Throughout a physician’s career, computer-assisted learning offers several advantages over traditional educational vehicles. Search and retrieval of information is more rapid and comprehensive. Content is dynamic and can be quickly and easily updated. Digital documents can incorporate multimedia elements. Resource information can be stored more efficiently and economically in digital format. From a cost standpoint, computers require a high initial investment but that expense would ultimately be exceeded by the alternative of accumulating an extensive hardbound library.
Neurosurgery is highly dependent on computer technology. Diagnostic imaging and surgical navigation demand substantial computer facility. Neurosurgeons’ familiarity with computers enables the specialty as a whole to take advantage of the numerous opportunities that computers offer for medical education — opportunities that will continue to evolve.
Computers can be used for education in two main ways. The first involves directed learning via computers, whereas the second involves learning through the day-to-day use of computers. As time passes, the latter model will gradually supersede the first, allowing surgeons to take care of patients and simultaneously learn through self-evaluation and competency maintenance.
Under the older model, computers are used to deliver educational content and assess performance. Most of the educational content currently available online follows this paradigm. The most common example of this type of computer-assisted learning is online continuing medical education. A wide variety of CME activities covering the spectrum of clinical topics are now available online. These activities have many advantages for busy clinicians. First and foremost, they can be conducted at the convenience of the learner. They usually provide immediate feedback and a self-evaluation process, as well as immediate validation of earned credit. Typically, the materials are updated frequently and cost per credit is low.
The self-assessment test for neurological surgery, known as SANS Wired, is a good example of a computer-based tool that provides a mechanism for periodic knowledge assessment and learner-driven study. Each SANS question provides immediate feedback, with a detailed critique and hyperlinks to additional content on the Internet. Users can explore a given topic through the SANS examination using only a Web browser to broaden their reach to study materials. Learning occurs primarily through the process of investigating incorrect responses to practice test questions. The user can study entirely from the SANS Wired system without the need for textbooks. The system tracks the user’s progress and also permits the user to interrupt the study process at any time. Yet even though the SANS experience is flexible and “termless,” the content is structured and based on defined learning objectives.
The second way that computers can be used for education involves learning through the routine use of computers. By incorporating computers into clinical activity on a day-to-day basis, the learning process becomes perpetual and less well defined. For example, clinical expert systems and clinical decision support systems provide a vast potential for learning in a relatively unstructured fashion. Knowledge acquisition tends to be driven by the interest of the user or the need to solve a particular clinical problem. Under these circumstances, performance evaluation is more difficult because the learning objectives are not defined in advance. Furthermore, since not everyone is studying the same thing, cohort performance comparison is not possible. As computer-based clinical tools evolve, however, the routine-use realm will offer the most opportunity for expansion of educational activities.
One specific type of learning that is of paramount importance to neurosurgeons, the mastery of technical skills, cannot be easily accomplished using computers. Virtual reality and simulation platforms for surgery are only in their infancy. There are a few simulators for exercises such as ventricular endoscopy and temporal bone drilling, but they are expensive and rudimentary and currently are not in widespread use. Ideally, the sophistication of these platforms will improve so that clinicians can use actual patient data for both surgical rehearsal and training. This would not only promote competency with technical skills but also improve safety for patients in future.
As the capabilities of handheld computers expand and as data transfer improves, too, additional educational applications that work in conjunction with clinical tools will likely emerge. Indeed, young physicians routinely “Google” everything from drug doses to treatment recommendations, often using their cell phones or personal digital assistants.
Computer-assisted learning is clearly an integral part of medical education throughout a physician’s clinical career. The body of knowledge has now expanded well beyond the ordinary physician’s capacity to carry adequate reference materials physically or to memorize information — and it will only expand more, necessitating further development of everyday opportunities for computer-assisted education.
Joel D. MacDonald, MD, is associate professor of neurosurgery at the University of Utah Medical Center.