture is recording. Participants will be notified that it's recorded. Hopefully you guys were. And then once the meeting is over, the file will save. And if you've chosen the Zoom cloud or your Zoom account, you'll get an email that it was when it's ready for you to view. Again, you log into the Zoom website, you'd scroll down to recordings, and then you'd see all of the lectures that have been recorded. You'd click the one you want, say it's this one, and then you have an option to view which file type you'd like to view. If you wanted to just see everything, you just click the main recording, and this is what you would see. This would be the PowerPoint, this would be the speaker, and then you even get an audio transcript, which I think is a nice feature because you can search this transcript for a keyword. So this example, I think, uses Android. So if you wanted to search for when the lecturer mentioned something particular, you could search for it, and then you would be taken to exactly where that appeared in the lecture, which is very nice. And then if you reviewed your lecture and you wanted to share it with others, you could actually go back to this main screen right here where our recordings are, and then in the top right-hand corner is the share button. So you actually see that sort of in the background here. And then again, choose your settings. You could password protect it, and then you'll have a link right here that you could then email out or share with whoever you'd like so they could then review the lecture. And that's it. I did just want to share again, all of this came from COVID experience and then just from Zoom itself. They have great resources, great support. This is the support website with lots of videos, and this is a particular document geared toward teaching and educating and using Zoom more for lectures as opposed to just meetings. Thank you. Okay thanks, Amy. So now I'm going to go over using YouTube. All right, so we're going to talk about how to get rich and famous by being a YouTube star. Not exactly though. I did find out to even make any money on YouTube you have to have a thousand subscriptions to start with before you can even put ads on it. So that would be a completely different lecture on how to do all of that marketing. This is more focused on the education side of things obviously. We've learned how to do a lot of this by trial and error and so we're definitely not experts either, but we found that there were some really good benefits to teaching with YouTube. This isn't intended to be an exhaustive lecture on how to do all of the tiny little details. YouTube has a lot of tutorials that I learned all of this from and it's very easy to access. We wanted to show you the capability of YouTube and to spark some ideas that you might have on how you can use it in your teaching on how these benefits might apply to you. So as Dr. Kim said we first started using YouTube because we found it was a lot smoother. Ultrasound is a very dynamic exam and oftentimes we're pointing out very small structures so if there's any kind of glitch or if it skips we could miss one of those structures. We found on YouTube because there's a buffer it's a little delayed it's able to handle any kind of issue with the internet to keep things moving very fluidly. And then as Dr. Kim said and for me I think one of the biggest benefits is having that channel automatically set up for you every time you record a lecture it already goes there the audience can go back and see it whenever you want it doesn't take any extra steps. YouTube is very different than Zoom and it was kind of hard for me personally to wrap my head around some of these things because I was so accustomed to Zoom. Zoom is definitely a video conferencing platform whereas YouTube is more set up for sharing your content sharing your videos trying to share it with as many people as you can. So it's set up very different so we'll go over some of that jargon and try to clarify some of those things. So the basics like I said the videos can either be live or like Dr. Kim said you can upload videos later. Dr. Kim uploads some powerpoints of anatomy showing some cartoons and explaining things before that we do a live demonstration so you have both options. Channel is kind of a thing that I never really paid attention to. I'm sure you've all watched YouTube videos but I honestly really didn't understand this channel thing. Everybody's always saying subscribe to my channel but I never really understood what the purpose was. Channel is just the site any time a video is uploaded to YouTube the channel is whoever uploaded it and every time that same person is uploading videos it just puts all of their videos in one place and you can see all of the videos that one person uploaded. So you can go to Dr. Kim's channel and see all of her videos. It's just a website like Dr. Kim showed the screenshot of her library of all of the videos. And then the benefit of subscribing to the channel is then you can see when new videos posted you can see if somebody's actually live currently. And then as Dr. Kim said we we found out all you have to have is a gmail account to have a YouTube channel and you just log into YouTube put your gmail info in and you're already looking at your channel. And then as we said it it there's a buffer so it's a little delayed. It's not a a teleconferencing platform like Zoom so the only way to interact is through chat. We're still troubleshooting on how to do that in our own workshops. What the best way to communicate is because we have seen it is a little delayed so that is that's been the main downside. But for the purpose of showing the ultrasound and having these workshops we've been enjoying it a lot. So I'm just going to show a couple things this is how and Dr. Kim showed her screenshot but that's a basic channel shows all the videos you can access. So what do you need to set up? So I'll go over this briefly but you have to have a way to connect. This is how you connect an ultrasound machine to the computer. There's a lot of different models this is just the kind we have it runs about $80. Our ultrasound machine has a HDMI cable this converts that HDMI to USB so we can plug it into the computer. Once you have that you need a software to bridge this ultrasound connection to YouTube. There's a lot of different kinds we found this OBS software is free. It's open source it's been working very great it's easy to use you just download it and when you first download it it's going to ask you for a stream key so we didn't know exactly what that was. When you start a new stream in YouTube it will give you a key so to start that you just go to the little it looks like a camera plus button and it gives you the option of uploading a video that was already recorded or go live. I wanted to demonstrate this all live and show you how to do but I as I was practicing just before we started it there's some loading things and it takes a while so I wasn't going to make everybody wait through everything and it was hard to do a screenshot of all of those things but it's pretty straightforward it'll go step by step it has some features that it'll ask you do you want chat enabled. It always asks you it's this content for children or adults things like that and then while you're setting that up it will give you a link that you can share to that you can email to set up with this live stream but then the important part also with this setup is it's something called the stream key it's this big long code and fortunately YouTube has a button that just says copy it so you just hit that copy and then you go to OBS here I will go back where it says the stream key enter the stream key once you set that up you're done you don't have to do that process over and over again with the OBS it's pretty easy as well OBS what it really is is it's just a studio it it can give you several screens together so you can put your webcam and then you can put the ultrasound so that's what we did you just go down where it has that plus button and then that lets you add as many things you could if you want you could have three different cameras showing different angles it's just a way to put everything together and then bridge it to YouTube so once you have everything set up you just hit start streaming so we're actually going to do that right now let me just switch over to our OBS which is already set up we have it plugged into our ultrasound machine and yeah so here we go we have it all set up you can see how there's two different screens we have the webcam set up and then we have the ultrasound machine and all you have to do once you have the key started you just hit start or start streaming we're on YouTube right now it's streaming that's all it is okay it's that easy practice a little bit so you can see my forearm muscles actually you can very clearly see the pronator and FCR primus longus we're on zoom right now so forgive us if it's a little choppy but you can go back and look on YouTube and it'll be very it'll be you can change the depth so they can see yeah like it'll be very smooth once you go to the less yeah shallow so you guys can really see the all the nerve you can see the um the honeycomb shape over media nerve over there and you can see pumping artery you can put the color flow actually can you see guys well as it looks really good actually it's better than a actual ultrasound screen YouTube screen looks better compared to two you can see everything together so you want to continue where you that's it yeah that's it so this is very easy so we're gonna change the speaker to Dr. Onishi so we're gonna stop sharing now and Dr. Onishi where are you good evening everyone sounds strange because I'm zooming in from Tokyo Japan I hope you can hear me um let me know if you are unable to hear you know send me a chat or something um once again uh thank you so much your kind invitation Dr. Kim and AAPMR I'm very excited to be part of this inaugural uh attempt to do this virtual NGR national ground round my name is Kentaro Onishi from the University of Pittsburgh Medical Center and today I'll be speaking to you about picture-in-picture remote ultrasound teaching and my other experience so so far um and you know a lot of it actually overlaps with what Ray just talked about I apologize for that you know coordination part but I think a repetition is sometimes helpful so I will uh briefly go over those setup situations and I will also show you a quick demonstration part as well once that setup is done for the picture-in-picture remote teaching but I will also focus my time on discussing how this teaching method expanded um my interaction with physicians from across the globe um so hopefully I'll be able to talk about that all right so before I get started let me go over my conflict of interest so one of the things about being in a quarantine and stay home the silver lining of this pandemic since last year in March was that you know we all became very creative in the way we try to teach our residents and fellows and one of the things I learned from physician from Japan because I my because of my role in Olympics Tokyo Olympics I tend to interact with a lot of Japanese sports medicine physicians in Japan and two physicians specifically Dr. Wadamakoto from Osaka and Dr. Sakai from Niigata actually were kind enough to share their experience in this teaching methods that they use to teach their colleagues called the picture-in-picture ultrasound demonstration and this is actual footage of you know Dr. Wada actually sending me that footage and demonstrating how to do picture-in-picture scan so the left top corner is showing the camera and a visual from the computer camera so you can see a head-on shot of the performing physician and to the right top corner is actually the video image shown through his mobile phone to show the probe positioning and finally it is superimposed with a live simultaneous casting or broadcasting of the wrist ultrasound image so this is kind of like how the picture-in-picture ultrasound demonstration looks like as Ray showed us earlier um if you are interested in reading formally about how to set this up and what's been our experience in the United States one of my former trainees Dr. Allison Schrader currently completing a fellowship at Mayo Clinic or just completed fellowship at Mayo Clinic or Twin City as well as my colleagues from the University of Iowa Dr. Medard Cole and Dr. Ryan Cruz have written about this so I just wanted to share with you that there are two publications from the same group that sort of spoke to this picture-in-picture teaching methods and here's really kind of how to set this up Ray kind of went over so I would just go over this briefly obviously you will need an access to a high-speed internet that is reliable you need a pc or mac and finally you need a ultrasound machine whether you're doing this in the office where you have a ultrasound machine or you are you know luxurious enough to have ultrasound machine at home but those are three hardwares that you kind of need or hard wire network that you need in order to set yourself up for picture-in-picture teaching and in addition you'll need to purchase the motion capture system which is shown here in the center of this slide this this can range from you know high definition to ultra high definition and the price ranges in here from according to Ray's most recent research which was priced at $79.99. When I purchased this, it was $120, so I should have waited it a little bit longer. But the more expensive high-end motion capture system can go up to $5,000, $6,000, sometimes $10,000, just so that you have the knowledge of the range that we have available. And then once you purchase these things, then you just have to check the back of the ultrasound machine is typically where the visual output is. And the visual output can vary from HDMI or DVI-D. You just want to make sure that you have the right set of connecting wires so that you can connect the ultrasound machine to the motion capture system, which in turn connects the capture system then to the computer. So you basically need two sets of wires to connect to the machine. And as Ray talked about, OBS system needs to be downloaded to your computer, and OBS is free, and therefore I recommend this, and reliable, and it can be used for both Mac as well as PC. If you decide to use additional camera in addition to what is a default for your Zoom, in this case iPhone or Android self-mobile phone, then you could download iVCam software for PC or EpocCam software for Mac onto your mobile phone to have additional pair of camera in order to broadcast additional videos or images. And once you have those downloaded, then the final step is to really connect these three devices, which is ultrasound, motion capture, and computer to get started. And OBS setup was gone over by Ray, so I will not go over that. So let's talk about my experience so far with this, you know, picture-in-picture capability. Even during the pandemic from March 2020 to March of this year, I've been invited to speak and do the demonstration scan at 25-plus virtual ultrasound conferences. This includes, you know, the AAP annual meeting in February of this year where Dr. Kim and I were able to talk about this picture-in-picture teaching methods, which essentially transpired to have this, you know, to result in this proposal. And this picture-in-picture teaching method has been generally well received, with one downside would be that learner's side or the student's side inaccessibility to ultrasound for follow-along scan. But I assume and I see that this shortcoming is slowly getting improved as a result of many residency programs and fellowship program directors recognizing the importance of having access to trainee ultrasound machines. And also, in the recent two or three years, I have seen many, at least my sports medicine fellows, pulling the trigger to purchase a reasonably priced ultrasound machine to have it at home, which then also improves that, you know, inaccessibility to ultrasound machine for that hands-on or follow-along part of the shortcoming of the virtual hands-on sessions. So, in short, the take-home for the picture-in-picture remote learning is that although, you know, I feel that the picture-in-picture remote teaching still won't replace all of the benefits of in-person ultrasound learning. This method affords learning experiences closest as it stands today to in-person meeting, when in-person meeting is not feasible, whether it's due to, well, the pandemic or whatever else the reason is. And I feel that even in the post-pandemic world, when in-person attendance is not possible, such as busy clinical practice, this teaching method will continue to provide an alternate method, teaching methods, and it was added convenience for both learners as well as teachers. I find this to be useful in case you are running late from the meeting, and then you are expected to teach your fellows with an ultrasound, and you're not possibly able to make it to in-person teaching, then I could just, you know, call my fellows and tell them, hey, why don't we switch this to remote teaching today, since I won't be able to make it for the in-person meeting. So, I think situation like that continues to exist even without pandemic, and I think that there's a role for picture-in-picture remote learning. And since I'm Zooming in from Tokyo, I have to, and I owe to you why I'm here in Tokyo today, I'm involved in IOC venue ultrasound program as the principal investigator of this quality improvement project, where ultrasound and this picture-in-picture teaching method, well, communication method will be used to use ultrasound as the first imaging modality for triaging Olympic athletes using the 5G network. So, I just wanted to briefly share about, you know, my role here in Tokyo, and that, you know, remote learning experience and teaching experience that we had in the past year is actually now attempting to assist our Olympians perform at its best. So, with that, I was going to do the quick demo scan. How are we doing with the time? I think we might have just enough time for quick scan. So, we'll go ahead and go do the scan, but stuff me any time. Let's do this switch. Hopefully, you are able to see this well. Let me know. I'm not in front of the computer screen. So, in this image, right side of screen is going to be medial and left side of screen is going to be lateral, and I'll just go ahead and quickly demo the wrist scan. I'll place the transducer right over the proximal crease or the wrist joint, which then allows us to visualize a couple of structures, namely pronator quadratus, and we also see flexor tendons moving, and also the medial nerve coming in. I'll bring the medial nerve into the center of the images, and of course, I'll optimize the image. So, we can actually have that conspicuous visualization of the medial nerve. Let's follow the medial nerve proximally first as it finds itself deep to flexor digitorum superficialis and superficial to flexor digitorum profundus, and you can actually then go back to where I started from as I scan distally, and I hope you are able to see the honeycomb appearing structures just deep to the flexor tendons, and I can continue to scan this nerve over to the now distal wrist crease, and I can continue to scan past where you can begin to see the carpal tunnel inlet and continue to scan this nerve, and if you can actually pay attention to about 9 o'clock position, there will be a fascicle and nerve that will take off toward the thenar muscles and that nerve, so to the left side of the screen is going to be the thenar muscle appearing, and the nerve that would come out here in about this area, 9 o'clock position to the nerve, right here, I'm oblique long axis to it, this is the motor recurrent branch. Hopefully you are able to see that. So just like that, you are able to kind of, you know, go through this demo scan with physicians remotely, and I recently had a fantastic knee ultrasound session with a Japanese knee ultrasound expert using this picture-in-picture sort of teaching method where I will show him some of the new scanning protocol, and in return he will show us some of the new scanning protocol that he's actually doing in Kanazawa, Japan, and that was actually a pretty exciting moment where, you know, I don't even have to hop on the plane to go see him in person to be able to do that, but you can do this remotely without needing to be in person, so I thought that that's, that's, you know, one example where picture-in-picture remote teaching can be an interactive learning experience as well. I just wanted to show you how to set up and, you know, it will be a system, and when you set this up, then you can do this at home as well as at your offices, and I think that this will actually have implications beyond the pandemic. Anyways, thank you so much for your attention. This is the end of my presentation. Hi, everybody. So now, thank you so much Kentaro from Japan. This is a real, real remote teaching. You demonstrated very well. So, we'd like to bring the questions from the floor. Please, you guys can put it in chat, or you can show your face, and you can have a direct conversation with us. I want to break the ice by asking the first question to Kentaro. So, when we were doing this with, we initially started doing it with Zoom, but it was very choppy. Yours looked pretty smooth. Did you change any settings or anything like that? I would like to, you know, disclose that for Japanese tech support group in this room, one, two, three, four, five, six, seven technologically extremely savvy Japanese experts in the room assisting me, but one of the things that you can do even at your home in order to improve that sort of like a sort of pixelated choppy videos to make it a little bit more, you know, smoother one is to do wire full or wired connections. So, don't use Wi-Fi, but use actual Ethernet cable. That would improve that. Ah, we thought like you have a special technique that is not choppy. No, this is really, you know, one thing in the world has become smaller as a result of remote learning and virtual learning, and one of the things that I've been really impressed with is, you know, Japanese, you know, sports medicine docs sort of passion to continue to apply new technologies. And I learned tons by interacting with them and watching them, how they actually manage that virtual learning. And one of the things I learned from them is that, you know, actually yesterday was that, you know, this, why, you know, why your connection improves that major problem of dynamic scanning, because, you know, one of the strengths of diagnostic ultrasound is that it's real time. And, you know, dynamic examination, if it's pixelated or, you know, glitchy, isn't going to show the, you know, the things that you want your audiences to see. So, I asked them and they basically answered, yeah, just use a wire. Yeah, I mean, that is a big benefit of being on this Grand Rounds because we had a hard time to figure it out how we can make it better on the Zoom. So, we are using YouTube. But anyway, any attendees have questions? Maybe we talked to you guys too much or too well. Okay. Everybody's very quiet. Okay. Then is there anything we should share? Amy, do you have anything to share more than what we did? Because you're very thorough, Zoom, like how to teach it through the Zoom. No, I don't think so. I think hopefully it was basic things, features that everybody knew. It's just a matter of adjusting your settings and talking to your administrator accounts to get some of these features and look at the Zoom website. Yeah. So, I mean, we really appreciate all the attendees didn't leave yet because it's already late night, but early in the morning in Japan. But I learned so much through this process and then I'm excited to use remote teaching as my resident giving me the feedback. I think we all the faculty should be familiar with remote teaching. We should not just ignore this part because the teaching paradigm needs to be changed. We cannot just give the lecture in the classroom anymore. And then we have to catch up with all young people. You know, they like everything to be done on their hand, not even on the computer, smartphone, smartphone. So, we have to be really familiar with the remote teaching platform. So, I'm so glad that even though I learned everything from Kentaro, Amy, and Ray, you guys are the ones who taught me, but I want you to be trying to through this Grand Rounds so you can share your knowledge with other people so we can have all the benefits. So, I thank you very much, everybody. And Kentaro, have fun and enjoy your parents' time with your parents and the Olympic game. And we appreciate AAPA and all that they invited us and that we were able to share this information. Thank you so much. And I thank everybody. Just good night. Bye-bye.

remote teaching

changing teaching paradigm

Dr. Kim

Dr. Amy Tenaglia

Dr. Ray Stanford

Dr. Kentaro Onishi

healthcare system

pandemic impact on education

challenges of remote teaching