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Genetics in Clinical Practice: A Team Approach

About This Manual

This manual is divided into two parts: a Guide to the Genetics Virtual Clinic and a Technical Reference. The Guide gives some background about the Virtual Clinic™ and Virtual Mini-fellowship™, gives biographical sketches for its faculty, tells how to install the program, and offers some suggestions about how to do the mini-fellowship. The Technical Reference can help solve technical problems you might encounter using the program.

Trademarks

Microsoft® and Windows® are registered trademarks of Microsoft Corporation. Apple® and Macintosh® are registered trademarks of Apple Computer, Inc. IBM® is a registered trademark of International Business Machines.

Copyright Statement

Copyright © 2002 The Trustees of Dartmouth College, and The Trustees of Columbia University.

This manual and the computer program it describes are protected by copyright law and international treaties. Unauthorized reproduction or distribution of this program or any portion of it may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This manual and the software are subject to license agreements with Dartmouth College, and are not to be copied or used except as specified in such agreement. Some materials in this program are from copyrighted publications and products owned by others. Refer to the publication data included in bibliographic citations, and the copyright notices in the original published form of the contained publications, all of which are incorporated herein by reference.

Information in these documents is subject to change without notice.

Development of this program was funded through an educational grant from the Centers for Disease Control & Preparedness (CDC) via a subaward from the Association of Teachers of Preventive Medicine.

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Credits

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Background: Ideal Continuing Education?

Ideally, a continuing education experience would provide for effective, efficient, and enjoyable learning. It would probably involve a visit to a major medical center, with opportunities to counsel, evaluate, and manage a variety of patients, interact with renowned experts who act as mentors, and attend excellent lectures. Of course, it would all be scheduled around your busy clinical practice, available whenever you had the time, without travel.

Virtual Mini-fellowships™ aspire to meet these desirable qualities for continuing education with a "Virtual Clinic", a highly detailed, computer-based environment that is intuitive and easy to use.

This program, dealing with genetics in clinical practice,

• is available anytime, on most commonly available computer system
• applies sound pedagogy and learning theory to create a carefully-designed, well-produced, comprehensive program of instruction
• provides case-based learning with simulated patients, allowing you to explore medical and psycho-social dimensions of genetic counseling
• features faculty members who are experts in their field
• provide detailed and insightful case discussions, in context with each simulated patient encounter
• offer "mini-lectures" on a variety of relevant genetic topics
• provides examples of "best practice" genetic counseling
• offers links to recommended Web sites for further information
• allows you to "interview" real patients with genetic conditions

These qualities are provided within a Virtual Clinic, a highly detailed, computer-generated environment that is intuitive and easy to use. We're convinced that you'll find this mini-fellowship to be a unique, informative, efficient, and highly enjoyable way to learn!

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Faculty

Joe Henderson directs the Interactive Media Laboratory at Dartmouth Medical School. Having developed award-winning interactive media programs for 15 years, Dr. Henderson is well known as a medical educator with a firm grasp of technology-based learning and its power to involve and inform. His goal is to provide for learning experiences that are intellectually and emotionally stimulating, enjoyable, and, in the best of cases, profound.

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Getting Started

These installation instructions and system requirements are for the CD-ROM version of the program. The instructions for installing and running the program over the Internet are a bit different, and can be viewed on the Installation Page.

Minimum Hardware Requirements

Windows System Specifications

	Required	Recommended
Operating System	Windows 98/ME/NT 4.x/2000/XP	Windows 98/ME/2000/XP
Processor Type	Intel Pentium II or 100% Intel-compatible microprocessor, 300Mhz, with 32MB hard disk space	Pentium II, 300Mhz or better, 32MB hard disk space
Video	2MB video RAM (16-bit color or better at 640x480)	4MB+ video RAM (24-bit color at 640x480 or higher)
CD-ROM Drive	2x CD-ROM drive with 300kBps data transfer rate	4x CD-ROM drive or faster
Sound Card	SoundBlaster or 100% SoundBlaster-compatible sound card and speakers	16 bit SoundBlaster or 100% SoundBlaster-compatible and speakers

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Macintosh System Specifications

	Required	Recommended
Operating System	System 9.2	System 9.2
Processor Type	Macintosh G3 processor and 32MB hard disk space	Macintosh G4 processor and 32MB hard disk space
Video	Thousands of colors	Millions of colors
RAM	64 MB	128 MB
CD-ROM Drive	2x CD-ROM drive	4x CD-ROM drive

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Installation

Windows Installation

Note: Windows NT, Windows 2000, and Windows XP systems need administrator access to install the Genetics in Clinical Practice program. Please see your systems administrator if you need assistance.

1. Insert the Genetics in Clinical Practice Disc in your CD-ROM drive.
2. Open "My Computer" from Desktop and open the CD-ROM icon. Start the installation by double-clicking "Setup.exe". You can install to the default location, C:\Program Files\Genetics in Clinical Practice, or choose your own location.
3. This program requires QuickTime (software from Apple Computer, Inc. that displays video and audio) version 5.0 or higher. If it is not currently installed, you will be led through its installation.
4. The program also requires On2's VP3 video codec which will be installed as needed.

Macintosh Installation

1. Insert the Genetics in Clinical Practice Disc in your CD-ROM drive.
2. Double-click the "Install Mac Genetics" icon and follow the instructions on screen.
3. If QuickTime is not currently on your computer, it will be installed during this process and your Macintosh will need to be restarted for system changes to take effect.
4. The program also requires On2's VP3 video codec. You will be led to install VP3 each time the installer is launched even though it only needs to be done once.

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Launching the Program

Before starting the program, check your monitor settings. This program works best at 640x480 or 800x600 screen resolution and 24 bits per pixel (millions of colors). The program will not run in 8-bit mode (256 colors). Usually monitor resolution higher than 1024x768 will make the video appear unacceptably small. Please refer to your computer system manual for guidance in how to establish these settings.

• If you have a PC running Windows
  
  • Select Programs, Genetics in Clinical Practice, and the corresponding program icon from the Start> menu
• If you have a Macintosh
  
  • Double-click on the Genetics in Clinical Practice program icon in the Genetics Virtual Clinic folder

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A Travel Guide to your "Mini-Fellowship"

What you do -and the order in which you do it-is up to you. That said, here's a recommended path to the program, one of several you might take.

First, insert your CD, launch the program, and sign in to the mini-fellowship. It's important that you use the same first and last name each time you log on if you want to maintain your progress records, especially if you are using the program to get continuing education credit.

Once past the credit and disclaimer screens (click the mouse to hurry these along), you'll be offered an Orientation. It only takes a few minutes and gives a good overview of the Clinic and the things you can do there.

Patient Roster: The core of the program lies in interacting with simulated patients, which you access from the Roster in the hallway. With each patient, you'll be asked to assess and counsel your patient(s), and make decisions about their care.

Conference Room: At the end of each patient visit, Dr. McCabe will offer to discuss issues raised by that encounter. He'll tell you what topics will be covered, who will be discussing the case, and how long they'll take so you'll know what to expect. You can return to these case discussions at any time by going to the Conference Room.

Counseling Room: The counseling room provides two examples of "best practice" genetics counseling. These video segments are abridged counseling sessions that emphasize the issues of immediate concern to their patients.

After getting some experience with a simulated patient or two, you might head down the hall to the Learning Resources Room. The Patient Interviews kiosk on the right lets you meet some remarkable people. Do one or more of the interviews; they don't last more than a couple of minutes each.

Lectures: The Lectures area on the left lists some topics you may be interested in. Each lecture can be done in their entirety (usually 5 to 10 minutes each) or by subtopic.

Internet access: You can access pertinent World Wide Web links from the middle kiosk in the Learning Resources room. Assuming you have a connection to the Internet established, clicking on the graphic of the computer will launch your default web browser application, enabling you to visit some approved Internet sites. When you are ready to return to the Virtual Clinic, click on the minimized tab "Genetics in Clinical Practice" on your Windows taskbar (usually at the bottom of your screen.)

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Using the Virtual Clinic

Signing in

Make sure you use the same name, with exact spelling, each time you use the mini-fellowship. Reasons for this are discussed in the Travel Guide.

Making a selection

You make selections in the normal way, by moving your mouse cursor and clicking the mouse button (left button for Windows users). When the cursor is over an area that can be selected, it changes from an arrow shape to a hand shape.

Moving around

There are a couple of ways to move around in the Clinic: from the Overview map or the Hallway.

Overview: You get to this view by clicking on any of the overview icons (they look like evacuation diagrams) that are scattered throughout the clinic. From the map, just click on any area that interests you, and that drops you into the appropriate location in the Hallway.

Hallway: To enter a room, click on the appropriate doorknob. To move down the hallway, click to the side of the screen in the direction you want to go. To get to the Overview, click on a "fire evacuation plan."

Viewing patient records

When in the Hallway in front of an examining room door, you can elect to view your simulated patient's chart. In general, you can turn pages by clicking on the appropriate side of the chart (NOTE that for slower computers, it can take some time for a new page to appear; please be patient). As your simulated patient's disease progresses, her chart grows quite a bit; we've provided record tabs to help you jump around. When finished viewing the chart, click on the "Done" tab or button.

Navigating through Lectures, Case Discussions

You can skip forward and backward through the lectures and case discussion screens by clicking on the VCR-like control strip available on most screens. The five buttons, from left to right, have the following effect:

• "fast-rewind" to the previous screen
• "rewind" to the beginning of the currently playing screen
• "stop" the audio, with options to resume or end your current section
• "play"
• "fast-forward" to the next screen

Note that this control strip is not available during video sequences or when no audio is playing. If the cursor isn't responding while trying to click these buttons, the program is probably busy and will return control shortly.

Taking a break: Exiting and Resuming the Program

You'll probably want to do your mini-fellowship in several sessions. To exit the Virtual Clinic program, go to the Clinic Overview by clicking on any Overview icon which looks like a fire evacuation diagram. Then click on the EXIT sign in the right lower corner. Your location (progress) in the mini-fellowship will be automatically saved. You'll be able to pick up where you left off the next time you sign back into the Clinic. An alternative way to Exit, which can be used anywhere in the Clinic, is to press Alt+Q (Win) or Command+Q (Mac).

When you come back to the program, sign in with the same name you used before and click the Restore button to pick up where you left off. Only select "Start Over" if you really want erase all record of your current progress through the mini-fellowship. If you simply want to show someone the program from the beginning, try signing in with a different name from the one you're using for your mini-fellowship...

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Keyboard Shortcuts

Keyboard shortcuts provide flexibility in using and navigating through the Virtual Clinic. Hold down the Alt (Windows) or Command (Mac) key while pressing a letter, as listed below:

Windows Shortcuts	Macintosh Shortcuts	Function
Alt+O (letter O)	Command+O (letter O)	Main Clinic Overview
Alt+V	Command+V	Menu of each Simulated Patient Visit
Alt+C	Command+C	Menu of case discussions
Alt+P	Command+P	Pauses video or audio; press again to continue
Alt+Q	Command+Q	Quits the program
Esc	Esc	Skips through video or audio clip. WARNING: this function will advance you through possibly vital information. Use sparingly.

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Program Updates

The developers and the publisher of this program have taken care to make certain that the information presented is correct and compatible with standards of care generally accepted in the United States at the time of publication. Nevertheless, as new information becomes available, changes in treatment and in the use of drugs may become necessary. Neither the publisher, the developers, the care providers, nor other individuals participating in the program assume any responsibility or liability for the consequences of any health care decisions made by a user of the program or other person with access to the information in the program.

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Troubleshooting Windows (98/NT/2000/ME)

Using multimedia programs can sometimes be frustrating because of the various hardware, software and operating system components that must work together. Most problems can be solved by simply inspecting the hardware and software setup of your machine.

Below are step-by-step guidelines for checking the most common causes of problems when running the Genetics program under Windows. Most technical difficulties are caused by outdated drivers for video, CD-ROM, and sound cards, or from improperly configured equipment. Your hardware manufacturer should be able to provide you with updated drivers. Manuals for your equipment and for Windows may explain optimal settings for your system.

If you are experiencing problems with the Genetics in Clinical Practice program, start by checking system requirements. This program requires at least 8MB of RAM and 23 MB of hard drive space. If you do not have sufficient memory on your system, the program will not run.

Windows Sound

Sound problems occur for many reasons, so they're often hard to track down. Here are some general suggestions for checking the most common sound problems. These steps don't need to be carried out in order; they are just general guidelines for checking the various things that can go wrong with sound.

Step 1: Verify all hardware components

Check that all cables are properly connected, that speakers are plugged in and turned on, that the volume on your speakers is set appropriately.

Step 2: Check sound drivers by playing system sounds

If your hardware is properly set up, make sure that you have Windows sound drivers installed by playing system sounds:

In Windows (98/ME/2000/NT):

• Begin by clicking the Start button, point to Settings and click Control Panel. Then, double click on the Sounds icon to open the Sound Properties dialog box.
• If the Events box lists items in black, select one (e.g. "Default Beep") and click the Play button. If you hear nothing, check your hardware; be sure your cables are securely connected, that speakers are on and volume controls are adjusted properly. If problems persist, check the manual that came with your sound device.
• If the events in the Events list are grayed out, then the Windows drivers for your sound device are not correctly installed or the computer does not have sound capability. Refer to the manual that came with your sound device for proper installation procedures.

Step 3: In Windows 98/NT only, check volume levels

• From the Windows Start Menu, select Programs, Accessories, Multimedia, then Volume Control.
• If you do not have the Volume Control installed on your system, select Settings, Control Panel from the Start menu. Double-click on the Multimedia icon and click on the Audio tab to set the volume.

Step 4: Update your sound driver to the most current version

See Updating Windows Device Drivers below for information about how to get the most recent updates.

Step 5: Check the README file for more details

If you are still having problems with audio playback, please refer to the README file located in the Genetics in Clinical Practice program group. This file provides detailed information on a variety of configurations and specific cards.

Windows Video

When running the Genetics program, you may see brief stuttering effects during video. Unless these effects occur frequently or are of long duration, they are no cause for concern. Installing the most current version of your video driver might help. See Updating Windows Device Drivers for information about how to get the most recent updates.

If you are having excessive problems during video play-back (stuttering, frequent loss of audio sync, etc.) you can try copying the media to your hard drive. Here's how:

1. Make sure you have approximately 350 MB free.
2. Insert the Genetics in Clinical Practice CD in and copy the entire folder called "Media" from the CD to the folder where your installed program is on your hard drive.
3. When you launch the Genetics program and are asked to insert a CD, click the Cancel button in the lower right. Your audio and video will now play normally from your hard drive.

If your fonts look particularly ragged, check to make sure that following TrueType fonts are installed on your system: Arial, Times New Roman and Courier New.

Although unlikely, if the program display becomes corrupted, let the Virtual Clinic program continue to run to refresh the display. If you still cannot see the display, quit the program using ALT+Q and restart.

Updating Windows Device Drivers

We recommend that you update your device drivers to the most current versions. The majority of sound and video problems will be corrected by updating Windows drivers. Your hardware dealer should have access to the most recent drivers. In addition, Microsoft has made a great deal of information and help available through the Windows Driver Library (WDL) and the Microsoft Download Service (MSDL); the MSDL phone number is (206) 936-MSDL (6735). Internet addresses are:

• http://www.microsoft.com
• ftp://ftp.microsoft.com

When you download the drivers, follow instructions found in the WDL.TXT file.

Windows Performance

Here is a summary of things to try if you are having performance problems:

• Do not run processor-intensive programs while the Virtual Clinic program is running, especially on a lower-end machine.
• Turn off CD-ROM drive caching to improve video performance.
• Turn off any screen savers.
• Defragment your hard drive (refer to instructions which came with your operating system).

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Troubleshooting Macintosh

Using multimedia programs can sometimes be frustrating because of the various hardware, software and operating system components that must work together. Most problems can be solved by simply inspecting the hardware and software setup of your machine.

Below are step-by-step guidelines for checking the most common causes of problems when running the Genetics under Macintosh. If you are experiencing problems with the Virtual Clinic program start by checking system requirements. This program requires 8 MB of RAM and 23 MB of hard drive space. If you do not have sufficient memory on your system, the program will not run. Additional hardware requirements are listed in the Appendix at the back of this manual.

Macintosh Sound

All Macintosh computers listed under the minimum requirements can produce sound without additional speakers or hardware. If there is no audio and you are using external speakers, the first thing to check is that they are plugged in, turned on, and all cables are properly connected. You may also need to adjust the software volume control. Here's how:

• Go to the Apple menu and select Control Panel. When the submenu appears, open the Sound control panel.
• Choose Volume from the submenu, and click and drag the volume control to an appropriate level.

You may also need to ensure that the Playthrough checkbox is selected under the Options section of the Sound In submenu.

Macintosh Video Display

Be aware that occasionally, you may see brief stuttering effects that are the result of normal system demands; unless these effects occur frequently or are of long duration, they are no cause for concern. If synchronization problems are persistent, try disabling control panels and extensions which may be taxing the processor. In particular, try this:

• Go to Chooser under the Apple menu and turn off AppleTalk by clicking the Inactive radio button.
• Then go to the Sharing Setup Control Panel and turn off file sharing.
• To disable extensions, use Extension Manager (if your system has it) or drag extensions into a different folder (e.g., ""Extensions Disabled").
• You will need to reboot your system for these changes to take effect.

If you are still having excessive problems during video play-back (stuttering, frequent loss of audio sync, etc.) you can try copying the media to your hard drive. Here's how:

1. Make sure you have approximately 350 MB free.
2. Insert the Genetics in Clinical Practice CD in and copy the entire folder called "Media" from the CD to the folder where your installed program is on your hard drive.
3. When you launch the Genetics program and are asked to insert a CD, click the Cancel button in the lower right. Your audio and video will now play normally from your hard drive.

You can restore extensions when you are not using the Genetics program by turning them back on in Extension Manager or by restoring them to the active "Extensions" folder in your "System" folder.

The program was designed to use the True Type (suitcase) fonts Times New Roman and Helvetica, which should be already installed in your system. If these fonts are disabled, or have been replaced with postscript or type 1 fonts, the computer will try to use what it considers the closest font, which may cause text layout problems (crowding, words off screen, strange line breaks, etc.). If this happens, reinstall original fonts.

Macintosh Performance

Here is a summary of things to try if you are having performance problems:

• Set your monitor resolution to a lower setting, like 640x480.
• Do not run processor-intensive programs while the Genetics program is running, including screen savers, email or web browser applications.
• Defragment your hard drive (refer to instructions which came with your operating system).

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Copyright © 2009 Dartmouth Interactive Media Laboratory, all rights reserved

Last Modified: 05/20/2009