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Online learning could solve refractive surgery training dilemma


To address a perceived unmet need for comprehensive refractive surgery training, Sunil Shah, FRCOphth, FRCSEd, FBCLA, and colleagues in England developed an electronically based course for those wanting to develop their knowledge and skills in cataract and refractive surgery.

Key Points

Solihull, England-Subspecialty training courses in ophthalmology often are subject to criticism because of the lack of detail provided to students wanting to specialize in a particular area.

Refractive surgery is one of the subjects known to be poorly served by comprehensive training courses, with many budding refractive surgeons gaining their knowledge from a combination of sources: device manufacturers, basic 1-day courses at conventions, and on the job.

Reasons that these sources are chosen abound. One is that many ophthalmologists wanting to gain additional knowledge and new skills are in full-time employment and, hence, find it difficult to attend didactic courses. Another reason is that most prominent and well-respected thought leaders, because they are in such high demand, have limited time to provide a series of lectures.

"I wanted to create a course that covered all aspects of refractive surgery rather than just certain features of it. As far as I am aware, the refractive surgery courses currently available run over the course of just 1 or 2 days. It was my aim to develop a course that was delivered by experts in particular topics and covered all elements of the discipline, including corneal refractive surgery, phakic IOLs [pIOLs], and refractive lens exchange, as well as cataract surgery," said Dr. Shah.

Having acknowledged the difficulties in providing such an extensive course over a time period that suited both the lecturer and the student, an alternative method to the traditional approach of training was needed.

"The answer to this dilemma was to develop an 'e-course,' where lectures are delivered online and could, therefore, be compiled and delivered at the lecturers' and students' convenience," said Dr. Shah.

He teamed up with one of his former corneal fellows, Johnny Moore, MD, PhD, FRCOphth, and senior lecturer Tara Moore, PhD, and, in collaboration with one of the world's largest electronic learning centers, Campus One at University of Ulster, Ireland, developed a course that offered a comprehensive suite of distance learning postgraduate courses in cataract and refractive surgery.

"The course was successfully launched 2 years ago, and it is now evolving with the addition of new technical capabilities and the availability of video and webcasts," said Dr. Shah.

Specialists deliver content

Internationally renowned refractive specialists deliver the lectures. Faculty members include Jorge Alió, MD, PhD; Dimitri Azar, MD; Ioannis Pallikaris, MD, PhD; Capt. Steven Schallhorn, MD; and Michael Mrochen, PhD, to name a few. The course content has been designed to cover the basics of refractive surgery, from how excimer lasers work to ablation profiles, topography, and aberrometry. It progresses through microkeratomes and femtosecond lasers to LASEK, LASIK, pIOLs and clear lens extractions, and the complications and management of each. Preoperative assessment and postoperative follow-up, prevention and management of complications, surgical variants of phacoemulsification, and modern IOLs for cataract surgery are covered as well.

"Working in a full-time position makes it difficult to attend courses, especially ones with this amount of content," said course attendee Simon J. Dean, MD, FRANZCO, a consultant ophthalmologist in Auckland, New Zealand. "To be able to browse the lectures online at times that suited me-usually late at night-allowed me to concentrate on the material. Being online at the time also enabled me to perform a quick Internet search on things that were of interest-something that you cannot do in a lecture theater."

Course content is geared toward ophthalmologists, optometrists, orthoptists, nurse practitioners, and ophthalmic technicians. In addition, continued professional development points are accredited to individual weeks of study.

"The course is unique in that it enables students to study at their own convenience, regardless of time and location, with the support of e-tutors and discussion pages. Weekly discussion themes are based on different case scenarios," said Dr. Shah. Student learning outcomes are then assessed each week through multiple-choice tests and contributions to discussion boards.

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