Computerized Education

The explosion in computer performance, hardware, and software has had profound effects on education, data management, communication, and entertainment. The impact

FIGURE 3 ■ Virtual reality laparoscopic reconstructive training (Karlsruhe Endoscopic Surgery Trainer).

FIGURE 3 ■ Virtual reality laparoscopic reconstructive training (Karlsruhe Endoscopic Surgery Trainer).

of this modality on surgical education is just beginning to be felt (90). The "information age" has quietly crept into the surgical training programs throughout the country (91). It is no surprise to see that the house staff, familiar with computer technologies, gladly accept these methodologies. One recent study investigated the use of multimedia interactive computer programs to familiarize residents in laparoscopic skills. The comparative scales for the most effective method to familiarize and raise their knowledge regarding new laparoscopic procedures were as follows: textbook (4.7), lectures (5.1), videos (6.0), animal labs (7.3), and multimedia interactive computer programs (8.8). There are lots of problems with the more standard methods of surgical education when applied to laparo-scopic surgery (91). First, with printed material such as this syllabus, there is no method of questioning the information unless those truly interested seek out references, read those, and synthesize their own opinions. Lectures provide the student with the possibility of real-time interaction through questioning and answering. The limitation of this modality is that it is entirely dependent upon the skill and knowledge of the lecturer. Couple with this the inherent problems of inhibitions in students in a large group, which can stifle potential educational interaction. Videos can be a very good reference but again, like textbooks, lack the ability to interact with questions and answers. Animal labs allow the student to experience live surgery, make mistakes, and correct them, and provide animate experience with such issues as tissue handling, bleeding, visual imaging problems, etc. These experiences are costly, limited in availability, and lack true educational values unless a skilled proctor is present continuously to provide feedback (92). Multimedia interactive computer programs can provide all of the aforementioned qualities necessary, and also provide interactive references to specific questions via "Help" commands. In addition, computer programs have been shown to increase retention of important facts and decrease the learning curves, can be scaled to individual performance abilities, are inexpensive compared to animal labs, and are mobile. The computer method of training can be self-directed, self-paced, as well as interactive. Rosser et al. at Yale University's

Minimally Invasive Surgery group have developed a CD-ROM tutorial to aid in the transfer of cognitive knowledge thought to be essential for establishing laparoscopic skills. The tutorial was designed to provide surgeons with the knowledge base thought to be essential for acquiring basic laparoscopy skills originally designed for an intense two-day course (Yale Laparoscopic Boot Camp). The main menu consisted of eight main menus that could be taken in any sequence. They were as follows: dexterity drills, laparoscopic equipment, strategy of positioning, operating procedures, troubleshooting, clinical applications, and post-test statistical analysis. The tutorial requires almost no reading with audio prompts to a layered, regimented program with abundant illustrations and embedded videos. Using the embedded post-test and statistics package, they were able to show no difference in the post-test scores for students taking the two-day course versus the multimedia computerized tutorial (91).

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