By Professor Mark Taubert, Consultant in Palliative Medicine, Velindre University NHS Trust & Cardiff University School of Medicine, Cardiff, UK
Mr Glenn Davidson, Artstation, Cardiff, UK
Dr Mike Fedeski, Artstation, Cardiff, UK
Dr Jelle van Gurp, Coordinator Clinical Ethics Radboud University Medical Centre; Assistant professor Ethics of Healthcare, Nijmegen, Netherlands
“The pandemic has created an increased focus on video meetings and presentations, and the importance of sound has perhaps been drowned out in this narrative. Sound, and the increasingly sophisticated ways it can be recorded in, at relatively low cost, should become an increasingly important consideration in development of newer post-pandemic curricula in healthcare”
Medical student teaching has been affected globally since the start of the covid-19 pandemic, with a reduction in opportunities to join clinical settings, hospital ward rounds and clinics as a consequence of severe lock downs and travel restrictions. In May 2020, the palliative care team at Velindre Cancer Hospital in Cardiff, recorded a ward round using binaural sound microphones, as part of an international education collaboration during the pandemic. A recording device was set up to accompany Prof. Mark Taubert, a Palliative Care Consultant, and his team on a typical ward round. With medical student teaching on the wards severely curtailed, palliative care teachers from Cardiff and Nijmegen (Radboud UMC; the Netherlands) were keen to find innovative ways of learning from the clinical setting, on matters relating to palliative care, advance care planning, oncology, and of course covid-19. The suggestion to use binaural sound to capture the setting came from Artstation, who were already in a dialogue with the universities about new ways of conveying teaching.
Binaural recording is a method of recording sound that uses two microphones, arranged with the intent to create a 3 dimensional sound sensation for the listener; for many, it actually feels like being ‘in the room’ with the performers, speakers or musical instruments. This effect is often created using a technique known as “dummy head recording“: a mannequin head is fitted out with a microphone in each ear. The alternative technique adopted here is to build the microphones into earphones that one of the participants can wear, in this case MT. Binaural recording is intended for replay using headphones, and will not translate properly over stereo speakers. Rather than presenting an aural scene in front of the listener, the effect is to place the listener inside the scene. This three dimensional or “internal” form of sound has also translated into useful advancement of technology in many things such as stethoscopes creating “in-head” acoustics and IMAX movies being able to create a three-dimensional acoustic experience.
As an educational resource and technique for capturing sound and data, binaural recording has a number of promising advantages. Recording sound is relatively unobtrusive and requires low technical attendance. The microphone can be plugged into most smart mobile phone devices. Indeed, at the time, it is easy to forget that a recording is being made. Binaural recording captures almost everything that occurs within a 360 degree compass. Its comprehensive content enables interpretations to be made that are not available via other data-capture techniques, which include the influence of place/position on people and of circumstances and events. The cost of the recording equipment is modest, as high-fidelity cable-free headsets that can be run from a mobile will be available at under £100.
Three patients, Michelle, Angela and Vicky agreed to participate in the ward round recordings and signed consent forms. All were inpatients in the cancer hospital, receiving urgent treatments for their cancer during May 2020, a time when the UK was going through its first lock-down. Conversations included how lock-down has affected cancer care and family life, the sounds and noises on a ward, having Do Not Attempt CPR (DNACPR) discussions and decisions, and even Welsh ‘cwtches’ and teddy-bears. Written consent was obtained from each patient, and all three were very keen for these resources to be used for educational purposes. All were given the opportunity to listen to the recordings subsequently and retract their consent, but none did.
The recordings were then made available to medical students at Cardiff University School of Medicine and to Medical Students at Radboud University Medical Centre in Nijmegen. Several video meetings were set up with MT (Cardiff University) and JVG (Radboud University Medical Centre) and students, in order to discuss what had happened with each of the three patients.
For the student sessions, the two sound artists, MF and GD, joined in order to explore how the use of binaural recordings had influenced the learning experience. The sound of the busy hospital is very much captured, and the noise of putting on PPE, as a consequence of the covid-19 precautions, is very much representative of the new ways of working that hospitals have faced. Students commented on the noise from plastic equipment, bins and even hand washing, noises that may go unnoticed by health care professionals in the day-to-day business of a real life ward round, but for patients these sounds are ever-present, including at night in a hospital setting.
At one point during the recordings, a crow outside the hospital is very noticeable, but it does not interrupt the ward conversation which continues to flow. Comments from staff on the ward round included reflections of the process of making the recording and then listening back into it. This actively involved the participants (co-producers) in reflecting on the case history being studied, whilst observing the nature of sound and positioning of things in a recorded setting, which evoked the memories of what happened and where individuals stood or sat during the recording.
Students commented positively on the immersive nature of these audios, some describing how they looked over their shoulder when listening to these audio-files, because it “feels like someone is actually walking or talking behind you”. The position of various sounds is very realistic, and some felt could even be unsettling when listened to properly via a headset. Students found this element of the binaural recording very engaging, and it created a sound environment around them that also kept them focused on the content of each conversation. Students also appreciated the opportunity to listen closely to professional role models performing real life conversations with patients with complex and life-threatening diseases. Such focused (audio only) but still multifaceted (message, tone, rhythm) information could, in the future, be emulated by students in successive communication training sessions.
The pandemic has created an increased focus on video meetings and presentations, and the importance of sound has perhaps been drowned out in this narrative. Sound, and the increasingly sophisticated ways it can be recorded in, at relatively low cost, should become an increasingly important consideration in development of newer post-pandemic curricula in healthcare.
The recordings can be accessed here: https://soundcloud.com/glenn-davidson-4/sets/velindre-binaural-recordings/s-r6ncMAEzP5p
For further information, please contact Artstation: glenn AT artstation DOT org DOT uk