NEXT-GENERATION DISTANCE LEARNING SYSTEM FOR
PROFESSIONAL EDUCATION AND TRAINING
26 August 1999
A project funded by the
Defense Advanced Research Projects Agency
National Science Foundation
in an award to the
Massachusetts Institute of Technology
and via Subaward #CCS600658001C to
Original Title: “Digital Library for Networked, Dual Use Education and Training”
Interactive Media Laboratory
Hanover, NH 03755
A.1. Introduction and Overview
The Interactive Media Lab (IML) at Dartmouth Medical School has developed a prototype distance
learning system originally titled “Digital Library for Networked, Dual Use Education and Training,” and
now titled “Next-Generation Distance Learning System for Professional Education and Training.” Its
purpose is to provide experience that could inform the full implementation of a digital multimedia,
interactive learning system that could provide professional training at any time and at any location in the
world. The primary target audience for this project is personnel in the Army and National Guard, but the
experience gained is applicable to education and training in any profession. A key aspect of the system is
that it demonstrates methods of delivering advanced training applications over Next-Generation
(broadband) Internet and, at the same time, be usable via combinations of current-generation Internet and
For purposes of this project, “advanced applications” have the following characteristics:
• they deal with complex topics that are not amenable to standard, technical training approaches; there is
an emphasis on decision making by more senior personnel, in situations where qualities such as
judgement, creativity, intuition, and leadership can determine success
• they apply learning models that are appropriate to these more complex topics (contrasted with, eg,
“drill-and-practice” approaches typical of military technical training)
• they make extensive use of media (notably motion video) that require higher bandwidths than current-
generation Internet provides; that is, broadband networks (alternatively, local CD-ROM + dial-up
Internet) are required
• they incorporate user interfaces other than traditional “Web-browsers,” interfaces that are more
immersive, more intuitive and easy to use, and more appropriate to specific training applications
In this report, “Next-generation Internet” (NGI) is equivalent to broadband Internet (at least 1.5 Mbps,
guaranteed), used via interfaces that may depart from standard browser interfaces. It does not refer to the
NGI initiative, per se;1 that said, the research described here is applicable to that program.
Research and development involved
• the development, adaptation, or adoption of software tools, methods, designs, and learning models to
provide an infrastructure for development and dissemination of advanced training applications
• the development and demonstration of two exemplar advanced training applications, developed and
delivered via that infrastructure
Because the Interactive Media Laboratory has specialized in the development of medical professional
training programs, and because health care is a critical component of military operational readiness, the
exemplar programs deal with military medical topics: SimTrauma and Regimental Surgeon deal with
management of combat-related trauma and functioning as a senior medical staff officer, respectively; the
latter program also deals with management of an infectious disease outbreak in a combat situation. As an
indication of the need for such programs, Regimental Surgeon has been adopted by the U.S. Army Medical
Department (AMEDD) Center and Schools, Ft. Sam Houston, TX, for the training of Army and National
Guard medical personnel (see Appendix A, letter from the Commandant, U. S. Army Academy of the
Health Sciences). There are plans also to implement SimTrauma, once it has been updated to incorporate
new video CoDecs.2
This effort has also contributed to the development of a new model, the Virtual Practicum,3 which is
optimized for the delivery of advanced training applications for military and medical professional education
and training. The model is described in Section C.1.3 and in Appendix B of this report.
The purpose of this project is to assist the development—by or for the U. S. Army and National Guard—of
a fully-realized, digital multimedia distance learning system (DLS) that would take advantage of Next-
Generation (broadband) Internet capabilities; the DLS would provide education and training support to
military professionals at any time or location. This goal would be accomplished via deployment of a
prototype system that would provide experience and demonstrate capabilities in two areas of importance to
the development of such a system:
• Infrastructural issues concerned with the technical aspects of delivering educational materials in a
rapidly evolving Internet/Web environment
• Education and training issues concerned with the application of technology-based learning in areas of
military importance, and models and methods for doing so
The prototype system would also serve to help policy-makers and educators within the Army and National
Guard understand the potential of the DLS by providing concrete examples of its functions and potential
impact on learning.
As previously outlined, facilitating objectives involved developing an NGI-compatible infrastructure to
support development and delivery of advanced training applications, and the development of two exemplar
advanced training application that would be delivered using that infrastructure.
B. PERSONNEL INVOLVED IN THE PROJECT
The following personnel were involved in the development of this project:
Interactive Media Laboratory:
Joseph V. Henderson, MD, Principal Investigator, Program Designer, Director, Producer
Charles Officer, BS, Systems Programmer, Programming Team Leader
Andrei Pascovici, MS, Systems Programmer
Douglas D. Campbell, BA, Multimedia Programmer
Mark M. Noel, BS, Multimedia Programmer
Maria-Teresa Wilson, MA, Associate Educational Multimedia Designer; Associate Producer
Susan K. Johnson, MS, Graphics; Interface Design; Animation
S. Benton Roberts, System Administrator, Production Engineer
Alison Burton, Office Manager
The video compression/decompression/streaming methods used during this project were judged adequate for
Regimental Surgeon, but compression artifacts interfered excessively with a few video sequences in SimTrauma. New
video CoDecs, such as MPEG-4 and Sorensen, eliminate this problem.
Henderson, JV. Comprehensive, Technology-Based Clinical Education: The “Virtual Practicum.” Int’l J. Psychiatry
in Medicine, 1998; 28:41-79. Available online at http://iml.dartmouth.edu/~joe/vpract.html.
Charles Hutchinson, PhD, Conceptual Evaluation of Emerging Technology, Thayer School of Engineering,
Joseph Rosen, MD, Conceptual Evaluation of Emerging Technology, Dartmouth Medical School
Carl Beckman, PhD, System Performance Evaluation, Thayer School of Engineering, Dartmouth College
Thomas C. Reeves, PhD, User Impact Evaluation, University of Georgia Department of Instructional
Graduate Students, Thayer School of Engineering:
John Erickson, PhD, Research Assistant
Daniel O’Connor, Research Assistant
Amol M. Joshi, BS, Research Assistant
Vladimir Ristanovic, BS, Research Assistant
C. ACTIVITIES AND FINDINGS
C.1. Major Research Activities
A prototype system was developed for delivering distance learning utilizing high-bandwidth network
(Internet and intranet) connections, but which could also be accessed via lower-bandwidth connections.
High bandwidth, which permits the streaming (real-time delivery, eliminating time-consuming downloads)
of full-motion video and high quality audio, is a defining characteristic of the Next-Generation Internet. As
such, this project instantiates the application of NGI technology.
As previously stated, the project involved work in three areas: development of a distance learning system,
the development of two exemplar programs, and evaluation of each of these efforts. The development of
the delivery infrastructure and exemplar programs was conducted simultaneously, with technological
demands of the programs defining, in part, the capabilities required of the supporting infrastructure.
Work was conducted in two phases. During Phase I, a technology review was conducted and all functions
of the prototype system architecture and infrastructure were implemented. One prototype of an exemplar
application and the Internet/Web-based services to support that application were developed. Reports written
during this effort can be found in Appendix D. At this point, a series of initial formative evaluations and
demonstrations were conducted in-house at the Interactive Media Laboratory and the Army Training
Support Center at Ft. Eustis, VA.
Phase II involved the refinement of the first exemplar program, the development of the second program,
and additional formative evaluations of the programs and supporting infrastructure. Finally, a final
formative evaluation of both the infrastructure and the exemplar programs was conducted. An external
investigator, Thomas Reeves, PhD (University of Georgia) conducted the final formative evaluation at the
AMEDD Center and Schools, Ft. Sam Houston, TX; the report of that evaluation is contained in Appendix
D. Finally, numerous demonstrations of the final prototype were conducted at ATSC and AMEDD Center
and Schools; audiences included policy-makers, course directors, directors of distance learning initiatives,
and senior educators.
C.1.1. Development of System Infrastructure
The prototype system’s infrastructure makes possible four primary features: storage, retrieval, and delivery
of streaming media; use of a web-based front-end for programs; dynamic content updating; and centralized
user tracking. Below are brief discussions of these features.
As previously stated, a key aspect of this project is the extensive use of video and audio in training
applications, usable across a wide range of network bandwidth and client-side computing power.
Infrastructure development began with a review of current and emerging technologies. Through this
review, hardware and software to stream video and audio via high-bandwidth computer networks were
identified, integrated, and implemented. Where network bandwidth is limited, a hybrid combination can be
used, in which the program itself is delivered via Internet while bandwidth-consuming audio and video
media are delivered via client-side CD-ROM.
Because digital video data files can be so large, bandwidth requirements are relatively high, and delivery
must be timely for effective training, there are many considerations when choosing appropriate hardware
and software for audio and video. The main requirements for this project were
• Easily integrated into commercial multimedia authoring environments such as Asymetrix ToolBook
and Macromedia Director
• Video must be of sufficiently high quality to serve educational goals, meaning
- at least 15 frames per second
- at least 240 x 180 pixel frame size
- high quality audio that stays tightly synchronized to the video
- sufficient image clarity, color, and contrast so that it is not
- not distracting or bothersome to the learner
• The video delivery system must be fault-tolerant; that is, it should recover cleanly when network
congestion or other problems interrupt its delivery momentarily
• There must be as little delay as possible between user action and the start of video playback; this was
found to be equivalent to "buffering" time, i.e., the amount of time a streaming video clip must
download and fill its "playback buffer,” used to accommodate brief interruptions in the data stream
For this project, at then-current stages in the evolution of compression and streaming methods, this project
used Microsoft Netshow 2 as a video-streaming server, running under Windows NT Server and delivering
Netshow video files compressed with the Cinepac CoDec. Using an inexpensive Pentium II NT server, we
were able to handle delivery of video to about 30 classroom computers simultaneously on a local 100BaseT
network before we began to encounter network saturation problems.
Currently, there are quite a few new solutions that are significantly better than the Netshow 2 / Cinepac
combination in many respects. In the field of suitable video delivery systems, the RealPlayer from
RealNetworks now handles high Quality of Service (QoS) video much better, while the latest version of the
Microsoft Media Player (replacing the Netshow player) also has much better support for new video formats
and server software. Apple's Quicktime streaming is also a very strong contender. Better video compression
has the double benefit of both increasing video quality (in terms of clarity, resolution, frame rate, etc.) and
making the video files smaller, thus relieving some network delivery and congestion problems. The only
downside to this is that, in general, the more powerful the video CoDec, the more powerful the user's
computer must be to decode it and play it back smoothly. However, given the rapid pace of improvements
to hardware, this is usually a satisfactory trade-off. CoDecs that are suitable for use with current video
players, delivery systems, and typical client machines include the Sorenson CoDec included in Apple's
Quicktime, the industry standard MPEG-1 (usable in almost everything), and Microsoft's own version of
MPEG-4, usable in the Microsoft Media Player.
A major feature of this prototype is its use of the World Wide Web as the user interface for authenticating
and launching programs. Users can access the program via websites (described in section D.2), which
provide familiar navigation and interface elements for the user and can take advantage of commercially
developed methods for conducting secure transactions through the encryption capabilities built into almost
all commercial web browsers. Once a user logs into the web site to start the program, the web server and
the "Helper Application" take care of delivering, or "serving" the program contents and media, often from
servers other than the web server. This approach offers the benefits of specifying multiple "mirrors" for
high bandwidth content, such as program and video files, that can be located on a high speed local network
and which cache media from authoritative servers over (relatively) slower connections to the Internet. As
such, only a basic computer and Internet connection are required to use training applications, enabling
personnel to learn at home, on a base or ship, in the field, or at any other networked location.
Another system feature is the easy updating and revising of training materials delivered over the Internet, as
well as the capacity to easily add new materials. There are two dimensions to this feature: The ability for
developers to modify existing programs or add new ones, and the mechanism for updating the programs as
delivered to the learners.
For performance reasons, users run the programs from their local computers. The key to keeping these
training materials up-to-date then becomes using the network to make sure that all the user's program,
media, and data files are completely up to date every time the program is run. Every time a user launches a
program, the Helper Application makes a comparison between the program materials that already exist on
the user's computer and the authoritative copy kept on a central server. If local copies of programs or data
need to be updated, the system will handle the appropriate transfers before the program starts. In most
cases, this dynamic content updating is totally automated and happens without any user intervention. In
cases where the system detects that updating the necessary files will take a significant amount of time over
the existing network connection, it will tell the user what is happening and offer the option of aborting the
Related to this function is the ability to track users' progress, regardless of their geographical locations.
User progress and performance data are collected by the actual program being run, and are uploaded to the
central server when the user exits the training session. This way, the user's most recent progress data can be
used to pick up the training or simulation in the right place, even if the user has switched physical
computers from one session to the next. This approach also allows for easier analysis and reporting of user
C.1.2. Development of Exemplar Programs
Two exemplar programs were developed to demonstrate the capabilities of the prototype infrastructure.
These programs were designed to provide highly realistic and immersive training experiences, employing
video, audio, graphics, and text. Users “interact” in combat medical situations by choosing locations to
visit, procedures to implement, and questions and responses in simulated dialog. These simulated
encounters enable users to practice making rapid decisions in nebulous, high-pressure situations. They can
learn from their mistakes in a safe environment by receiving feedback and experiencing the “virtual”
consequences of their choices.
Regimental Surgeon and SimTrauma were developed as exemplar programs. The focus of Regimental
Surgeon is to provide more concrete training dealing with preventive medicine and infectious disease
outbreaks in the combat theater, and to reinforce military culture and command structure, and the necessity
of respecting and operating effectively in those milieus. SimTrauma was designed to teach and reinforce
the fundamentals of a standard method of trauma management taught throughout the military (and civilian
practice), called Advanced Trauma Life Support (ATLS). To ensure content accuracy in the programs, the
IML consulted content experts from the Uniformed Services University of the Health Sciences, and the
Medical Advisor to the commanding general at Camp Pendeleton. Three military surgeons closely
monitored program development, one of whom was a member of The Committee on Trauma, American
College of Surgeons. Former Surgeon General C. Everett Koop (himself a surgeon) acted as the “virtual
mentor” for the program.
In order for the exemplar programs to be readily delivered via the Internet, a compatible and flexible means
of programming, or “authoring,” was required. IML evaluated the advantages and limitations of leading
interactive media programming authoring systems, as well as IML’s proprietary language, 5L. Two
systems were selected: Macromedia’s Director 6.02 and Asymetrix ToolBook II. Director was chosen for
its visual layout tools, solid structure, user support, and large community of programmers. ToolBook II was
selected because it is the program most commonly used by the U.S. Army for multimedia production. An
evaluation of Director and ToolBook II can be found on the IML web site at
C.1.3. Virtual Practicum Model
As noted previously this effort has contributed to the development of a new model, the Virtual Practicum,
which is optimized for the delivery of advanced training applications for military and medical professional
education and training. The model was instantiated in a separate program, dealing with care of HIV
patients. This program was demonstrated to DoD educators at the AMEDD Center and Schools, at the
Army Training Support Center, and at the Uniformed Services University of the Health Sciences. There
was unanimous agreement that the model is applicable to most non-technical professional education topics
in the military, whether medical or not.
The Virtual Practicum model is described briefly in this section. An extensive description can be found in
The Virtual Practicum model is derived from Donald Schön’s reflective practicum.4 Schön criticizes most
professional education as focusing on the high ground of "manageable problems [that] lend themselves to
solution through the application of research-based theory and technique" and not preparing students to
work in the swamp of "messy, confusing problems [that] defy technical solution."
“The irony of this situation is that the problems of the high ground tend to be relatively
unimportant to individuals or society at large, while in the swamp lie the problems of
greatest human concern. The practitioner must choose. Shall he remain on the high
ground where he can solve relatively unimportant problems according to prevailing
standards of rigor, or shall he descend into the swamp of important problems and non-
"The dilemma has two sources: first, the prevailing idea of rigorous professional
knowledge, based on technical rationality, and second, awareness of indeterminate,
swampy zones of practice that lie beyond its canons.”
Outstanding practitioners, who deal well with the swamp, aren't generally said to have more knowledge
than others (though scientific and technical knowledge are essential); instead, they're described as having
more "wisdom," "talent," "intuition," or "artistry.” But these are commonly regarded as phenomena that are
not amenable to "scientific" examination; as a result, education in medicine and public health tends to
believe that it cannot adequately deal with them.
Another way of expressing Schön’s concern is that educators in military settings tend to ignore the
transactional5 nature of practice, i.e., the psychosocial aspects in which the highly variable nature of
human behavior and human situations plays a significant role. Management of an infectious disease
outbreak is such an area. Scientific understanding of infectious disease of military importance is
exceptional, and technical methods for their prevention and management are available. However, public
health is often compromised by behavioral factors—ranging from prevention of transmission to persistence
in taking prophylactic drug regimens—that require knowledge and skills that “lie beyond the canons” of
technical rationality. Many parallels for this exist in non-medical military situations (and, of course, in a
great many non-military situations). It is in these indeterminate zones of practice that we find well-
developed scientific and technical knowledge, balanced with empathy, intuition, and artistry that mark the
exceptional practitioner. The application of emerging communication technologies provides a new
opportunity to consider how we might better prepare students to develop these various forms of knowledge,
and to work effectively in “the swamp.”
The Virtual Practicum is an example of a model that seeks to do so, in part by applying Schön’s idea of a
“reflective practicum,” designed to overcome the “high-ground/swamp” dilemma. Schön describes the
reflective practicum as
“... a setting designed for the task of learning a practice. In a context that approximates a
practice world, students learn by doing, although their doing usually falls short of real-
world work. They learn by undertaking projects that simulate and simplify practice ...
Schön DA. Educating the Reflective Practitioner: Toward a new design for teaching and learning in the professions.
San Francisco: Jossey-Bass, 1987.
Contrasted with more procedure-oriented practice. As Schön points out, post-Flexnerian medical schools, seeking
respectability within the academy, have chosen to emphasize rigor over relevance, and heavily emphasize the technical-
scientific aspects of practice. This may largely be true of schools of public health as well.
The practicum is a virtual world, relatively free of the pressures, distractions, and risks of
the real one, to which, nevertheless, it refers ... It is also a collective world in its own
right, with its own mix of materials, tools, languages, and appreciations. It embodies
particular ways of seeing, thinking, and doing that tend, over time … to assert themselves
with increasing authority…”
“Students practice in a double sense. In simulated, partial, or protected form, they engage
in the practice they wish to learn. But they also practice, as one practices the piano, the
analogues in their fields of the pianist’s scales and arpeggios. They do these things under
the guidance of a senior practitioner… From time to time, these individuals may teach in
the conventional sense, communicating information, advocating theories, describing
examples of practice. Mainly, however, they function as coaches whose main activities
are demonstrating, advising, questioning, and criticizing.”
The Virtual Practicum model takes this description literally, using technology to create a computer-
generated, immersive environment that has all of these elements, as follows:
• It provides a technology-based “virtual workplace” that approximates the world of actual practice,
represented as media elements (graphics, video, sound, text) within which the learner can move, work,
• Students learn through simulated professional practice, particularly simulated problem-cases that
compress time and space, giving the experience of dealing with “swampy” problems that can evolve
over a virtual time span ranging from minutes to years. There are also documentary-style “interviews”
with genuine individuals, either practitioners or those who have experienced the impact of their
practices (positive and negative): these provide narrative impetus and context for considering the
practice of medicine or military science as real-world “war stories”
• It provides a virtual world sufficiently immersive and intrinsically enjoyable to allow even busy
professionals to ignore, for a time, the pressures and distractions of the real world. The Virtual
Practicum may also reduce the risks of real-world practicing as students develop and apply new
knowledge and skills, since these are done in a technology-generated environment before applying
them in the real world.
• It is a collective world in its own right, providing an inviting, strong sense of place that one can visit
repeatedly to learn, containing language, materials, and tools that have analogs in the real world of
practice and that borrow from the esthetics of best-practices in computer game design; a key feature is
use of narrative and case-based reasoning to increase engagement, enhance reflection, and improve
• It embodies particular ways of seeing, thinking, and doing via cycles of experience, reflection,
abstraction, and experimentation in the tradition of Dewey, Schön, and Kolb; “story-telling" used in
the case presentations provides an underlying structure and context for discussions and reflection that
“assert themselves with increasing authority” and intensity.
• Activities include realistic simulations, documentary-style interviews with real individuals, and
computer-generated exercises that allow for heuristic learning of facts and rules (Schön’s “scales and
• All this is done under the guidance of senior practitioner (in the best case, also a master teacher) who
- teach in a conventional sense, “communicating information, advocating theories, describing
practice examples” via mini-lectures and case discussions.
- function as a coach, “demonstrating, advising, questioning, and criticizing” via case discussions
and guided (with feedback) reflection and experimentation.
Reaction of learners, practitioners, and educators to the Virtual Practicum model has been uniformly
positive and enthusiastic. Two programs have been produced for the education of primary care providers,
Primary Care of the HIV/AIDS Patient and Management of Cancer-related Pain, funded by Pfizer
Pharmaceuticals and the National Cancer Institute, respectively. Two more, dealing with topics in medicine
and public health (clinical genetics and HIV counseling) are in development, with funding from the Centers
for Disease Control and Prevention. The model is also being applied to patient education, in a program for
cancer patients about to undergo treatment, funded by NCI.
It is likely that wide adoption of the model and its attendant methods will positively affect professional
education in medicine and public health and, at the same time, stimulate the development of new concepts,
models, and methods for technology-based learning.
C.2. Major Research Findings
Findings are reported in the accompanying reports (Appendix C). A summary of findings follows:
• It is possible to develop and deliver advanced applications (as defined previously) involving extensive
use of motion video using off-the-shelf authoring and media serving tools, and with Unix- or Window
• Assuming adequate bandwidth and no switching delays, network-delivered video was equivalent in
performance to standalone, local CD-ROM with one exception: network delivery required a 2-3 second
buffering delay, resulting in an equal latency between requesting a video segment and displaying it;
CD-ROM latencies are consistently much less than 1 second;
• Compared to development of CD-ROM-based delivery of educational programs, very little change is
required to develop for delivery of programs via broadband networks; the only exception is to design
interactions to accommodate increased latencies and to use pre-buffering strategies (single or multiple
stream, with or without predictive methodologies) while the user is making choice decisions or
viewing text and images (requiring much lower bandwidths);
• Macromedia Director 6.0, with software extensions allowing video streaming, is adequate for the
development and delivery of advanced training applications;
• Toolbook 6.2 which, as already noted, is used extensively for military courseware development, is also
capable of delivering streamed media over networks and is sufficiently flexible to support advanced
training applications; however, this version of Toolbook was found to be very “buggy” and awkward
to use, requiring considerable additional effort to devise “work arounds” for bugs and inadequate
• Under conditions simulating use of broadband Internet in a realistic training situation (100-base T
- A single NT-server (single processor, 300 MHz) with a single, 6 Gbyte hard disk could support 20
simultaneous users with no decrement in performance;
- Learners found the system, Web interface, and exemplar programs easy to use and acceptable vis-
• Learners, educators, and policy-makers at the AMEDD Center and Schools found the design of the
exemplar programs acceptable and stimulating deeper consideration of the application of technology-
based learning and NGI for professional education and training; as noted previously, both exemplars
will eventually be used in the AMEDD curriculum.
• The technologies, methods, and experience gained in this project have immediate applicability to other
professional education outside the military; a follow-on project has been implemented, exploring the
use of NGI and advanced training applications for public health professional education and training.
C.3. Research Training
Several groups gained experience and training in the research and development of distance learning
systems and multimedia production, including graduate students, military personnel, developers at IML and
the AMEDD Center and Schools, and faculty at Dartmouth and the AMEDD Center and Schools. In
addition, two graduate students in engineering completed Master’s theses and one doctoral student
completed his dissertation while participating in the project.
C.4. Education Activities
As described previously, education is the primary focus of this project and benefactors include end-users,
as well as personnel involved in the development and implementation of computer-based training,
interactive multimedia programs, and distance learning systems that might employ Next-generation
D. PUBLICATIONS AND PRODUCTS
Several publications resulted from this project. Unless otherwise indicated, all publications are available on
the IML Website http://iml.dartmouth.edu. Follow links to documents. Several of these publications can
be found in Appendix C.
A Next-Generation Distance Learning System for Public Health. J. Henderson, Am. J. Preventive
Medicine, Volume 17, 1999. (Direct evolution of this project.)
Comprehensive, Technology-based Clinical Education: the “Virtual Practicum.” Joseph V. Henderson,
Int’l J. Psychiatry in Medicine, 28:41-79; 1998.
Commercial Streaming Solutions Survey. Vladimir Ristanovic, January 1997.
Enhanced Attribution for Networked Copyright Management. A thesis submitted to the faculty in partial
fulfillment of the requirements of the PhD degree by John S. Erickson, Thayer School of Engineering,
Dartmouth College, June 1997.
Improving Access to High Quality, Network-Based Education and Training. Amol M. Joshi, January 1997.
A Performance Estimation Model and Content Sourcing Algorithm for the Seamless Integration of Hybrid
Multimedia Applications. Amol M. Joshi, January 1997.
Predictive Prefetching Algorithm for Real-Time Delivery of Digital Video in Interactive Applications.
Vladimir Ristanovic, May 1997.
Protocols for Real-time Media Transmission. Vladimir Ristanovic, May 1997.
A Technical System Performance Evaluation. Carl Beckman, August 1997.
A Video Streaming Performance Model and Content Sourcing Algorithm for Optimizing the Quality of
Service of a Multimedia Server. Amol M. Joshi, April 1997.
A Website concerning this project is located at http://iml.dartmouth.edu. Follow links to DLS.
D.3. Other Specific Products Developed
Both exemplar programs can be used as stand-alone CD-ROMs, independent of the Internet. One copy of
each of these programs is enclosed. Additional copies will eventually be available from the AMEDD
Center and Schools, Ft. Sam Houston, TX. Meanwhile, limited numbers of copies can be requested from
the Interactive Media Laboratory. These programs are
Regimental Surgeon: Preventive Medicine in the Combat Theater. Interactive multimedia program
deliverable via broadband network only or via CD-ROM. Interactive Media Laboratory, Dartmouth
Medical School, 1998.
SimTrauma: Advanced Combat Trauma Life Support. Interactive multimedia program deliverable via
broadband network only or via CD-ROM. Interactive Media Laboratory, Dartmouth Medical School, 1998.
E.1. Development of Disciplines
Through this project, IML has furthered the field of distance learning by developing and demonstrating a
prototype system that makes use of high-bandwidth Next-Generation Internet capabilities. Additionally,
IML has contributed to the field of instructional and multimedia design by developing a pedagogical model
based on highly immersive and interactive learning environments that emphasize rapid decision-making in
“swampy,” high-stakes situations.
From a technological innovation perspective, the proposed work has accelerated the application of Next-
Generation Internet services for military and civilian professional education and training, including video
streaming; CD-ROM/network hybrid delivery of instructional content; broadband network delivery of
content; immersive learning environments; automatic update of instructional software content; as well as
technical methods for producing instructional software for this environment. From an education and
training perspective, the work has advanced our knowledge of the application of these technologies using
more effective models for professional education and methods for organizational change.
E.2. Other Disciplines of Science and Engineering
This project took advantage of and applied advances in computer and network systems architecture design
for purposes of professional education and training. It furthered the development of video streaming
technology, bandwidth management, systems engineering, and the development of a hardware
infrastructure capable of delivering networked, multimedia software applications.
E.3. Education and Development of Human Resources
As described in Section A, the AMEDD Center and Schools has adopted Regimental Surgeon for
incorporation in its curriculum for the training of senior medical staff officers. They are about to fund
upgrading of the video segments of SimTrauma, following which the program will be used for training in
combat trauma management in the Army and National Guard.
A significant indicator of the success of this project is funding by the Centers for Disease Control and
Prevention of an elaboration of the prototype for the education and training of public health professionals.6
In addition, the Health Resources and Services Administration has funded exploration of satellite-based
broadband networks for the education of rural care providers; this effort will benefit directly from
experience gained during this project.
E.4. Physical, Institutional, and Information Resources for Science and Technology
In collaboration with colleagues at the Massachusetts Institute of Technology, IML specified server
requirements to deliver advanced training applications via broadband networks. This greatly assisted
Henderson, JV. A Next-Generation Distance Learning System for Public Health. Am. J. Preventive Medicine,
Volume 17, 1999.
procurement of hardware and software systems for serving streaming video for the Army Training Support
Center, Ft. Eustis, Virginia.
E.5. Other Resources Beyond Science and Technology
The experience, tools, and methods derived from this project are widely applicable to any applications of
NGI to education and training, particularly for practitioners and students in the professions.