Eur J Plast Surg (2003) 26:377
LETTER TO THE EDITOR
Commentary on “Can face-to-face patient education be replaced
by computer-based education?,” A review by Keulers et al.
Published online: 12 November 2003
The title query of the article, ”Can face-to-face education
be replaced by computer-based education?” points to the
emerging dilemma of the role of artificial intelligence in
society as a whole, and in medicine, in particular. The
review well documents the increasing retention of learn-
ing as the number of senses stimulated increases, with
multimedia interactive methods being the most effective.
The author’s review of the literature seems to suggest
an affirmative answer to the query. However, as he points
out none of the studies were done on plastic surgery
patients. I would suspect that the effectiveness of
multimedia is greatly dependent upon the type of material
The majority of medical and surgical information is
quantifiable and has rather consistent deductive reason-
ing. The indications for gall bladder removal are pretty
much agreed upon, the methods of removal reasonably
standardized, and the results measurable. Such informa-
tion lends itself to interactive education. The increasing
utilization of internet resources such as WebMD is a good
example. However, as information becomes more sub-
jective, standardization of multimedia is more difficult.
I would suspect that even within the broad field of
plastic surgery, application would vary. In reconstructive
surgery, the defect is definite, even if severity varies.
Treatment options may be multiple, but they are definable
and similar from surgeon to surgeon. Therefore, stan-
dardized education of the problem could be valuable.
Cleft lip deformity is such an example.
Cosmetic surgery is perhaps the biggest hurdle for
computer-based education. First, the indications are very
subjective. Second, surgical procedures are not well
standardized among surgeons. Finally, determining pa-
tient motivation and expectation may be the most
important of all. I find this difficult determination to best
be made by listening to the responses of the patient during
a seemingly unrelated explanation of the potential proce-
In summary, the author makes a convincing case for
the value of multimedia education in selected situations. It
probably has value in explaining the diagnosis in most
areas. Its value in explaining treatments, however, greatly
diminishes as the variability of procedures and of
expectations becomes more subjective.
This commentary refers to the article which can be found at
F. Barton (
Dallas Plastic Surgery Institute,
411 N. Washington Ave., Suite 600, LB 13,
Dallas, TX 75246, USA