Producing a Successful PeRLs Video - Wiley Online Library

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COMMENTARY

Producing a Successful PeRLs Video Academic Emergency Medicine publishes selected peer-reviewed videos that present state-of-the-art research, practice, and evidence in the field of emergency medicine. These videos are referred to as peerreviewed lectures (PeRLs). This commentary reviews considerations for creating, filming, and producing high-quality PeRLs videos. ACADEMIC EMERGENCY MEDICINE 2013; 20:1183–1189 © 2013 by the Society for Academic Emergency Medicine

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cademic Emergency Medicine (AEM) publishes selected peer-reviewed lectures (PeRLs) in video format that present state-of-the-art research, practice, and evidence in the field of emergency medicine (EM).1–3 Intended audiences for these PeRLs include medical students, residents, and practicing physicians. Author guidelines and specific production instructions are published on the AEM home page.4 We suggest a number of considerations to successfully organize a filming session and for creating, filming, and producing high-quality PeRLs videos. These suggestions include a unique method of creating a physical set-up of the filming room that allows presenters to use a script to ensure accurate and efficient speech. Tips on creating effective slides that visually support the presentation and engage the audience are also offered. CREATING A PERLS VIDEO Accepted PeRLs videos must be high quality in subject content, lecturer effectiveness, and video production. Devoting time to each of these three areas will help minimize the additional time, effort, and expense of multiple reshoots. Expect that even under ideal circumstances a successful PeRLs submission will require a great deal of time and planning, similar to that needed for a written peer-reviewed publication. When starting the PeRLs process, the first step is to become well versed in the journal requirements and guidelines (Table 1). A PeRLs video should contain both the presented audio/video materials (such as PowerPoint slides or Keynote) and a live video of the presenter. Presentations should be limited to 30 minutes, unless previous arrangements have been made with the AEM editorial staff. Videos can be produced with local

The authors have no relevant financial information or potential conflicts of interest to disclose. Sponsored by the Division of Women’s Health in Emergency Care at the Department of Emergency Medicine at Warren Alpert Medical School of Brown University. Related articles appear on pages 1180, 1181, and 1182

© 2013 by the Society for Academic Emergency Medicine doi: 10.1111/acem.12241

resources specific to the author’s institution. Alternatively, commercial video producers may be contracted for this purpose. Arranged audio/video systems should be devised to successfully film and produce a video for PeRLs publication that will meet the demands for quality and formatting prior to submission. An initial “rough” draft video of lower formatting and structural quality may be submitted for initial review. Final submissions must meet the high-quality standards noted in the author guidelines. All submitted materials, including outlines and video draft(s), are subjected to rigorous peer review by academic experts for content, educational value, and audio/video quality. TOPIC SELECTION Topics that are relevant to the practice and academic mission of EM are suitable for a PeRLs submission. A short list of acceptable broad topics includes: cuttingedge medical reviews, evidence-based teaching and evaluation pearls, research methodology, and other topics geared toward clinical and academic professional advancement. Once a topic is selected, it is strongly encouraged that authors submit an outline to the PeRLs editorial board for review prior to recording or submitting a video, to prevent submission duplication or excessive work on a topic that is mismatched for an AEM audience. PRESENTATION DEVELOPMENT When designing a PeRLs video, the target audience should be an informed emergency physician, and the material presented should be aligned with his or her expected knowledge base. Identifying and focusing on this “sweet spot,” where the lecturer can engage and challenge the learner without becoming uninteresting or overwhelming, is critical for any successful presentation. After this balance is achieved, a good lecturer quickly reviews basic principles to activate the learner’s recall of previously mastered material and then uses this base to bridge on to new information.5 The lecturer should then conclude with a recap of pertinent

ISSN 1069-6563 PII ISSN 1069-6563583

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Table 1 Peer-reviewed Lecture Required Content Each video lecture should contain the following information:

• • • • • • •

A written abstract describing the content of the lecture. Lecture title, author, and institutional affiliation on a title slide. Conflict of interest statement. A brief overview of the lecture content (1 minute). The body of the lecture (30 minutes). References and further reading (30 seconds). Contact information for questions. Please note that brand names should not be shown in these lectures unless clearly relevant to the discussion.

take-home points. Recently, a 2011 PeRLs video by Hart and Joing6 focused on designing a presentation that meets the needs and expectations of the adult learner. There are unique conditions associated with designing a PeRLs video that deserve consideration. Given that the PeRLs audience is a virtual audience, it is impossible to gauge the learner’s interest or involvement with the lecture. Many traditional tools to actively engage learners are not applicable to this format, such as break-off discussions, directed questions, and hands-on exploration.7 It is important to incorporate techniques that lead to audience engagement, including reinforcement of topic relevance to learner needs, interesting case vignettes or personal anecdotes, complementary visual images, and clearly communicated take-home points. Humor can be a great addition, as long as it is not insulting or off target. If a lecturer is trying to teach a particularly difficult concept, it is likely to be more successful if he or she pauses and repeats the core information by giving the learner a working example that clarifies the information and highlight its significance. Keeping in mind that PeRLs videos are 20- to 30-minute sessions, the lecturer should focus on four or five take-home points, as more can overwhelm the learner and paradoxically decrease knowledge acquisition.8 Common issues identified in production, design, and content are noted in Table 2. PRODUCTION Videos need to be original and produced solely for the purposes of a PeRLs submission. Submissions of “live” grand rounds or regional conference lectures do not meet PeRLs standards. Filming a PeRLs video requires a high-quality digital video camera. The lecture should be produced as a split screen with views of both the lecture slides and the presenter. In creating an educational video, it is important to view the camera as the audience. It is essential to communicate thoughts and ideas with “savoir-faire”—confidence, grace, and some humor thrown in for good measure. One option to produce the split screen is to film the presenter using a green screen (chroma key compositing) backdrop. Successful production using a green screen can be accomplished using available software,

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high-quality studio lighting, standard high-definition video (HDV) format cameras, high-quality microphones, and a teleprompter. The green screen itself may be made from chroma key green fabric, paper, or paint on a wall. Many collapsible chroma key green portable backgrounds are available online; this is probably the simplest method for establishing a green screen background. High-quality and well-placed lighting is essential for the green screen effect to work well. Various tutorials available online discuss the details of lighting placement for the green screen effect. In short, the green screen needs to be lit separately from the presenter, so that no shadows are cast on the green screen. Two examples of computer software available for live production are BoinxTV for the Mac OS X platform (boinx.com), and Wirecast by Telestream for Windows (http://www.telestream.net/). The advantage of live production software is a more efficient production of videos involving multiple layers, such as a PeRLs video. Instead of editing as a single layered video, the green screen effect, the presenter, and the slides and any additional on-screen text can be affected in real time while the speaker is talking through the presentation. The result is a near-finished product immediately following the end of the presentation. Usually only a simple cut or fade at the beginning and cut or fade out at the end are required prior to compressing the video in a final format for online delivery. Another advantage of live production software integration is the live view of the green screen effect so that any needed lighting adjustments can be made prior to the start of the presentation. This avoids the potential problem of discovering insufficient uniformity of lighting of the green screen during postproduction editing when the presenter is no longer available. Used HDV cameras work well for this live production setup, especially since the tape mechanisms, which may be damaged in older cameras, are not needed and the video signal is delivered over FireWire (IEEE 1394). An alternative to a green screen is to film the presenter against a black backdrop (black silk cloth), scale the footage, and add additional background of the same color to fill in the rest of the screen. With this approach, the PowerPoint slides can then be composited to the left or right of the presenter. This technique enables the edges of the presenter to remain pristine and in some cases facilitates a more simplified and timely editing process. High-quality audio is important to ensure good delivery of the presenter’s message. Many well-built USB microphones are available along with a pop filter to prevent artifact entry into the audio signal. Standard studio microphones with XLR outputs can be used along with a device to convert the balanced XLR signal to USB. Various commercial teleprompter set-ups are available online, along with instructions on how to create your own using beam splitter glass. A teleprompter enhances the finish of the presentation by allowing the presenter to look straight into the camera and read any needed presenter notes. This method of “maintaining eye contact” helps give the viewers the sense that the presenter is speaking to them.

Simplify table and charts goal: • Table < 9 cells • Bar graph < 6-8 bars • Adding additional slides if necessary • Include absolute numbers on pie and bar graphs. Consciously select images that support content of discussion. Choose high-resolution images that are clearly visible on both small and large slide projection. Crop and magnify to improve recognition.

Poorly designed graphs and tables

Projected images are too blurry

Portion of image showing teaching point is too small Potential copyright issues regarding downloaded Internet images

Use images with clear domain origin such as those: • Created by author • Purchased from professional site • Uploaded from identified “domain free” site. Include slide reference with image domains after text reference slide.

Limit to six lines of text per slide (or one table/graph). Bullet information (vs. writing out full sentences).

Too much text per slide

Inserted images are off subject

Contrast font from template (either dark template and light text or vice versa). Pick simple sans serif font and avoid unnecessary font change. Minimize capitalization of entire words; smaller case letters are easier for learner to decipher.

Use simple or solid colored templates.

Include tactics that are known to engage adult learners such as: • Posing questions • Case studies • Personal stories on subject material

Identify topic that is contemporaneous and relevant to clinical or academic EM. Gear talk toward an audience of experienced emergency physicians. Identify specific intent of talk and four to five take-home points. Use these points to write your objectives.

Solution

Text is difficult to read

Slide design: Distracting background template

Inability to gauge a virtual audience without visual and verbal feedback

Covering excessive or extraneous material

Covering material too superficially

Content: Picking appropriate topic

Problem

Table 2 Common Issues Identified in Production, Design, and Content for PeRLs Submissions

Copyright free sites can be found by searching “domain free” sites on the Internet.

A well-placed image will greatly enhance a lecture but a poorly placed one will lose an audience.

Templates with excessive detail can interfere with text and graph legibility. Avoid red and green font as indistinguishable to color-blind learners and difficult to read. Use font size 30 and up as slide will not take up full screen on viewer’s computer (final video will also include superimposed speaker). The slides should act as cue to lecturer to expand upon given idea not as written script. Learners lose focus when they try to listen and read simultaneously.

Include brief refresher of expected known material then quickly bridge to new information that expands this base. Including too much content paradoxically leads to “retroactive inhibition” a process in which the learner actually retains less information. A good lecture is composed of three clear parts: Intro: Identification of four to five points to be taught and establishment of lecture’s relevance to audience’s needs Core: Teaching identified objectives in engaging manner Wrap-up: Review and reinforcement of key principles.

Comment

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PeRLs = Peer-reviewed lectures.

Poor eye contact with camera

Lecturer stumbles and loses focus

Artificial and stiff posturing

Loss of natural cadence

Going off on tangential material

Patient identifiers are present on imaging slides Reference slides follow incorrect format Presentation style: Choppy and uncomfortable delivery

Problem

Table 2 (continued) Solution

Practice using slide transition clicker from lap to avoid being heard on microphone.

Even accomplished speakers should realize that fulfilling the PeRLs technical qualifications may require significant adjustment to personal lecturing style. Specifically, successful PeRLs speakers are able to enthusiastically engage an invisible audience without pacing or using excessive hand gestures while speaking naturally and looking straight into a camera lens.

Consider dry run with inexpensive camera/smart phone to identify and correct unconscious mannerisms and/or word additions such as “ah” and “um.”

Memorize presentation or use projected script/slide outline to stay on track and on time. Vary volume and tone throughout talk. Identify and emphasize key words within sentence. If using a script, practice appropriate word inflection. Practice talk while sitting down with hands on lap to get used to minimizing body movement and to using voice rather than body to emphasize key points. Reshoot at beginning of slide and use fade in during editing process. Use teleprompter or have written text projected directly above camera.

Found at http://onlinelibrary.wiley.com /doi/10.1111/j.15532712.2012.01303.x/full

Comment

Comply with Academic Emergency Medicine format for reference citation.

Remove or black out unique identifiers.

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Figure 1. Video production studio and equipment setup. Illustration by Zack Becker, zackbeckerdesigns.com.

FILMING FEATURES There are many factors to keep in mind when filming. Movement affects image quality in a negative way, both for movement of the presenter and for camera motion. To minimize movement, consider having the presenter sit in a chair and placing the camera on a tripod. Many successful lecturers engage their audiences by walking and gesturing as they talk; however, a PeRLs video requires the video of the presenter to be captured as a headshot displayed next to the presenter’s slides in the final video presentation. This may require additional practice by some presenters to adjust their techniques and effectively communicate with minimal movement. Adequate presenter lighting is essential. A light may be placed above and to the side of the presenter (not in view of the camera frame). Keep in mind, professional lights can heat up the presenter very quickly! A box of tissues available to wipe off facial perspiration will help avoid moisture reflection artifacts. An external microphone on a stand above the presenter’s head (also out of the camera frame) may be used with sound captured directly, in addition to the camera microphone. The presenter should consciously approach his or her appearance and wardrobe selection to maximize the impact of the video image. Clothing choices should avoid stripes, checks, and neon colors. White and red tend to “bleed” images on camera. Optimal color and fabric pattern choices are solids, but

avoid matching the color of the screen. In addition, beware of jewelry that either interferes with sound capture or is visually distracting. Figure 1 illustrates a physical setup to consider for the filming room. As demonstrated, the presenter sits in a chair in front of a black backdrop with a microphone (Oktava MK012 hypercardiod, Oktava, Tula, Russia) placed above the head, and a light (Lowel-Light Manufacturing, Hauppauge, NY) at an angle off to the side. The presenter directs his or her gaze just above the camera (Panasonic HMC150, Panasonic, Kadoma, Osaka, Japan) toward the screen on the opposite side of the room. A table may be placed between the presenter and the screen, out of camera view, to support both the laptop computer and projector. SLIDES A PeRLs video should display a presenter providing a good oral presentation accompanied by multimedia. The AEM editorial board recommends PowerPoint slides with a plain font, such as Sans-Seriff, Times New Roman, or Helvetica, and 32-point type, with a clear color contrast. Slide presentation software such as PowerPoint is ubiquitous and used daily by millions,9 but many lecturers quickly lose their audiences by failing to use PowerPoint effectively, with slides that are overburdened with bulleted lists, complicated figures, and distracting transitions. A judicious word count, generally

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no more than five lines per slide, and a well-conceived photo, figure, or illustration can reinforce a speaker’s words and keep an audience engaged. Ultimately slides should enhance a speaker’s message and not duplicate the speaker’s words. The short 30-minute format of a PeRLs video encourages speakers to be concise and avoid tangential comments. Effective time management becomes critical if multiple speakers are contributing to a single PeRLs video presentation. A successful arrangement has been to develop two distinct slides sets (Data Supplement S1, available as supporting information in the online version of this paper). The first set is labeled as the presentation slides, which are the PowerPoint slides that support the presenter’s content, and ultimately appear in the final video to the left or right of the presenter’s head shot in a split-screen technique. The second slide set is labeled as the dialogue slides and represents the written script that the presenter has prepared. Each slide of the dialogue series corresponds to a matched slide in the presentation slide series. For example, presentation slide #5 might be a picture of a new graduate with the words “Options” and “Considerations” in bullet form. Dialogue slide #5 would then contain the actual words the presenter is reading to the camera such as, “New graduates have several considerations in the job market including …” The dialogue slide is projected on the wall opposite the speaker and immediately above the camera so that the presenter is able to read it, giving the impression that he or she is speaking directly to the audience through the camera lens. Constructing the dialogue slides using black lettering with a white slide background supports the presenter’s ability to read it at a distance. Advantages of a presentation/dialogue set-up include allowing the presenter to include the intended content without memorization, permits more precise timing, limits unnecessary “ums” and “ahs,” and prevents the speaker from looking down at handheld notes. As this teleprompter set-up is unfamiliar to many presenters, it is important that adequate time is scheduled to practice reading the dialogue slides to ensure that the presenter gains comfort with the set-up and is able to project a natural demeanor. An additional advantage is that postproduction editing becomes simplified by allowing the videographer to match up the head shot with the presentation slides. To do this effectively, the presentation and dialogue slides will need to precisely match. For instance, if the first slide is an abstract slide and the presenter is not speaking during the showing of this slide, then the first slide in the dialogue set should say “silent.” For more tips on postproduction syncing and software, see the PeRLs author guidelines on the AEM Web page.4 GRAPHICS AND ILLUSTRATIONS Images have the ability to communicate powerfully as well as improve recognition and recall. It is estimated that a learner retains 20% of what is heard with an increase to 50% if the ability to hear and see relevant content occurs simultaneously.10 Visuals should support a crafted lecture in a clear and meaningful way. The best visuals are often ones designed with an eye toward simplicity. Extra or decorative elements often result in

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visuals that feel cluttered and distract from the overall presentation. Displaying unrelated overlapping images, multiple color schemes, extraneous text, or superfluous animation creates unnecessary visual noise. Experts in design and communication use a signal-to-noise ratio to gauge a slide’s effectiveness.9 Slides with high ratios have high signal clarity with limited background noise. For example, a slide with a solid colored background that displays a graph simplified by removing its unnecessary lines and legends will have a high signal-to-noise ratio and greater ability to effectively and efficiently communicate its meaning to its audience. Clear effective typeface (e.g., Garamond, Baskerville, Helvetica, Gill Sans) at font sizes that enable them to be legible from the back of the room (>32) are best for projected slides and provide clear view through computer screens. Use different sizes and weights (bolding) to create hierarchy naturally. If using bulleted points, no more than four to six per slide is judicious. If images are to be used, it is important to use professional stock photo images purchased with copyright privileges. There are many Web sites that offer low-cost or free images (i.e., iStockphoto, Fotolia, Flickr) for this purpose. REFERENCE SLIDE/COPYRIGHT/CONTACTS Per AEM requirements, at least one reference slide should be included with each submission. As there should be adequate time (15 to 20 seconds) for viewers to scan reference material, the authors suggest ending a split-screen projection after the conclusion slide for a single projection of the references, copyright, and contact information slides. CONCLUSIONS Lectures accepted for publication in the PeRLs category undergo rigorous peer review for scientific foundation, educational content, and presentation quality. Authors have a number of options available to meet standards for creating, filming, and producing high-quality PeRLs videos. Alyson J. McGregor, MD, MA ([email protected]) Department of Emergency Medicine Warren Alpert Medical School of Brown University Rhode Island Hospital Providence, RI Jeannette Wolfe, MD Department of Emergency Medicine Tufts University School of Medicine Springfield, MA Scott Joing, MD Department of Emergency Medicine Hennepin County Medical Center Minneapolis, MN John H. Burton, MD Department of Emergency Medicine Virginia Tech Carilion School of Medicine Carilion Clinic Roanoke, VA Supervising Editor: David C. Cone, MD.

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References 1. McGregor AJ, Safdar B, Greenberg MR, Choo EK. Gender-specific emergency medicine research: overview and opportunities. Acad Emerg Med. 2013; 20:1180. 2. McGregor AJ, Davenport M, Miner J, Siegel T, Safdar B. Gender-specific emergency care: part one. Acad Emerg Med. 2013; 20:1181. 3. McGregor AJ, Choo EK, Poznanski S, Hendrickson RG, Greenberg MR. Gender-specific emergency care: part two. Acad Emerg Med. 2013; 20:1182. 4. Wiley Online Library. Academic Emergency Medicine instructions for authors. Available at: http:// onlinelibrary.wiley.com/journal/10.1111/%28ISSN% 291553-2712/homepage/ForAuthors.html. Accessed Sep 12, 2013. 5. Malik AS, Malik RH. Twelve tips for effective lecturing in a PBL curriculum. Med Teach. 2012; 34:198– 204. 6. Hart D, Joing S. The millennial generation and “the lecture”. Acad Emerg Med. 2011; 18:1186–7.

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7. Harolds JA. Tips for giving a memorable presentation, part I: The speaker as an educator. Clin Nucl Med. 2012; 37:669–70. 8. Harolds JA. Tips for giving a memorable presentation, part III: composing an important formal presentation. Clin Nucl Med. 2012; 37:872–3. 9. Reynolds G. Presentation Zen: Simple Ideas on Presentation Design and Delivery. Berkeley, CA: New Riders, 2012. 10. Collins J. Education techniques for lifelong learning: giving a PowerPoint presentation: the art of communicating effectively. Radiographics. 2004; 24:1185–92. Supporting Information The following supporting information is available in the online version of this paper: Data Supplement S1. Two distinct slide sets: presentation slides and dialogue slides.