Virtual medical school may become a reality

Proponents see the project as a blending of e-learning and clinical training; detractors worry that development of interpersonal skills will be forfeited.

By Myrle Croasdale, amednews staff. Dec. 2, 2002.

Online medical education is leaping into new territory via the International Virtual Medical School.

Whether the project lands on solid ground or ends up mired in a bog has yet to be determined, but there may be as much value in the effort as there is in its success.

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"The suggestion is that if we don't do this, others will take over the role, and the future of medical education will no longer be [in the hands] of the medical schools. " said Ronald Harden, MD, director of the project and of Scotland's University of Dundee Centre for Medical Education. "If we don't take advantage of e-learning, we might loose our relevance."

Dr. Harden's institution, along with more than 20 U.S. medical schools, is heading up the creation of an extensive online medical curriculum.

"Schools are so competitive," Dr. Harden said. "Everyone wants the best students, the best faculty, the best endowments. It's no longer sustainable. ... The leading countries should be setting standards for medical education internationally."

While Scotland's medical schools could have tackled the project alone, Dr. Harden said bringing in others will not only make the curriculum more culturally diverse, but it should ensure broader acceptance of the program when it's finished in 2004.

Schools from outside the United States are among those contributing to the $4 million budget for the coming year. The National Board of Medical Examiners is also a supporter.

Michael S. Gordon, MD, PhD, director of the University of Miami's Center for Research and Medical Education, said he felt it was critical for his school, which has done significant work with medical simulation dummies, to participate in the electronic curriculum.

"It's inevitable that more education will be delivered over the [Internet]," Dr. Gordon said. "If you don't join them, you're putting your head in the sand."

Family physician Stephen Smith, MD, associate dean for medical education at Brown Medical School, is creating the structure for the curriculum.

The idea for how to do it came to him at 3 o'clock one morning.

"I woke up ... [and said] I've got it! We need to create a virtual practice so every IVMed student would become like a junior partner in the practice and interface with electronic medical records, seeing virtual patients everyday," Dr. Smith said.

20 U.S. med schools are participating in the virtual medical school project.

Enter virtual patient George Farmer, who jammed a nail in his leg while mending a rusty fence. Now the wound is swollen and sore.

"The patient teaches about the body's defense systems," said Dr Smith, who explained the case also provides additional content on the science behind these defenses.

Farmer hasn't had a tetanus shot in 15 years, so he gets one and a follow-up appointment is made. When he returns the student learns that while his leg is doing better, Farmer's farm is not and he's feeling hopeless. The student gets a lesson on depression and hopefully develops a sense of concern for the patient.

"The danger of distance learning is that the student becomes unmotivated," Dr. Smith said. "If we can create enough drama in designing this practice, students will actually begin to feel a sense of personal responsibility. Creating an emotional aspect to e-learning makes that learning much more powerful." Dr. Smith has created a set of 68 patients who will be seen over a 50-week period in the virtual practice in which 560 educational objectives are covered.

Making virtuals reflect reality

One model for how this curriculum could be used would be as a track that runs parallel to traditional on-site programs. Students could stay home longer by using the program until they need to move to the school for clinical work.

Another model serves developing countries by bringing the e-curriculum into their medical centers. Students wouldn't have to leave the country for medical training, and their clinical experience would be more culturally relevant.

With so many schools involved in the project, it's easy to imagine disagreement on the curriculum, but the program is being constructed so each school can tailor it to suit its own needs. The software will also be sensitive to a student's learning level.

The reason the program can be so flexible is that it is being constructed in segments.

"We're not creating the whole curriculum from scratch, " Dr. Harden said. "It's like a Lego set. Each small brick of learning can be combined with others. ... All the schools contribute small pieces, and they can assemble them into whatever course they want."

For example, a segment on virtual patient Farmer developing high blood pressure could stand alone, while resources such as guidelines for measuring blood pressure from the student's home country could be added.

In another illustration, Dr. Harden said a urologist was able to use the program to pull together a course in 2 1/2 hours that in the past would have taken him two weeks to create.

All involved with the virtual medical school emphasized it would be used in tandem with clinical training.

"It's a blended model, [intended to combine] the best of e-learning and the best of clinical training," Dr. Harden said.

M. Brownell Anderson, senior associate vice president for medical education at the Assn. of American Medical Colleges, said the virtual medical curriculum is a paradox.

The stated goal of medical educators is to foster caring relationships between patients and physicians and to have faculty who role model such behavior, she said. By delivering medical education through a computer, students with few social skills could thrive.

"I think the major issue is 'How are they going to assess students' personal qualities and their ability to interact with other people, as well as their communication skills?' Things we say we want to foster in physicians," she said.

A virtual medical school with simulated patients and electronic interaction with faculty members lacks the power of role modeling and the daily challenge of dealing with fellow students and real patients, she said.