Chapter 15: The First Web-Based Textbook

Chapter 15: The First Web-Based Textbook

Loading...

Media is loading
 

Description

In this segment, Dr. Goepfert describes a promising, but ultimately failed, attempt to publish what was the first web-based text book. In 1997 he secured some funding to set up a team to plan the book and identified companies that could collaborate on design. His vision was to create an entirely web-based and interactive publication that kept text to a minimum, relying instead on multi-media and multidisciplinary training in head and neck surgery. The project was completed in 3-4 years and he presented it to the Vice President of Academic Affairs, Margaret Kripke, who was very enthusiastic. The textbook was launched and housed on the MD Anderson server. Dr. Goepfert then explains that a committee decided that MD Anderson could not pursue any web publishing. He then comments on the difficulty of obtaining high level support for projects. The web-book project closed down when an outside publishing company decided that marketing the book would not be profitable. He then talks about what the web can offer researchers and clinicians, e.g. education via visual documentation of surgical techniques; a forum in which physicians can submit cases and receive input from specialists; a storage bank for cases for future reference. He notes that MD Anderson could be producing educational programs and offered for a fee. Dr. Goepfert first talks bout the family origins of his interest in education and communication. He then mentions his Hayes Martin Lecture on education in ’95, which focused on the fundamentals on what it takes to be a physician scientist.

Identifier

GeopfertH_02_20120828_C15

Publication Date

8-28-2012

City

Houston, Texas

Topics Covered

The Interview Subject's Story - The Administrator; Contributions; Professional Practice; The Professional at Work; Discovery, Creativity and Innovation; Influences from People and Life Experiences; Education; Personal Background

Transcript

Tacey Ann Rosolowski, PhD:

Okay. That’s good to know. Now, you mentioned also that you wanted to say something about publishing and its failure at MD Anderson. Does that come under this heading or is that a separate topic?

Helmuth Goepfert, MD:

No. What failed at this institution is the web publishing.

Tacey Ann Rosolowski, PhD:

Web publishing. Okay. Well, maybe you could talk about that.

Helmuth Goepfert, MD:

The example is when I left the division—you know I was head of the division ad interim for two three years or whatever it was—I obtained a fund from the institution that was in the amount of four hundred thousand to five hundred thousand dollars to develop something. So, I got all my faculty together and asked the question, “Is there anything of significance that you scientists—?” And I particularly addressed the scientists because the clinicians were happy with what they were doing. I asked the scientists, “Is there anything you need?” “No,” they said, “we are okay right now.” I said, “Okay, because I want to launch a web-based book.” Mind you, this was 1997 or something like that. So, I can’t remember exactly when it was, but it was when I finished my division head duties. So, I set up a team, and we went through multiple architectural changes because the companies then appeared and disappeared rapidly on the scene. This was at a time when the dot-coms sort of went up and down and sideways. So, the creation of this was based— My vision was to create an entirely web-based publication on head and neck cancer. In order to keep it simple, I was going to use faculty of MD Anderson only, and I abided by that with one exception, I think. And it was not just a textbook put on a disk, but a program that could evolve into something interactive. Now, mind you, at that time it was very labor-intensive. We had to find a person that would be able to translate the content of what was given onto the website; pictures, segments of video and so forth to show how things were done, programs on radiation oncology, and the book was basically called Head and Neck Cancer According to the MD Anderson Cancer Center. And we finished this in a matter of about three or four years. Nobody ever had done this. As I say, the principle was that text would be at a minimum because reading text on the screen is getting better, but it’s different. It’s tiresome. It’s not like reading a book. So even though Kindle says it’s different—I like Kindle too—you lose the ability to check what’s coming.

Tacey Ann Rosolowski, PhD:

That’s true. Or go back and remind yourself.

Helmuth Goepfert, MD:

Go back and remind yourself of what you read that was difficult to find. But anyhow, we were able to finish this project, faculty only, and present it to the then Vice President of Academic Affairs Margaret Kripke [Oral History Interview]. Margaret loved it. She said, “This is wonderful.” I said, “We’re going to launch it next month.” It will be housed in an MD Anderson server, but it would be web bound and text at a minimum. The highlights of anything would be on bullet points only. Evaluation done by this and this and these principles, staging done according to—and you could click and up came a separate view of the staging available, treatment modality and such and such based on this and this and the evidence is based on this and this publication.

Tacey Ann Rosolowski, PhD:

When you say staging, do you mean—? What do you mean by that?

Helmuth Goepfert, MD:

Staging of cancer.

Tacey Ann Rosolowski, PhD:

Oh, okay. Stage I, stage II, okay.

Helmuth Goepfert, MD:

So this you could always pull up the reference in the system. So, it was complex. It was not very user-friendly because the system still was in its initial phase. Yes, there were things that today would be totally different, but in those days, you sort of had to go two steps back in order to go a step forward and stuff like that. And it required more savviness than it would now. The concept of user-friendliness was just being sort of brought about in order to make these things better. Be that as it may, we set it on the server—on MD Anderson’s server—and months later a committee that existed then at the Institution for Scientific Publication or whatever it was decided, no, MD Anderson is not going to pursue anymore web publishing period. No reason given. It was basically their statement. So here I was, I had what I thought was a great publication to start something rolling in not only the institution but beyond that for people to start doing this. It still hasn’t been done, but the institution lost its momentum in doing web publishing, something that is sorely needed now.

Tacey Ann Rosolowski, PhD:

Why do you feel it’s so needed?

Helmuth Goepfert, MD:

Because it’s the way that we can connect with the outside in an efficient patient-management way. I think the decision-making support is not that easy to get out there in the sense of having it. Yes, there are some programs that facilitate it, but they are not really that flexible so that physicians could, for example, put in all the information. It would be guided here to an expert, that expert would sift through it and within two or three days give an answer.

Tacey Ann Rosolowski, PhD:

So you saw the web-based book as a communication tool between physicians outside and specialists within the institution?

Helmuth Goepfert, MD:

No, as a first step. It was mainly to disseminate our information on the web base, not in a book that sits on a shelf collecting dust. I mean, I had already identified that you can take out a chapter and say we need to update this chapter. You would take out the chapter, update the chapter, and put it back in again. That’s the way I saw it, and I saw it predominantly at that time as a way to communicate our knowledge to the outside—what you usually do for that purpose. Now, publishers outside that I approached after that really were not able to use it or gather momentum with it. The one that was most interested was certainly Brian Decker, from Toronto—the Decker Publishing Company. He put a tremendous effort into this. He tried to work with Eleanor to do it, but he could not get a business plan that would say this is going to make money for us. Whereas books in hard print make money, web publishing does not. So, it is one of those conundrums that will have to be solved somehow or another. It sort of underlines my belief that web education is underutilized. I think it’s very much underutilized in complex disease processes like cancer.

Tacey Ann Rosolowski, PhD:

In the ideal world, what would you visualize?

Helmuth Goepfert, MD:

I would visualize several products. One of them would be the identification of certain advanced surgical procedures that would create, through the visual documentation of these procedures with video, a library that could be utilized by experts all day if they needed to do this operation. It would create a forum by which physicians out there could submit their difficult cases onto a platform that the only thing we would have to do is make sure that they submit the appropriate information in the shell that we allow them to utilize, and then we would have some kind of a board in front of us with faculty that would be ideal to answer the questions specific to this case. So we do not have only the so-called Tuesday morning MPC—multidisciplinary planning conference—that we have now, where faculty of our organization answers the questions from the people in our network, which is the host programs, and that only can be done once a week. This would be a continuum that could be accessed by anybody out there that wanted to know something about a specific situation. There would be a storage bank where these cases could be sort of loaded and kept for future references. It could be used then for educational efforts, for annual meetings or something of that nature, and basically once the physician expert at Anderson would render an opinion plus supply a list of references that supported his/her decision, it would then go back to the physician who asked the question. And I see that as the best way. And you can use this for nursing training. Nurses out there need oncology training. This can be used as that. It can be used for physical therapists, for their duties. It can be used by nutritionists. It can be used for medical oncologists in order to train the nurses in the safe administration of chemotherapy. It can be used by radiation oncologists to give the necessary parameters of appropriate treatment for—be it breast cancer, rectal cancer or what have you. It would allow for multiple medical and paramedical specialties to create educational programs that could be sold by MD Anderson or offered by MD Anderson for a certain fee. Now, it’s a major undertaking, and the short—I would say the short answer is, yes, we need to do it. The long answer involves—stumbles on the fact that the MD Anderson faculty is already overtasked. They are torn between research and patient care. They have been told they need to increase nine percent the productivity—God knows how they’re going to do it—and they have their own responsibilities vis-à-vis societies that they participate in—scientific societies. Or they have educational programs that they have to run out there and are sent to Pakistan or wherever it is so they give their talks. So, all of that is basically in the mesh of where the faculty finds itself now. But, as I say, in some form it will have to be a way to make things easier, because I think we are still using outdated technology to teach out there.

Tacey Ann Rosolowski, PhD:

I’m really struck at how often the issue of education has come up, as you’re talking about your own career. Where did your interest in and commitment to education come from?

Helmuth Goepfert, MD:

From my father.

Tacey Ann Rosolowski, PhD:

How did that happen?

Helmuth Goepfert, MD:

Because he was basically a general surgeon and a great man to educate people. He was not a Chairman of a department, but he was a very practical educator in the sense of bringing things down to diagram. He would use this for patients, and he would use this for his students and so forth. So, it comes from that time. It comes from that time, and it comes from seeing how Dick Jesse would educate us, how Ballantyne would educate us. Some of them would sort of know that they were doing education. Ballantyne never knew really that he was educating us, because we saw what he was doing and that was education enough. Yes, I had an interest in educating, and it was part of why I stayed here, because you could do it here at MD Anderson with fellows.

Tacey Ann Rosolowski, PhD:

Okay, so you felt you were making a real impact.

Helmuth Goepfert, MD:

Yeah. When I got to the United States I said I didn’t want to go into private practice. The majority of physicians, in those days, that came to the states from Latin America and from wherever it was in the world ended up doing private practice. It is only in the last few years that many of them have sort of come as immigrants and sort of settled in institutions like MD Anderson.

Tacey Ann Rosolowski, PhD:

Now, why didn’t you want to go into private practice?

Helmuth Goepfert, MD:

I didn’t like the business part. I’m not a number person. My basic knowledge of economics is that you can only spend what’s in the bank. (laughs) So that’s all. I don’t know more than that. As I say, I had no interest in doing that. I know that some of my colleagues were making money hand over fist, but I didn’t care for that.

Tacey Ann Rosolowski, PhD:

Now, I noticed from your CV that you chaired the Joint Council of Head and Neck Training Oncologic Surgery and also you delivered the 1995 Hayes Martin lecture, Training the Head and Neck Surgeon Scientist—both real big evidence of your interest. So, tell me about those two opportunities for—

Helmuth Goepfert, MD:

The Hayes Martin lecture—Hayes Martin was the man I mentioned to you in relation to McComb. The Head and Neck Society had an annual lectureship in which one of the leaders in the field would be asked to give a lecture. When I was offered that opportunity, I took it and I made it on the training of the head and neck surgeon scientist. So that was—it’s a paper that is published. I even did a questionnaire sent out to the 16 existing programs finding out how much research their fellows were trained in. It was a gamut from left to right—nothing very much.

Tacey Ann Rosolowski, PhD:

Now, can you summarize the main points of that lecture on education?

Helmuth Goepfert, MD:

It was basically what we have discussed, and I would say what made—the fundamentals of what does it take to be a surgeon scientist. I don’t have a copy of that with me, but it is published. In my CV you can get the reference and you can find it. It’s in the library. But, as I say, the other part is the Joint Council of—

Tacey Ann Rosolowski, PhD:

Advanced Training in Head and Neck Oncologic Surgery.

Conditions Governing Access

Open

Chapter 15: The First Web-Based Textbook

Share

COinS