1. Virtual Communities in Medicine International collaboration in Medical Education Shlomi Codish, MD Head, Computer Assisted Learning Unit Ben Gurion University of the Negev codish@bgu.ac.il

2. Stating the problem Medical information is exponentially increasing and constantly changingMedical information is exponentially increasing and constantly changing One person can never “know everything”One person can never “know everything” Medical schools must shift from teaching information to teaching learning skillsMedical schools must shift from teaching information to teaching learning skills Teaching takes place in hospital while a lot of medicine takes place in the communityTeaching takes place in hospital while a lot of medicine takes place in the community

3. Teaching Clinical Medicine Takes place in many different locationsTakes place in many different locations Done by many people with differingDone by many people with differing attitudesattitudes motivationmotivation teaching skillsteaching skills Patient population notPatient population not Similar across wardsSimilar across wards No consistent exposureNo consistent exposure

4. Patient simulations Computerized, and later on, Web-Based patient simulations are applied to address these problems.Computerized, and later on, Web-Based patient simulations are applied to address these problems. Various approaches:Various approaches: Cognitive approachCognitive approach Specific skills, i.e.Specific skills, i.e. physical examinationphysical examination history takinghistory taking differential diagnosis listsdifferential diagnosis lists Simulate specific problems to cover a “core curriculum”Simulate specific problems to cover a “core curriculum”

5. Problems again (and solutions?) Quality of medical informationQuality of medical information Peer review?Peer review? Complexity of computerized systemsComplexity of computerized systems Front ends (SRDC?)Front ends (SRDC?) “not invented here syndrome”“not invented here syndrome” a-priori consortiaa-priori consortia Volume of simulationsVolume of simulations

6. Specific initiatives Stanford Short Rounds ConsortiumStanford Short Rounds Consortium User basedUser based Diagnostic ReasoningDiagnostic Reasoning commercialcommercial CLIPP casesCLIPP cases Academia and professional organization cooperationAcademia and professional organization cooperation ACP onlineACP online Professional organizationProfessional organization IVIMEDSIVIMEDS Virtual medical campus – academia and commercial interestsVirtual medical campus – academia and commercial interests

7. Case study - CLIPP Initiated by COMSEP – Council on Medical Students Education in PediatricsInitiated by COMSEP – Council on Medical Students Education in Pediatrics Cases created by COMSEP membersCases created by COMSEP members Extensive Peer Review processExtensive Peer Review process Case selection academic and well plannedCase selection academic and well planned Financed by COMSEPFinanced by COMSEP http://www.clippcases.org

14. Case Study: SRDC Project initiated at Stanford SUMMITProject initiated at Stanford SUMMIT Easy front end text based application for creating simple simulationsEasy front end text based application for creating simple simulations Financed by research fundsFinanced by research funds No significant participationNo significant participation No peer-reviewNo peer-review Project fizzled outProject fizzled out http://summit.stanford.edu/ourwork/DEVELOPTOOLS/SHORTROUNDS/srdc.html

15. Case Study: DxR Initiated at SIU as academic endeavorInitiated at SIU as academic endeavor Went commercial – various vendorsWent commercial – various vendors Cases developed at developer’s discretionCases developed at developer’s discretion Minimal peer-reviewMinimal peer-review Funded commerciallyFunded commercially Widely used, in very varied situationsWidely used, in very varied situations http://www.dxronline.com

20. IVIMEDS The International Virtual Medical School Joint effort of 37 medical schools in 14 countriesJoint effort of 37 medical schools in 14 countries An attempt to benefit from each member’s expertise to create a full medical school combining e-learning and face to face teachingAn attempt to benefit from each member’s expertise to create a full medical school combining e-learning and face to face teaching Use of >200 simulated patients!Use of >200 simulated patients! http://www.ivimeds.org

21. Hardware simulators While not the topic of this talk…While not the topic of this talk… Hardware simulations are available in Israel on a national level:Hardware simulations are available in Israel on a national level: Advantages includeAdvantages include Enables hands-on approachEnables hands-on approach Nearest real life situationNearest real life situation Particularly useful for emergency medicine and proceduresParticularly useful for emergency medicine and procedures Disadvantages includeDisadvantages include Costly – to maintain and to useCostly – to maintain and to use Requires travelRequires travel Obviously, a correct mixture is bestObviously, a correct mixture is best http://www.msr.org.il

22. Other collaborative efforts Health Education Assets Library H.E.A.L (www.healcentral.org)Health Education Assets Library H.E.A.L (www.healcentral.org)www.healcentral.org Dermatology Atlas (www.dermis.net)Dermatology Atlas (www.dermis.net)www.dermis.net Pathology question bankPathology question bank ACP Clinical Problem Solving Cases (cpsc.acponline.org )ACP Clinical Problem Solving Cases (cpsc.acponline.org )cpsc.acponline.org

26. Summary The problems facing medical education dictate the use of simulated patientsThe problems facing medical education dictate the use of simulated patients This is costly, time consuming and frustratingThis is costly, time consuming and frustrating Most previous efforts have failedMost previous efforts have failed Poor planningPoor planning Poor fundingPoor funding Poor implementationPoor implementation Software designSoftware design Educational design and contentEducational design and content Actual student useActual student use Poor evaluationPoor evaluation

27. More summary The only way to go is to combine effortsThe only way to go is to combine efforts Development consortia more successful than individual effortsDevelopment consortia more successful than individual efforts