Wednesday, October 9, 2002

Colleges in 16 Countries Work to Create Virtual Medical School By KATHERINE S. MANGAN Led by Scotland's University of Dundee, an international group of medical schools is trying to create the world's first online medical school. More than 50 institutions in 16 countries have helped plan the International Virtual Medical School, which its organizers plan to open in the summer of 2004. The institutions include all five of Scotland's medical schools, at the Universities of Aberdeen, Dundee, Edinburgh, Glasgow, and St. Andrews. Initial financing for the project, amounting to $140,000, came from the Scottish Higher Education Funding Council. The virtual school would allow students around the world to pursue a medical education through a combination of computer-based learning and clinical experience in local health facilities. The goal is to counteract the "brain drain" of students from developing countries who, having left to pursue a medical education, often don't return. Degrees will be granted by the individual medical schools participating in the project. Because each one is already accredited, graduates of the virtual program would be unlikely to run into any accreditation obstacles to practicing medicine, its organizers say. Ronald M. Harden, director of Dundee's Center for Medical Education, says students could be based at any of the participating medical schools, in a hospital, or at home. The approach, he says, "would ensure that the right learning is available for the student at the right time and in the right place." Like those enrolled in traditional programs, students in the virtual medical school would spend their first two years immersed in an intensive study of basic sciences and the next two to three years applying their knowledge in clinical settings. But instead of learning in a classroom, they would take online courses, engage in online group activities with other students around the world, and tap into computerized databases and "virtual practices." During the first two years of the curriculum, about 70 percent of the students' time would be taken up by distance learning, and the remainder by working in a community setting like a clinic or hospital. After that, the proportions would shift to about 30 percent computer-based learning and 70 percent working in a practice setting. Students would be able to tap into the expertise of faculty members around the world, and to customize their educations to suit their needs and interests, proponents say. Among the American medical schools participating in the project are those at Brown, Wake Forest, and West Virginia Universities, and the University of Miami. A 'Virtual Practice' For the proposed school, Stephen R. Smith, associate dean at Brown University Medical School, has developed a "virtual practice," in which students examine fictional patients daily, using computerized medical records similar to those used in real practices. Each patient presents a challenge that teaches students a key lesson, Dr. Smith explains in an e-mail message. "The first virtual patient, George Farmer, for example, sustained a puncture wound to his leg while mending a fence on his farm. Mr. Farmer presents to the practice a day later with a red, swollen, and painful wound on his leg. Through this virtual patient, the student will learn about antibody-mediated immunity, the role of the skin in the body's defenses, a little about the microbiology of C. tetani, a little about the pharmacology of tetanus toxoid vaccine, and a little about the disease of tetanus." New technologies that allow students to learn about medicine while sitting at their computers present "an interesting dichotomy," says M. Brownell Anderson, senior associate vice president for medical education at the Association of American Medical Colleges. Although the group supports the use of technology to deliver medical education, and is intrigued by the possibility of a virtual school, she warns that there is no substitute for direct interaction with patients. "We're trying to make the interaction between physician and patient as human and caring as possible," she says. "At the same time, we have all of these advances in technology, in which material is taught in a more virtual than actual sense, that have the potential to undermine the very essence of that caring relationship." But organizers of the planned school say they are taking great pains to ensure that the human side of medicine is preserved, even when students are spending much of their time interacting with virtual images. "People often say, 'How can you learn medicine with e-learning?'" says Dundee's Mr. Harden. "They have this misconception that that means listening to a bunch of recorded textbooks." Instead, he says, students can "listen" to a patient's heartbeat through vibrations in their computer mouse. They learn that giving a virtual patient too much medicine can kill him, or provoke a panicked call from his wife in the middle of the night. The scenarios are played out by simulated patients, whose responses are programmed into the computer. It may not be quite the same as looking a real patient in the eyes, but proponents of the virtual system say it will open doors to people who otherwise could never become doctors. "This will provide a more relevant and powerful learning environment to students who don't have access to a traditional medical education," Mr. Harden says. Easy-to-print version E-mail this article

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