In 2003@@@, a group of doctors started meeting regularly via computer conference several times per year in order to discuss interesting -- usually difficult -- cases. There are fewer than ten doctors who participate, and all are associated with teaching hospitals in major metropolitan areas. (There are only enough patients in this subspecialty every year to support a handful of doctors.)

In addition to the doctors, a number of other medical professionals are allowed to listen in on these case discussions: fellows, residents, clerks, and researchers. Usually, they play only a passive role in the actual conference.

The conferencing software, which we will call "LectureNotes", that they use was developed by a medical devices company, and originally was intended for use training salespeople in a traditional "lecture" format: one person doing most of the talking and the rest of the people mostly listening.

The medical devices company provides LectureNotes as a promotional benefit to the doctors. The software is entirely Web-based, but requires a technical administrator at the devices company. The administrator deals with passwords, with setting up the conference, and troubleshooting technical issues. The administrator might also play an active role in turning microphones off and on during the conference.

@@@ picture of screen -- does Sherman have a better one?

LectureNotes takes up the full screen, and has the following sections:

• video: there is a small area at the upper left of the screen which projects the video of the person who is speaking or who last spoke. The video feed comes from a webcam on or near the speaker's computer, pointed at whoever is sitting at the computer. (This means that those without
• participants: a scrolling list of people who are logged in
• presenters: a scrolling list of people with special "presenter" status. Presenters have the power to manipulate or modify various things, while non-presenters can only observe/listen. In the way that Squares currently runs, all participants are also presenters, so this pane is redundant.
• agenda: not used
• slides: a large area (taking the majority of the screen) which is used to present PowerPoint slides. Those usually consist of pictures (X-rays, CT scans, MRIs) of the patients.
• toolbar: controls for many things, including "raising a hand" (i.e. requesting permission to speak), various ways of annotating the slides, advancing to the next slide or retreating to the previous one.

In the list of participants, there is an icon which represents a "hand up" that can appear next to a participant's name. Associated with that icon is a color: Red means that the person wants to speak, yellow means that they have been given permission to speak, and green means that they are speaking.

The presenters can "draw on" the slides, and have several different drawing tools to select from.

To speak, a participant holds down the Control key. That puts the "hand up" icon next to their name. We were unclear about exactly how people were cleared to speak: one person told us that they were always cleared to speak, while another said that the medical devices company's administrator pushed buttons to enable/disable microphones.

Observation

We observed a group at a local hospital the day of a Squares conference. We arrived a bit early, and observed during the setup, the Squares conference, and then for a little bit afterwards. Kelly Booth advised us not to tape the conference.

Ahead of time, we had agreed that we would divide up duties as follows:

During the Squares conference, doctors P3 and P4 each sat at a computer at their desk in their respective offices. P1 and P2 sat and watched in P3's office. P1 and P2 had told us that they expected more people, but aside from a staff surgeon who entered, stayed for about ten minutes, and left, there was nobody else in the room.

Because we had been led to believe that there would be a lot of people in the room, we stuck ourselves to the back wall of P3's office. Partway through, when it became apparent that nobody else was coming and that our position didn't let us see what was on the screen, Ducky moved up. She lodged herself just behind P3 and as close to the left wall as possible to minimize her appearance on P3's webcam.

Afterwards, we chatted with P1 and P2 briefly.

Follow-up interviews

P1 and P2

The best-laid plans of mice and man often go astray, and so did the plans of Duck and Sherman.

• Even though we had scheduled interviews with P1 and P2 at different times, they assumed that we would interview the two of them together. They wanted to be interviewed together. As they were doing us a favor, we couldn't really force them apart.
• While we know that we are supposed to interview people in their offices, P1 and P2 both resisted, and for good reason. Both offices had other peoples' desks in them and precious little space to sit. To interview P1 and P2 in either of their offices would have been very disruptive to their officemates. Thus we went down the hall to a conference room.
• We didn't have a chance to discuss how we would deal with a two-person interview, and Sherman did not write down who said what.

P3

We arrived at the hospital at 0715 (with a voice recorder this time!), and stopped at the hospital coffee shop to do last-minute coordination over coffee, only to discover P3 at the coffee shop. He was ready to go, and seeing the chance to get more time with him, we jumped at the opportunity.

That morning, we discovered that the voice recorder's batteries were dead. He was able to recharge them in the car; we realized that this was sub-optimal, but figured they would last the 15 minutes that we had. (We couldn't just stop at a convenience store and buy new batteries, as this particular recorder had a built-in battery.)

It turned out that P3 was very unhurried that morning. Apparently, he needed to be at the hospital early in case some problem cropped up in pre-op, but he didn't have any specific obligations. He generously gave us about an hour of his time, during which time our recorder died, was recharged, and died again. Hence our notes from that interview are partially a verbatim transcript and partially just recopied handwritten notes.

P4

• How does the speaker indicate to others what visual artifact he/she is referring to?
• How does the physical layout affect the collaboration?
• How do they manage screen real estate?
• How do the participants manage turn-taking?
• How do status levels affect the collaboration?

Turn-taking

Turn-taking worked well: P3 continuously scanned the list of participants to see who had their hand up, and called on people explicitly. (Unfortunately, the list of participants was longer than the participant window. P3 had to scroll through the list of participants essentially continuously in order to see who had a hand up)

We witnessed only three interruptions -- places where one person spoke over another, and it was never disruptive. In one case, it was a very quick answer to a question. In another, someone who had had the floor needed to make a quick amendment. In the third, @@@?

However, we were told that this had not always been the case -- that the participants had had to learn how to interact.

P4: "A new person can ruin a session by holding the control key down." (i.e. keeping the mic open)

P4 complained about how anybody could "move the slides around" [presumably meaning advance/go backwards].

P4: "They think it's a dialog, but it's not."

One aspect of the moderated approach is that people would sometimes have to "save up" their comments until they had the floor. A "hand up" signal doesn't convey urgency -- it's not clear if the participant wants to comment on something that was just said or about some new topic. P4 mentioned that sometimes by the time your turn came, what you had wanted to comment about was long gone.

Physical layout

Because the webcam and microphone were both pointed at the person sitting at the computer, other people in the room were essentially shut out of the discussion. P3 later commented that he wasn't sure there was a active role for the junior people in Squares: that the role of the learner in that situation was to learn, not to advise.

We did observe P2 ask a question during Squares.

Side channels

We also observed P1 and P2 whispering to each other during Squares, even moving their chairs together to be able to better communicate.

+ Witnessed marking on screen

+ Witnessed deictic reference

+ Very comfortable and collegial, several jokes

+ Setup was a PITA.

+ Since digitization, taking film home no longer an option, and home access to digitized images is not allowed.

+ Not sure how the source feed for the webcam was selected.

+ Sometimes remote voices unintelligible.

+ Only heard 3 remote people.

+ P1 and P2 seemed minimally engaged (at least part of the time)

+ P1 and P2 whispered to each other.

Camera

P2 didn't like how the camera portrayed people:

P2 (to Sherman and I during setup): "Oh, the camera is looking down. I don't like how it's looking down."

There were several jokes about the cameras. During the setup phase, P4 said to us:

P4: "I'm not as good-looking [as P3] so they won't let me have a camera."

Later, during the conference, P3 made a comment about the video:

P3 (to R1): "I'm not as good-looking as you, but we'll have to live with that."

R? [presumably R1]: "Well, as long as you understand that."

Location / participation

P4: Sometimes when it's slow, I can get other work done.

It was interesting to me how some good material surfaced during times that were not formal interviews or observations, just smalltalk.