Virtual Communities in Medicine Virtual Communities in Medicine

International collaboration in Medical International collaboration in Medical EducationEducation

Shlomi Codish, MDShlomi Codish, MDHead, Computer Assisted Learning UnitHead, Computer Assisted Learning Unit

Ben Gurion University of the NegevBen Gurion University of the Negev

codish@bgu.ac.ilcodish@bgu.ac.il

Stating the problemStating the problem

• Medical information is exponentially Medical information is exponentially increasing and constantly changingincreasing and constantly changing

• One person can never “know everything”One person can never “know everything”• Medical schools must shift from teaching Medical schools must shift from teaching

information to teaching learning skillsinformation to teaching learning skills• Teaching takes place in hospital while a lot of Teaching takes place in hospital while a lot of

medicine takes place in the communitymedicine takes place in the community

Teaching Clinical MedicineTeaching 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

Patient simulationsPatient simulations

• Computerized, and later on, Web-Based Computerized, and later on, Web-Based patient simulations are applied to address patient simulations are applied to address these problems.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 Simulate specific problems to cover a “core curriculum”curriculum”

Problems again (and solutions?)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

Specific initiativesSpecific 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 Virtual medical campus – academia and commercial interestsinterests

Case study - CLIPPCase study - CLIPP

• Initiated by COMSEP – Council on Initiated by COMSEP – Council on Medical Students Education in Medical Students Education in PediatricsPediatrics

• Cases created by COMSEP membersCases created by COMSEP members• Extensive Peer Review processExtensive Peer Review process• Case selection academic and well Case selection academic and well

plannedplanned• Financed by COMSEPFinanced by COMSEP

http://www.clippcases.org

Case Study: SRDCCase Study: SRDC

• Project initiated at Stanford SUMMITProject initiated at Stanford SUMMIT• Easy front end text based application Easy front end text based application

for creating simple simulationsfor 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

Case Study: DxRCase 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 Cases developed at developer’s

discretiondiscretion• Minimal peer-reviewMinimal peer-review• Funded commerciallyFunded commercially• Widely used, in very varied situationsWidely used, in very varied situations

http://www.dxronline.com

IVIMEDSIVIMEDS The International Virtual Medical SchoolThe International Virtual Medical School

• Joint effort of 37 medical schools in 14 Joint effort of 37 medical schools in 14 countriescountries

• An attempt to benefit from each An attempt to benefit from each member’s expertise to create a full member’s expertise to create a full medical school combining e-learning medical school combining e-learning and face to face teachingand face to face teaching

• Use of >200 simulated patients!Use of >200 simulated patients!

http://www.ivimeds.org

Hardware simulatorsHardware simulators

• While not the topic of this talk…While not the topic of this talk…• Hardware simulations are available in Israel on a Hardware simulations are available in Israel on a

national level:national level:• Advantages include Advantages 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

Other collaborative effortsOther collaborative efforts

• Health Education Assets Library Health Education Assets Library H.E.A.L (H.E.A.L (www.healcentral.orgwww.healcentral.org))

• Dermatology Atlas (Dermatology Atlas (www.dermis.netwww.dermis.net))• Pathology question bankPathology question bank• ACP Clinical Problem Solving Cases (ACP Clinical Problem Solving Cases (

cpsc.acponline.orgcpsc.acponline.org ) )

SummarySummary

• The problems facing medical education The problems facing medical education dictate the use of simulated patientsdictate 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

More summaryMore summary

• The only way to go is to combine effortsThe only way to go is to combine efforts• Development consortia more successful Development consortia more successful

than individual effortsthan individual efforts