Difference: DuckyShermanCSCWProject3 (13 vs. 14)

Revision 142005-12-04 - DuckySherwood

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 Ducky and Sherman's CSCW Project 3
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 Doctors really only communicated with their subspecialty peers around twice per year, at large conferences in their larger specialty (not subspeciality) area.  If they wanted to discuss cases, they would bring a bag of X-rays, patient files, and laptops, and grab a corner at the conference to discuss the cases.  Usually, however, this was junior doctors seeking advice from senior doctors.  In general, senior doctors did not consult with each other.
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+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.)
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+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.
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+One explicit goal of Squares is to come to cross-Canada consensus on treatment protocols, i.e. "if symptom X arrises, administer Y treatment".  The field is evolving rapidly, and not all the doctors will be able to experiment with all of the new treatments; a goal is to share what each person learns with all the others.

Another goal is to identify which areas warrant more study.  If they find that collectively, they are seeing a lot of patients with a particular project, then perhaps it's worth someone doing a detailed literature search.

 Software
 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.
 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.
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+Three remote doctors participated (R1 through R3).
 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.
  Side channels 
At one point during Squares, P3 rolled his chair back to where Ducky was and made an enthusiastic comment.  It appeared that he was excited about how well the process was working, and needed to tell someone.  In a face-to-face meeting, like a trade show presentation, he probably would have leaned over to his neighbor and enthused.  Because there were no side channels to peers that he could use during Squares, he enthused to Ducky instead.
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+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
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+We also observed P1 and P2 whispering to each other during Squares, even moving their chairs together to be able to better communicate.  When asked about that, P1 and P2 said that they were talking about what was happening, especially regarding a case that had a big surprise in it.
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++ Witnessed deictic reference
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+ Emotional support 
We noted that the gathering was very comfortable and collegial.  Several of the doctors made jokes, including light-hearted teasing of each other.
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++ Very comfortable and collegial, several jokes
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+Based on our interview with P3, we think that a significant benefit of Squares to the doctors was emotional support.  The type of surgery that they do is extremely long and gruelling, all patients respond differently, and there are frequent trade-offs that the doctors are forced to make.  In particular, decisions about how aggressively to treat something are difficult: what do you do when a more aggressive treatment is more likely yield a higher chance of living but also a lower quality of life?
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+ Referring to artifacts 
The software gave the ability to draw on the screen with several different tools.  During Squares, we saw two different doctors pointing out something on the screen with those tools.  We also witnessed one incidence of P3 referring to something on the screen and circling his cursor (which we believe nobody else saw) around an area.
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++ Setup was a PITA.
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+ Setup 
The amount of work that happened before the conference starts was significant.  The doctors take turns preparing cases and moderating.  Each session has a theme, and so three to five cases need to be found on that theme.
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++ Since digitization, taking film home no longer an option, and home access
to digitized images is not allowed.
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+When Vancouver hosts, P2 does most of the legwork.  P2 says that P3 and P4 will give her a starting point that might be as sketchy as a name, or a description of a case and a rough timeframe.  P2 then has to track down the charts, find the appropriate films, and sit down with a radiologist to figure out which films are the most illustrative and hence the best use.  For older, non-digitized films, she needs to digitize them.  She then pulls all the images together and creates a PowerPoint presentation, and sends that to the administrator at the medical devices company.
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++ Not sure how the source feed for the webcam was selected.
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+When other sites host, P2's job is easier.  The remote site sends her either a polished PowerPoint presentation or simply raw images.  She does tweaking as required, and forwards it on to the service administrator.
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++ Sometimes remote voices unintelligible.
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+On the day of the conference, it takes a while for everybody to get set up. Every hospital has a different IS system, and sometimes, the IS department has to do something extra to get the software access through the firewall.  One time the URL that was mailed out was incorrect, and one of the doctors didn't know how to go to the main login page and navigate from there.  Sometimes passwords are forgotten.
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++ Only heard 3 remote people.
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+Setup problems are exacerbated by there being as much as four months between sessions to forget how things were done last time.
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++ P1 and P2 seemed minimally engaged (at least part of the time)
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+P2 does the setup basically on a volunteer basis.  She is part-time and not paid for Squares administration work.  P3 has said that he couldn't do it without her.  Thus Squares depends upon what is essentially a charitable contribution.
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++ P1 and P2 whispered to each other.
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+ Camera
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+ Video
 People were uncomfortable in small ways with the camera.

P2 didn't like how the camera portrayed people:
 R? [presumably R1]: "Well, as long as you understand that."
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+It wasn't clear how the source feed for the webcam was selected/switched.  Different participants had differing beliefs about that.

It wasn't clear to us how useful the video was -- it was relatively low quality, the doctors didn't look at the camera (so the eye contact was "wrong"), and it constrained the doctors' movement.  (If they leaned forward, it would see the top of their head; if they leaned back, it would see their torso.)  However, P3 was adamant that the video was useful.  He felt that anything that added richness to the interaction was good.

If one of the major benefits is emotional support, than it might well be that video is important.  A picture of someone might have a much stronger emotional resonance than simple audio.

 Audio 
The sound quality of the remote voices was spotty.  Usually it was intelligible, but it varied.

P3 explained that every site had slightly different hardware, camera, microphone, and bandwidth.  Thus quality was uneven over all the sites.
  Location / participation 
P4 prefered to work in his own office instead of coming down to P3's office where everyone else was.
 P4: Sometimes when it's slow, I can get other work done.
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+ Improvements desired 
P3 expressed a number of concrete and abstract desires for improving the Squares experience.

Many of his frustrations centered around the hardware.  He wanted a bigger screen and a wide-screen format screen.  He wanted everybody to have the same (presumably high-quality) hardware/microphones/cameras.  Part of the constraint was financial, but part was informational: he wanted someone to give a recommendation on which cameras/monitors/CPUs/microphones he should buy.

He felt that there were some changes to the system that would be helpful: 
P3: I think it could be a little smoother to bring people in and out, dampen the mic on the non-speaker, and there is clumsiness in hooking up to various stations.

He also was very frustrated by the limitations of PowerPoint, but was unable to articulate precisely what the problem was or how it should be fixed.  He expressed the opinion that that was the job of people with good communication skills to figure out.
 It was interesting to me how some good material surfaced during times that were not formal interviews or observations, just smalltalk.
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+ Set ALLOWTOPICCHANGE = DuckySherwood, ShermanLai

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