The Compact Disc Interactive format was jointly developed by the Matsushita (Sony) and Philips corporations. CD-I players have been marketed by Philips, Magnavox and GoldStar since 1988. Contrasting with today's most sophisticated multimedia-capable computers, which cost thousands of dollars, a consumer CD-I player with full-motion video capability uses a standard television monitor and costs approximately $700. CD-I players require no special software, and they can play audio Compact Discs and Kodak Photo CDs as well.

Like VHS videocassettes, CD-I is a low-cost playback system which allows viewing of 60 minutes of full-motion full-screen video on standard television sets. Unlike videocassettes, however, CD-I titles allow rapid random access to information. Using the CD-I controller, a hand-held device much like a videogame joystick, teachers and students may access any portion of CD-I instructional material as easily as pointing and clicking" a computer mouse. Once selected, information may be reviewed sequentially like a videotape, or nonsequentially, like a reference work. Audio CD-quality sound allows medical education topics like heart murmurs and breath sounds to be taught with greater realism.

The CD-Interactive Introduction to Knot Tying and Suturing:
The CD-Interactive Introduction to Knot Tying and Suturing CD-I was developed at St. Louis University Health Sciences Center with the support of the Medical Information Associates (MedIA) publishing company and Ethicon, Incorporated. It represents one of the first educational applications to explore the advantages of CD-I full-motion, full- screen video. Designed for instruction of medical students, housestaff, allied health professionals and practicing physicians, the course provides an introduction to wound preparation, wound closure, and surgical knot tying techniques in a hands-on workshop environment, using pigs' feet to practice actual wound closure. Safety, surgical lighting, wound cleansing, anesthesia, instrumentation for exposure and suturing, and the proper choice of suture material for wound closure are key features of the course. The interactive nature of the CD-I course allows instructors to proceed in any desired sequence, at a pace and level of detail appropriate to their students' needs.

Instructors Have Flexibility:
The CD-Interactive Introduction to Knot Tying and Suturing workshop is organized with many choices for interactivity. Information may be accessed selectively using a graphic user interface, or sequentially, like a videotape. In general, inexperienced users prefer sequential navigation, whereas more experienced users use topic-specific methods. When information is selected by clicking user interface buttons, full-screen narrated photo and video sequences appear.

In addition, special capabilities exist. Hot spots are words or pictures displayed by the user interface which allow the student to access special, related or more in-depth information when it may be most useful. Hot spots are easily identified by a green color code-- a green frame around a picture, a green button, or green italicized text.

When video is being played, sound and playback speed can be adjusted at any time by clicking on graphic control bars that pop up" at the bottom of the screen. This control is especially useful when teaching and practicing knot tying and suturing skills.

Students Have Fun:
The CD-Interactive Introduction to Knot Tying and Suturing course has been successful in teaching over 300 medical and allied health care students. Groups of 20 to 60 students have been taught using standard video monitors or large-screen video projection in classrooms and auditoriums. A favorite seating arrangement for 18 to 36 students is theater-in-the-round". This layout is used to teach third year medical students at St. Louis University Medical School, and is easily accomplished in the average general-purpose classroom.

We have preferred to avoid evaluation of student performance by skill testing -- this introductory course is designed to introduce basic surgical skills in an interactive, entertaining fashion. As a result, students report enthusiasm for learning knot tying and suturing skills that spans all ability and experience levels. Beginners seem to most appreciate the stop-action, slow-motion and infinite loop" features of video segments. More advanced students enjoy the optional 100-question self-test section of the course.

The Future of High-Tech" Educational Aids:
Interactive audiovisual teaching aids may help to ensure continued high-level skill training in professional schools of the future, despite trends toward shorter course duration, fewer patient contacts, and dwindling instructor support. Such aids must be entertaining, and adaptable to differing student proficiency levels. They must capitalize on the observation that multisense learning is superior to traditional noninteractive lecture methods.

Compact Disc-based instructional media offer rich graphic, video and audio information. The CD-I format offers all the benefits of computer- based multimedia on an affordable, portable playback device. The CD- Interactive Introduction to Knot Tying and Suturing CD-I course has been a successful experiment in technology-assisted healthcare education. We will soon have a take home" CD-ROM version of the course, which will allow students to practice skills on their own computers with audiovisual cues similar to those presented in the teaching laboratory.

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