This is the first in a series of articles introducing and following the progress of a relatively new masters course in cataract and refractive surgery. Over the next few issues, we aim to give you a taste of what is being taught, tutored, and discussed.
The quote, "Doctors are not deprived of information, they are drowning in it,"1 is absolutely appropriate for cataract and refractive surgery. The subject is rapidly evolving, and ophthalmologists continually need to update their knowledge. Unfortunately, refractive surgery is generally overlooked during postgraduate education, and the interested individual acquires most of his information from conferences, scientific and trade journals, and the Internet. Although a company may offer coursework for its own individual products, these courses rarely cover the vast breadth of the field. Potential sources of information can be biased because of marketing, the tendency to publish good results and to omit bad ones, and the positivistic belief that new is necessarily better. Such thoughts leave surgeons to question themselves:
- Is epi-LASIK much different from LASEK?
- Must I really purchase a femtosecond laser or be surpassed by the competition who does own one?
- Do patients perceive the advantages of an aspheric IOL?
The need for unbiased answers, not just updating, has led us to design an Internet-delivered course featuring continual tutoring by experts.
Learning via Internet technologies, or e-learning, has successfully been used in several medical specialties2,3 and is ideal for full-time professionals because of its flexibility. Students can perform any learning activity at any time, even on the weekends. The University of Ulster, Northern Ireland, has provided health science e-learning courses since 1998. Within this context of online teaching expertise, a fully online refractive surgery course was developed in 2005. To date, two cohorts of students have successfully completed the program. The team responsible for online teaching and tutoring includes three consultant ophthalmologists and two optometrist e-tutors; experts in the field who have provided lectures for the course offer additional tutoring. A course director is responsible for administration, pastoral support, and responding to general queries from students. WebCT Vista (Blackboard, Inc., Washington, DC) is the virtual learning environment.
The present-day course, regularly updated and consisting of nine parts, covers all aspects of theory behind cataract and refractive surgery in 1 year. After successful completion, students can progress to a second year and undertake research, leading to a masters qualification. Only a minimal level of basic Internet skills is needed to participate in this online course.
Various renowned refractive surgery experts, having recognized the deficiencies in current training in refractive surgery available today, are graciously providing lecture material for this e-learning series. The format varies from plain text with illustrations and PowerPoint (Microsoft, Corp., Redmond, Washington) presentations with speaker notes to surgical videos and iPod (Apple Computer, Inc., Cupertino, California) audio files.
Topics of study include the history of refractive surgery, preoperative and postoperative diagnostic techniques, indications for surgical techniques, description of surgical instruments and surgical steps, recognition and management of complications, clinical governance, and medicolegal aspects. Two or more lectures are delivered online weekly.
Communication between students and tutors is facilitated through asynchronous online discussion areas, which are open to everyone within the Web area. Tutors also use private e-mail to inform and encourage students. Additionally, the course provides a forum for students to ask tutors and fellow students questions that are directly or indirectly related to topics.
Each week, the tutor proposes discussion themes related to the weekly lecture material, and students and tutors continue the conversation via asynchronous postings. Therefore, a student may work when it is convenient for him; those who prefer to work at midnight have access equal to those who like to put in an hour before they go to work—be it in London; Auckland, New Zealand; or Taipei, Taiwan. Discussion themes are typically real or simulated problem-solving cases, description of diagnostic or surgical procedures, and critical evaluation of new techniques or personal experiences. Figure 1 demonstrates the interface used to deliver material, and Figures 2 and 3 are representative of discussion themes.
Learning is assessed weekly through an online, 12-question multiple-choice quiz, which is to be completed within a fixed time frame. Questions are based upon the weekly lectures; grading occurs automatically. Additionally, tutors grade each student's contributions to discussion. A final grade of greater than 50% is required for successful course completion and university certificate award.
To date, students from Australia, England, Malaysia, Estonia, Ireland, Italy, New Zealand, Scotland, and Wales have successfully completed this course including ophthalmologists, optometrists, nurse practitioners, laser technicians, and orthoptists. According to a questionnaire distributed at the end of coursework, all students stated that they enjoyed the learning experience, 92% felt their knowledge had improved and they would use what they had learned from the course. In that same questionnaire, 83% felt their clinical behavior changed, 75% felt they would use what they learned in their everyday profession, and 83% stated the course had a positive impact on their profession. All students highly valued the opportunities to interact, discuss, and debate key clinical issues with peers and tutors within the online discussion boards.
E-learning can successfully improve knowledge and skills in the fields of cataract and refractive surgery. Different cultural and professional backgrounds benefit equally from the flexibility of an e-learning course and exchange of experiences between peers and tutors.
Enhancement of professional knowledge—rather than formal education—is mainly the result of adult learning within the workplace. This is certainly acceptable in the business world, but it is a risky process in health care. E-learning can improve the theoretical knowledge of refractive surgery as well as the practical approach to real cases through training provided by a problem-solving approach akin to that adopted within the discussion forums of this course. Additionally, because diagnostic processes in refractive surgery are largely based upon the evaluation of images, the Internet is the ideal medium to present and process photographs, topography films, and other images.
Future development plans for this course include the evolution toward integrated e-learning (ie, association of pure e-learning with different learning techniques) that includes teleconferencing to facilitate direct observation of surgical performance and classical resources such as electronic books and textbook chapters. The high value of mentoring within a surgical discipline, where teacher and trainee swap information and ideas prompted by real-life scenarios, is well recognized within the medical educational fraternity. The course team constantly strives to improve the e-learning experience through use of modern technology in an attempt to emulate or, where possible through use of expanded database knowledge, improve on the classical mentoring experience.
Continuous professional development is now a requirement for all clinicians, and e-learning is a user-friendly method to obtain this. Both continuing education and training (CET) and continuing professional development (CPD) accreditation are available upon successful completion of this course. For more information, please contact course director Tara Moore, PhD, NTF, at t.moore@ulster.ac.uk.
Antonio Leccisotti, MD, PhD, is a Visiting Professor at the School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, and Director of the Ophthalmic Department, Gènèrale-de-Santè Toscana, Siena, Italy. Dr. Leccisotti states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +39 335 8118324; fax: +39 0577 578600; leccisotti@libero.it.
Damien McConville, MSc, MBCS, FHEA, is a Learning Technologist at the Institute of Lifelong Learning, University of Ulster. Dr. McConville states that he has no financial interest in the products or companies mentioned. He may be reached at +44 0 2890368537; d.mcconville@ulster.ac.uk.
Johnny E. Moore, FRCOphth, PhD, is a Visiting Professor at the School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, and Department of Ophthalmology, Mater Hospital, Belfast Hospital Trust Northern Ireland, and Director of Leeson Eye Institute, Dublin, Ireland. Dr. Moore states that he has no financial interest in the products or companies mentioned. He may be reached at +353 0 16674778; johnnymoorebal@gmail.com.
Tara Moore, PhD, NTF, is a Course Director and Senior Lecturer at the School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland. Dr. Moore states that she has no financial interest in the products or companies mentioned. She may be contacted at tel: +44 0 7793226873; t.moore@ulster.ac.uk.
Sunil Shah, FRCOphth, FRCSEd, FBCLA, is a Visiting Professor at the School of Biomedical Sciences, University of Ulster, Coleraine, UK, Visiting Professor at the School of Life & Health Sciences, Aston University, Birmingham, UK, Medical Director, Midland Eye Institute, Solihull, UK, Consultant Ophthalmic Surgeon, Heart of England Foundation Trust, Birmingham, UK, and Consultant Ophthalmic Surgeon, Birmingham & Midland Eye Centre, Birmingham, UK. Dr. Shah states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +441217112020; fax: +441217114040; sunilshah@doctors.net.uk.
