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P&S Journal

P&S Journal: Spring 1996, Vol.16, No.2
Columbia's Own Private Hollywood

By Sally R. McLain

"Center for Biomedical Communications/Audio Visual Services" may be a mouthful, but the mission of this center is simple: Provide the latest technology in multimedia services to the University and beyond.
The Center for Biomedical Communications/Audio Visual Services World Wide Web home page can be found at

At any moment, the sound engineer could drift off to sleep. Or so it seems. He sits in front of his controls-a cart on wheels heavily laden with sound equipment, two small video monitors, two videotape recorders, and stacks of tapes and odds and ends. He's connected to his controls with wires and headphones, but to the casual observer, his relaxed frame says "couch potato."

But all of a sudden he appears to be fully alert. "Hey guys, stop," he shouts through the doorway into the adjoining room, which serves as the set. "Her mike's picking up a rustling sound and I think it's going to be a problem." As it turns out, he isn't sleeping after all but is tuned into elements not apparent to the untrained eye and ear.

The sound engineer, along with two camera operators, came to this examining room in Atchley Pavilion a little more than two hours ago. They arrived with everything necessary for a two-camera shoot, including portable lighting and what seems like miles of cable and extension cords. They've been hired by Dr. Rita Charon, associate professor of clinical medicine, to tape the second in a series of videos she uses in her clinical practice course. The videos show medical students, in a "good cop, bad cop" fashion, the right and wrong ways to conduct certain exams.

Although it's nothing out of the ordinary for a professor to use video as a teaching tool, it may be a little surprising to think she could have her own video production facility just steps from her office. No, the crew hired for today's shoot didn't come from a Soho studio. In fact, all the paraphernalia needed for today's production was brought down an elevator in Presbyterian Hospital, across a bridge to the Milstein Hospital Building, and down another elevator to this Atchley examining room.

They've come from the Center for Biomedical Communications/Audio Visual Services (CBC/AV), which has been a division of Columbia University Health Sciences since 1971. Biomedical Communications is a sophisticated name for an interdisciplinary department offering a full-range of communications services in a 20,000-square-foot, state-of-the-art facility located on the 20th floor of the Presbyterian Hospital building. Medical illustrators, graphic artists, photographers, and skilled video editors are part of the 20-member staff. At its head are director Jeff Szmulewicz and deputy director Anne Jacobs.

In the video, "Dr. Wright, Dr. Wrong: Taking a Sexual History," Dr. Carolyn Westhoff plays both "Dr. Savage" (above) and "Dr. Grace" (below). The video is part of a series produced by the Center for Biomedical Communications/Audio Visual Services as a teaching tool for Dr. Rita Charon's clinical practice course.

The video in progress features three case studies dramatizing a physician taking sexual histories-a potentially uncomfortable subject for many patients. The two performers in the current scene are a professional actress and Dr. Carolyn Westhoff, associate professor of clinical obstetrics and gynecology. Dr. Westhoff plays the role of Dr. Grace, who conducts the exam in exemplary fashion, and the professional actress portrays a patient who has come to discuss her interest in becoming pregnant through artificial insemination. In the previous scene, Dr. Westhoff played Dr. Savage who, as the name suggests, communicated miserably with the patient. The result? One very confused and unhappy patient.

Ms. Jacobs, who approaches her job with a quiet energy, has stopped in to check on progress. She notices that the actress's face has become shiny under the bright lights so she goes to the crew's portable makeup kit. "Just let me take the shine off your forehead, here," she says as she dusts a little powder on the actress's face.

Although she doesn't claim to be a makeup artist, Ms. Jacobs says this is all part of life in CBC/AV. "To survive here, you must be able to multitask. On any given day I could be working on our multimillion-dollar budget one moment and then acting as a projectionist the next."

Back in her office, which has the modern and minimalist feel you'd expect on Madison Avenue, Ms. Jacobs takes a call from a client who has a question about a podium setup. The word client is used to describe both University and corporate accounts-assuring that all projects are dealt with professionally. Mr. Szmulewicz, who just returned from shooting a special project in Mexico for the Southern Clinical Neurology Association, pops his head in Ms. Jacobs' office. He's excited to share the news that the center has been awarded the 1995 Communicator Award of Excellence for its video project "Diagnosis Epilepsy." The video was recorded on location at the Comprehensive Epilepsy Center with technical assistance and leadership from Dr. Timothy A. Pedley, director of the Comprehensive Epilepsy Center and professor of clinical neurology. This award is the highest honor recognizing a standard of excellence and work that serves as a benchmark for the industry, explains Mr. Szmulewicz.

Dr. Carolyn Westhoff gets in character for her portrayal of "Dr. Savage" while CBC/AV's Eric Capstick adjusts the professional actress's microphone and camera operator Marc Wishengrad looks on.

It is not the first award CBC/AV has won, but the staff isn't resting on its laurels. Such performance might explain why Ms. Jacobs carries a pager with her at all times. "The services of the center are available 24 hours a day," she says. "Jeff's and my philosophy is you always say yes."

Each day is varied. Earlier today, Ms. Jacobs met with Drs. Judith Sulzberger and Isidore Edelman to review a first draft script for a video on CPMC's human genome research and then acquired a slide of a colon excision from Dr. Kenneth Forde. A large pharmaceutical company requested the image for use in a print ad. This is a common request, Ms. Jacobs explains. If the CBC/AV or a physician has the right media an outside source requests, the University or the physician is compensated for use. "Most doctors are willing to participate because it's for educational purposes."

Mr. Szmulewicz believes high-quality presentation materials help instructors and lecturers convey their thoughts in the most seamless and effective way. But individual presenters would find it difficult to express those ideas as effectively without one essential tool. "Amidst the excitement of our production activities lies our most important service-projection support," he says. "Faculty rely on our crew of full-time projectionists/technicians to provide support during lectures and to maintain the audiovisual equipment in top operating condition throughout the medical school. Our goal is to handle all audiovisual support for faculty and speakers so they can concentrate on their lectures and not worry about anything else."

That's where Brian Soda comes in. Mr. Soda, a graphic artist, produces slides that incorporate anything from text to diagrams to photography. Today, he's embellishing a photograph of a golf course to include large golf balls representing various drugs whose names are labeled on each ball. That slide will be used in a presentation on a specific therapy to illustrate which drug gets closer to par.

Without a doubt, technology has changed dramatically in the decade since Mr. Soda first started working for the University. "I can receive digital files by e-mail and then turn them around in 24 hours with a finished product," he says. Today, all the slides he produces are computer-generated. "Ten years ago we did it all by hand, with pen and ink, Pantone film, and typesetting. Normal turnaround time was a week; now it's more like 24 hours. With computers, you get instant gratification."

Mr. Soda's Macintosh is attached to some rather advanced, and expensive, equipment. A machine with a built-in camera is wired to his computer, which sends separated images to the machine and then photographs each color on a single frame. The film is then processed in-house and mounted as slides. "So, the process goes straight from the computer where the graphic is created to film to slide or video," he says.

At this point, a physician arrives for his appointment with Mr. Soda. The doctor, says Mr. Soda appreciatively, has planned ahead and allowed a little extra time for work on his slides. His presentation isn't until next week and he's already let Mr. Soda do a first draft. The doctor, in a jovial mood, is like the kid in a toy store-excited and eager to see the results of his slide request.

"Many faculty really like to come up here to work with us," says Ms. Jacobs. "It's like an oasis for them." And who wouldn't be inspired in the presence of such high-tech equipment, interesting images, and all-around sense of excitement? The people in CBC/AV give the impression they're doing more than a job; they're doing what they're good at and enjoy. Plus, the constantly changing technology of graphics, photography, and video creates a rare energy and enthusiasm.

Just a couple weeks ago, Ms. Jacobs explains, CBC/AV acquired non-linear digital editing equipment, which brought with it a lot of excitement. Initially, one person learned to use the new system-which is run from a Power Mac computer rather than the dining-table length control board of the older method-while all the other video editors practically stood in line for the chance to be next. "Our new digital editing suite is the hottest technology at the current time," she says.

And with new technology come new capabilities. David Rosenzweig, the staff medical illustrator and art director, is branching out into computer animation.

Mr. Rosenzweig's first job at CBC/AV was illustrating a story for New York Magazine on separation of Siamese twins a few years ago. Much of the work he does is computer-generated, although he still does some pen and ink work and an occasional air brush job. If it's a medical procedure, he'll generally take photographs and then ask the doctor which scenes are most important to the illustration. "Then I draw from those photos," he explains.

Today, he and a medical illustration intern are working on sketches for a medical encyclopedia authored by a faculty member. "I was a biology major in college, so I've always had an interest in the human body," Mr. Rosenzweig says.

Anne Jacobs, deputy director of CBC/AV, keeps track of the video, photography, and art projects that are in-house at any one time.
Director Jeff Szmulewicz at the video editing controls.
Medical illustrator David Rosenzweig with his computer-aided drawing of the knee

He displays an illustration of the muscles of the shoulder. "People ask me, 'Why do they need drawings to illustrate surgical and medical procedures? Can't you just use photographs and get a clearer picture that way?' But it's not that simple," he says. "Illustration gets rid of extraneous information such as blood-this is more useful than a photograph for educational materials." That's why to do his job, Mr. Rosenzweig got a graduate degree from one of the few master's programs in medical illustration in the country. "When a doctor comes in and wants an illustration, you have to know about the procedure in order to communicate the idea visually. You have to know almost as much about anatomy and physiology as they do."

With a Power Mac, a laser printer for typesetting and black and white work, a high-end color printer "that costs about as much as a car," and an air brush, Mr. Rosenzweig has seven or eight jobs going on at once. And with that, he's back to his drawing board to complete a series of pen and ink drawings for a book on cancer.

Meanwhile, Charles Manley, photographer, works on making prints of a photo he was finally able to take this morning. The shoot had been arranged by another department the day before and when he'd gone to the agreed upon location, he found out the shoot had been postponed. "It happens." You have to be flexible, he says, and somehow everything falls into place.

Flexibility is what it's all about in photography. Each photography staff member can shoot, process, and print film. Plus, they are all experienced at photographing medical procedures. "You have to know the surgical environment," says Ms. Jacobs. "That's why people call us to go into the operating room; our photographers and camera people know how to get the shot without interfering with the surgical team." She explains how photographers and video camera operators have to finesse the situation to get the shot. "We sometimes have to control a video camera from an overhead boom to get a bird's-eye view without being in the way."

When asked whether he ever gets squeamish in the operating room, Mr. Manley's voice goes quiet and he takes on an expression of awe. "Generally speaking, it's quite beautiful. The human body is so interesting."

But that's not where it ends. Mr. Manley and the other photographers do studio work. Perhaps a physician needs a formal portrait to submit with a publication. CBC/AV's photo studio is something Richard Avedon would admire. A spacious room with up-to-date lighting, it accommodates portraiture and still life photography. Mr. Manley's most recent project was shooting the "hand" of a robot and a human's hand in a pose reminiscent of the famous Sistine Chapel scene. The photo was for a cover of a book being published by the Oxford University press titled "Early Visual Learning," which was edited by an associate professor in computer science at Columbia.

CBC/AV is in place to serve Columbia's Health Sciences Division, although it also does work for outside clients to help support its operation. "Clients get our name by word-of-mouth referral, mostly," says Ms. Jacobs. In fact, the physicians on staff seem to give some of the best referrals.

CBC/AV's corporate client list is impressive, indeed, with the likes of C-Span, CBS, Parke-Davis, and Wyeth-Ayerst. At times, those corporate contacts indirectly promote the name of the Health Sciences Division. "We often field inquiries from pharmaceutical companies, network and cable television stations, and publishers who are looking for ideas and contacts on medical-related subjects," says Ms. Jacobs. "We take those inquiries and help develop their concepts as well as recruit experts from the University to participate in those projects."

Back in one of the editing suites, Benton Roberts edits part of an instructional video CBC/AV is producing for a large pharmaceutical company's medical education effort. An animator will produce part of the video, which Mr. Rosenzweig is art directing. "It's sort of a 'Fantastic Voyage' scene in which we show their drug attacking an infection in the bloodstream," he explains.

Another activity today is a meeting between an audience in CBC/AV's video studio and two participants from Bassett Healthcare in Cooperstown, N.Y., who were unable to make it to the campus. The equipment for videoconferencing includes a television with a remote-control camera positioned on top that looks at whatever is facing the television. Videoconferencing allows two or more parties to be at separate locations while having a face-to-face meeting-a sort of video conference call with personality.

The videoconferencing equipment is used for distance learning and telemedicine. For example, the students in a School of Public Health course taught from the CBC/AV studio sit in a classroom downtown at the New York City Health Department. In addition, CBC/AV has satellite conferencing capabilities also allowing for both audio and video links.

Eric Capstick and Jeff Szmulewicz shooting a video on location in Latin America.
Graphic artist Brian Soda says producing slides with his computer system provides "instant gratification."

Mr. Szmulewicz emphasizes the value of distance learning technology. "In today's global society it's necessary to communicate with colleagues around the world. We have the resources and technology to provide our faculty with the power to exchange information and we'd like to see members of the CPMC community use those resources to a greater extent, permitting them to disseminate their knowledge and thoughts to a universal audience.

"Our growth potential is unlimited in this era of telecommunications. And with foresight, we can excel in conveying important messages and knowledge to the global community." Which takes us back to Dr. Charon's video shoot, now drawing to a close. Her video series is not intended for global use, but it does represent a theme with no borders. Just as physicians are more effective when they practice the art of graceful communication, a world-class medical school can only benefit from use of the latest media technologies at its fingertips.

copyright ©, Columbia-Presbyterian Medical Center

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