Computer-Based Multimedia In Plastic Surgery Education William B. Webber, M.D. and Gregory C. Rinehart, M.D.
Division of Plastic Surgery St. Louis University School of Medicine St. Louis, Missouri ABSTRACT Rapid developments in communications networks (cellular telephone, direct-link satellite, and international high-speed computer nets) and the continued success of affordable powerful personal computers (desktop, laptop and soon "palmtop" devices) have set the stage for educational materials accessible by electronic nwans. Computer-based multimedia are sophisticated audiovisual teaching materials built from digitized illustrations, photographs, audio and video recordings viewved by display on a computer screen. The computer interface allows interactive access to information, and coninectivity to other sources of information. Computer programmability allovs presentation of a single collection of information at different levels of sophistication (the "patient", "medical student" or
"surgeon trainee" level, for example), to appeal to different viewer needs. The information may be electronically updated or changed wvhenever appropriate. This desktop exhibit demonstrates multimedia plastic surgery teaching materials with full-fidelity digital sound, three-dimensional computer graphics, and "picture-inpicture" video capabilities that we have developed since 1989. We have used these materials at St. Louis Universityfor patient informed consent, and the education of medical students and surgical trainees. We are excited that similar multimedia teaching materials are now becoming commercially available in other fields of medical education, attesting to broadening interest among educators and publishers. INTRODUCTION Rapidly improving links between desktop computers and digital imaging and audio devices allow "do-ityourself' creation of sophisticated and customized medical educational curricula. Audiovisual teaching materials can be built from traditional education sources such as books, maps, films, and video and audio recordings by educators themselves. These multimedia materials can be enhanced by the quality of interactivity, which allows students flexible access to information. A single library of information about "hand anatomy and physiology", for
0195-4210/92/$5.00 X)1993 AMIA, Inc.
829
example, may be presented sequentially (like a videotape) or interactively (controlled by the learner's curiosity or level of understanding). Selected "layers" of information appropriate for viewers of different educational levels may be revealed by predesigned pathways. The information may be updated or changed whenever appropriate. These interactive multimedia teaching materials have the potential to dramatically improve learning efficiency [1,2]. MATERIALS AND METHODS Authoring Hardware. A Macintosh II series computer (Apple Computer, Inc.) with enhanced memory capacity (8 MB RAM; > 40MB hard disk) was used to create educational teaching materials. Photographs were imported using a color flatbed scanner (Microtek 300Z), a 35mm slide scanner (Barneyscan Corporation, Color Imaging Systems 3515), and video capture cards (Mass Microsystems QuickImage24 frame grabber and Videospigot full motion video card). Sounds are imported by microphone (Macromedia MacRecorder), excerpted from Compact Disk, or created by custom digital synthesis*. Multimedia programs are viewed by small groups on a 13 inch color monitor, or are video projected (in NTSC or RGB format) onto a screen for larger audiences. Finished educational materials may be transported by magnetic tape or disk, optical media (CD-ROM and CD-I disks), and may be distributed over any existing digital communication network without any theoretical loss of quality. Authoring Software. Imported photographs, illustrations, video and audio material are edited and assembled by commercially-available multimedia programs. Editing and annotation is performed by photo retouching (Adobe Photoshop), graphical retracing (Adobe Illustrator), graphical analysis (Innovative Data MacDraft) and compositing (Macromind Director paint and layout tools). Complex computer models may be created and animated (Paracomp Swivel3D Professional). Sounds * Original musical compositions courtesy of Billy Savage, Mediascore Corporation, Los Angeles, CA
.vyR^s;§~k>Ea .~ .^rw Ws
journal articles and watching one 90 minute videotape, the plastic surgery resident assisting in breast reduction surgery for the first time may quickly orient themself with a 20 minute multimedia computer session. As educators, we have stressed that this rapid overview may not soon supersede or substitute for traditional learning methods, but may accelerate the learning process by serving as a convenient introduction to the traditional resources that are available. A unique capability of this multimedia technology is in modeling complex dynamic concepts such as the moving human finger, and allowing the student to ask "what if" questions, and visualize immediate graphically-displayed answers (Figure 2).
may be edited and blended to match images (Farallon SoundEdit). Digital video clips are incorporated for added emphasis (Apple Quicktime and Adobe Premiere). All audio and image materials are assembled into multimedia compositions by scripting within Macromind Director (Macromedia, Incorporated).
RESULTS Multimedia materials that we have developed differ according to the needs of the target audience. Patient education materials stress photographs, video and narration, and have simplified interactivity capabilities. They tend to compliment traditional brochures, and are much less time-consuming and awkward than videotapes. Professional education materials, in contrast, contain more still and animated graphics, use video sparingly (due to inherently poorer image resolution), avoid music and narration (this can be annoying) and may have very complex interactive organizational structures.
~ ~ ~ ~.
..............
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|S~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Patient Education. We have employed multimedia teaching materials during consultations with patients to enhance their understanding of normal anatomy, pathologic deformities, and the nature of and risks associated with surgical treatment. Although most patients do not like to see "gorey" photographs or complex surgical videotapes, they appreciate seeing "before and after" photographs of deformities, illuminated with static and animated color graphic illustrations (Figure 1).
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Figure 2.
Excerpt from: "The Flexing Finger .:.... .:... ...
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Figure 2. Excerpt from "The Flexing Finger"' professional education selection.
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Figure 1. Preoperative photo and graphics analysis excerpt from"Rhinoplasty" patient education selection.
SUMMARY Since 1989, we have continuously developed multimedia plastic surgery teaching materials with fullfidelity digital sound, three-dimensional computer graphics, and "picture-in-picture" video capabilities. We have used these materials at St. Louis University for patient informed consent, and the education of medical students and residents. We are excited that similar multimedia teaching materials are now becoming commercially available in other fields of medical education, attesting to broadening interest among educators and publishers. References 1 Miller, RD. "A Floppy for the Teacher". CIO 4(9):104107, 1989.
Professional Education. Multimedia teaching materials have complimented traditional teaching materials primarily by condensing highlights from multiple information sources into one location. For example: rather than reading two textbook chapters, t;hree
2 Harrap, K. "4Using Technology to Teach Technology". ComputerData 15(6):37-38, 1990.
830
Division of Plastic Surgery St. Louis University School of Medicine St. Louis, Missouri ABSTRACT Rapid developments in communications networks (cellular telephone, direct-link satellite, and international high-speed computer nets) and the continued success of affordable powerful personal computers (desktop, laptop and soon "palmtop" devices) have set the stage for educational materials accessible by electronic nwans. Computer-based multimedia are sophisticated audiovisual teaching materials built from digitized illustrations, photographs, audio and video recordings viewved by display on a computer screen. The computer interface allows interactive access to information, and coninectivity to other sources of information. Computer programmability allovs presentation of a single collection of information at different levels of sophistication (the "patient", "medical student" or
"surgeon trainee" level, for example), to appeal to different viewer needs. The information may be electronically updated or changed wvhenever appropriate. This desktop exhibit demonstrates multimedia plastic surgery teaching materials with full-fidelity digital sound, three-dimensional computer graphics, and "picture-inpicture" video capabilities that we have developed since 1989. We have used these materials at St. Louis Universityfor patient informed consent, and the education of medical students and surgical trainees. We are excited that similar multimedia teaching materials are now becoming commercially available in other fields of medical education, attesting to broadening interest among educators and publishers. INTRODUCTION Rapidly improving links between desktop computers and digital imaging and audio devices allow "do-ityourself' creation of sophisticated and customized medical educational curricula. Audiovisual teaching materials can be built from traditional education sources such as books, maps, films, and video and audio recordings by educators themselves. These multimedia materials can be enhanced by the quality of interactivity, which allows students flexible access to information. A single library of information about "hand anatomy and physiology", for
0195-4210/92/$5.00 X)1993 AMIA, Inc.
829
example, may be presented sequentially (like a videotape) or interactively (controlled by the learner's curiosity or level of understanding). Selected "layers" of information appropriate for viewers of different educational levels may be revealed by predesigned pathways. The information may be updated or changed whenever appropriate. These interactive multimedia teaching materials have the potential to dramatically improve learning efficiency [1,2]. MATERIALS AND METHODS Authoring Hardware. A Macintosh II series computer (Apple Computer, Inc.) with enhanced memory capacity (8 MB RAM; > 40MB hard disk) was used to create educational teaching materials. Photographs were imported using a color flatbed scanner (Microtek 300Z), a 35mm slide scanner (Barneyscan Corporation, Color Imaging Systems 3515), and video capture cards (Mass Microsystems QuickImage24 frame grabber and Videospigot full motion video card). Sounds are imported by microphone (Macromedia MacRecorder), excerpted from Compact Disk, or created by custom digital synthesis*. Multimedia programs are viewed by small groups on a 13 inch color monitor, or are video projected (in NTSC or RGB format) onto a screen for larger audiences. Finished educational materials may be transported by magnetic tape or disk, optical media (CD-ROM and CD-I disks), and may be distributed over any existing digital communication network without any theoretical loss of quality. Authoring Software. Imported photographs, illustrations, video and audio material are edited and assembled by commercially-available multimedia programs. Editing and annotation is performed by photo retouching (Adobe Photoshop), graphical retracing (Adobe Illustrator), graphical analysis (Innovative Data MacDraft) and compositing (Macromind Director paint and layout tools). Complex computer models may be created and animated (Paracomp Swivel3D Professional). Sounds * Original musical compositions courtesy of Billy Savage, Mediascore Corporation, Los Angeles, CA
.vyR^s;§~k>Ea .~ .^rw Ws
journal articles and watching one 90 minute videotape, the plastic surgery resident assisting in breast reduction surgery for the first time may quickly orient themself with a 20 minute multimedia computer session. As educators, we have stressed that this rapid overview may not soon supersede or substitute for traditional learning methods, but may accelerate the learning process by serving as a convenient introduction to the traditional resources that are available. A unique capability of this multimedia technology is in modeling complex dynamic concepts such as the moving human finger, and allowing the student to ask "what if" questions, and visualize immediate graphically-displayed answers (Figure 2).
may be edited and blended to match images (Farallon SoundEdit). Digital video clips are incorporated for added emphasis (Apple Quicktime and Adobe Premiere). All audio and image materials are assembled into multimedia compositions by scripting within Macromind Director (Macromedia, Incorporated).
RESULTS Multimedia materials that we have developed differ according to the needs of the target audience. Patient education materials stress photographs, video and narration, and have simplified interactivity capabilities. They tend to compliment traditional brochures, and are much less time-consuming and awkward than videotapes. Professional education materials, in contrast, contain more still and animated graphics, use video sparingly (due to inherently poorer image resolution), avoid music and narration (this can be annoying) and may have very complex interactive organizational structures.
~ ~ ~ ~.
..............
*:|_.~~
.. . ~~~~ ~~~............ ....
|S~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Patient Education. We have employed multimedia teaching materials during consultations with patients to enhance their understanding of normal anatomy, pathologic deformities, and the nature of and risks associated with surgical treatment. Although most patients do not like to see "gorey" photographs or complex surgical videotapes, they appreciate seeing "before and after" photographs of deformities, illuminated with static and animated color graphic illustrations (Figure 1).
t~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Figure 2.
Excerpt from: "The Flexing Finger .:.... .:... ...
::
, .
gm~~~~~~~~~~l ga\
;.
......
.....
.W......
Figure 2. Excerpt from "The Flexing Finger"' professional education selection.
k..
|':...'...|-
' . . .001 1 - 0.....0....
NN.
V
.....~~......
,y
g...
Figure 1. Preoperative photo and graphics analysis excerpt from"Rhinoplasty" patient education selection.
SUMMARY Since 1989, we have continuously developed multimedia plastic surgery teaching materials with fullfidelity digital sound, three-dimensional computer graphics, and "picture-in-picture" video capabilities. We have used these materials at St. Louis University for patient informed consent, and the education of medical students and residents. We are excited that similar multimedia teaching materials are now becoming commercially available in other fields of medical education, attesting to broadening interest among educators and publishers. References 1 Miller, RD. "A Floppy for the Teacher". CIO 4(9):104107, 1989.
Professional Education. Multimedia teaching materials have complimented traditional teaching materials primarily by condensing highlights from multiple information sources into one location. For example: rather than reading two textbook chapters, t;hree
2 Harrap, K. "4Using Technology to Teach Technology". ComputerData 15(6):37-38, 1990.
830
