EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/104833
22 EW CATARACT January 2013 Cataract editor's corner of the world Glimpse into education program development by Erin L. Boyle EyeWorld Senior Staff Writer D ASCRS has always been committed to educating ophthalmologists worldwide. Recently, the ASCRS Foundation launched a new innovative computer program to teach phacoemulsification cataract surgery, the Massachusetts Eye and Ear Infirmary Cataract Master. This type of interactive and immersive program is a novel approach to decrease the steep learning curve of phacoemulsification surgery. The final product is a seamless computer software program interweaved with advice from experts, videos of surgery, and reference materials. EyeWorld spoke with the invaluable team of creators behind the completion, namely, Christopher Wisdo and Joanna Maunder, the computer software developers at Gnaritas, and Jack Wolfe, the expert animator, who describe the process of developing this type of educational tool. These are the unsung heroes in the creation of the Cataract Master. Bonnie An Henderson, M.D., cataract editor eveloping an educational web-based computer simulation tool such as the Massachusetts Eye and Ear Cataract Master is no easy task, but Gnaritas (Boston), the company that developed it, focuses on designing and developing such technology as part of its mission. "The development of a complex e-learning program such as the Cataract Master brings together a range of different elements: instructional design to ensure knowledge and performance goals are met effectively; technology and user interface expertise to make the best use of the opportunities provided by an online environment for interactivity and decision making; subject matter expertise to ensure the program's content is realistic, engaging, comprehensive, and accurate," said Joanna Maunder, director of educational content, Gnaritas. Developing the Cataract Master is in line with Gnaritas' expertise in cognitive science, educational theory, and technology, according to Ms. Maunder. The Cataract Master is a selfguided, self-correcting software curriculum teaching phacoemulsification. It allows new surgeons to develop and enhance their phaco technique. It was developed by Bonnie An Henderson, M.D., John I. Loewenstein, M.D., Adam Neaman, Ph.D., and several colleagues. Gnaritas built the program, and Jack Wolfe created the animations. Content development Gnaritas was founded in 1999 as a learning and knowledge management company. The company focuses on custom e-learning appli- Cataract continued from page 21 trating keratoplasty and Ophtec iris reconstruction lens implantation in eyes with a history of trauma. J Cataract Refract Surg. 2007;33:808-814. 5. Chung MY, Miller KM, Weissman BA. Morcher iris reconstruction lens and rigid contact lens for traumatic aniridia. Eye Contact Lens. 2009;35:108-110. 6. Aldave AJ, Baghdasaryan E, Miller KM. Descemet stripping endothelial keratoplasty after Ophtec 311 iris reconstruction lens implantation. Cornea. 2011;30:405-408. Editors' note: Dr. Miller is Kolokotrones Professor of Clinical Ophthalmology, David Geffen School of Medicine, Jules Stein Eye Institute, UCLA. He has no financial interests related to this article. Contact information Miller: kmiller@ucla.edu cations, project-based learning, research and reference portals, online communities, and website information architecture, she said. "Highly customized programs such as [the Cataract Master] are designed with deep understanding of the learner's needs (performance and knowledge goals), the subject matter, and the opportunities for interactive learning that technology can provide," Ms. Maunder said. "The accessibility of online training and the degree to which the learner can create [his or her] own effective self-paced learning experience are important factors." Animation design and production were also key to teaching program users about the surgical technique with the Cataract Master, she said. "A challenge with a project such as this is to make the learning experience as close to the 'real world' as possible, so that the tasks, decisions, and consequences of actions taken are meaningful to the learner," she said. "Another difficulty is managing different elements in parallel, so that the content, design, media, and technological requirements are all met." Process After the scope and instructional design of the Cataract Master were determined, a set of actions and pathways were created that allowed users to interact with the program as if they were experiencing the surgery firsthand. Resources were also added from multiple sources, including a library of more than 600 expert videos featuring surgical pearls. Videos correspond to educational points in the program, enabling users to learn more as they access further content. In addition, user testing enhanced the final program and its seamless use as an essential "walkthrough" of the surgery. "Custom technology development supported the instructional design," Ms. Maunder said. "We had to devise a way to translate the scenario content into its online form, deciding how to represent the activities in the application and developing a system to implement them. For example, the program was designed to show learners the consequences of their decisions through animations, feedback for mistakes, task-specific resources, and track individual actions so that targeted feedback can be provided, which required careful joint development on the content and technology sides." Animation Jack G. Wolfe created all the animations for the project for Gnaritas using 3D animation software. Mr. Wolfe was initially hired as a contractor and later employed as a parttime employee at Massachusetts Eye and Ear infirmary. He said he modeled the eye and then created a virtual camera to simulate the surgeon's view through the microscope. "Surgical tools were animated going in and out of the eye to simulate both correct and incorrect actions on the part of the surgeon, with each animation linking up visually with one or more, either following or preceding it," he said. "Completed animations were shared over email with Dr. Henderson, revised based on her feedback, and ultimately sent over to Gnaritas to be added to the software." Mr. Wolfe, an animator, learned about cataract surgery through watching live surgery, surgical video and discussing it with a medical student to develop his knowledge for the animation. "While working on the project, I had regular meetings with Dr. Henderson, who provided specific information about anatomy, tools, techniques, and potential complications that could arise," he said. "Communicating with her face-toface, via email, and over the phone allowed me to understand and simulate cataract surgery to an extent that would not have been possible without her level of expertise and dedication." EW Editors' note: Ms. Maunder has financial interests with Gnaritas. Mr. Wolfe has financial interests with Massachusetts Eye and Ear Infirmary. Contact information Maunder: jmaunder@gnaritas.com Wolfe: jgwolfe@gmail.com