Medical education

Harvard Med and Beth Israel create ‘virtual patient’

BOSTON – A computerized, ‘virtual patient’ is helping medical students learn how to deal with patients afflicted with a greater range of problems than most would see on the wards today. That’s because hospitals are discharging patients more quickly than before, moving them to various ambulatory centres and clinics that are off-site.

As a result, med students in recent times have had less opportunity to learn first-hand about many sicknesses and diseases, and how to treat them.

However, by using a web-based case simulation program created by The Carl J. Shapiro Institute for Education and Research at Harvard Medical School (HMS) and Beth Israel Deaconess Medical Center (BIDMC), students take care of a “virtual” patient over the course of several simulated years.

It’s all done in the span of a few hours, without leaving the comfort of their own homes.

Actors portray “patients” who can be scared, grouchy or otherwise human, even if they are simply a still image on a computer screen. Students are led through a series of possibilities by typing questions into the program and receiving responses that allow them to learn by trial and error.

They examine the patient, order diagnostic tests, and make treatment decisions that lead to different outcomes, depending on their choices. Students can view procedures, consult with specialists, and watch exemplary patient-physician interactions.

“Students are not seeing their fair share of common diseases, because so much of disease management has moved to the outpatient setting. The Virtual Patient fills those gaps in their clinical training.” says Grace Huang, MD, director of the Office of Educational Technology at the Shapiro Institute and an internist at Beth Israel Deaconess Medical Centre, who helped develop the 18 Virtual Patient cases that currently range from “A Young Man with HIV” to “A 70-Year-old Smoker with a Cough.”

Ultimately, the Virtual Patient allows students to gain experience with patients and medical conditions they would otherwise miss and to test their clinical skills in a safe learning environment.

As a Rabkin Fellow in Medical Education, Dr. Huang has also created interactive animations for handheld computers to instruct medical students in common bedside procedures, such as the lumbar puncture and paracentesis.

As director of the Office of Education Technology in the Shapiro Institute, she leads the production team for the Virtual Patient, a multimedia interactive computer simulation program that allows students to interview, examine, evaluate, and treat patients with common diseases.

In addition, Dr. Huang represents the Virtual Patient programs from around the country to the Association of American Medical Colleges in the context of its partnership with HEAL (Health Education Assets Library.) She also designs dynamic web-based didactic tutorials on physical examination, principles in pathophysiology, and on clinical reviews.

She is involved in a clinical research project to decrease procedural complication rates by introducing an online educational curriculum in conjunction with a formal procedure service at the Beth Israel Deaconess Medical Centre. Additionally, Dr. Huang is the Project Director of CME Online at Harvard Medical School’s Department of Continuing Education.

On a related note, on April 28 the Carl J. Shapiro Institute for Education and Research at Harvard Medical School (HMS) and Beth Israel Deaconess Medical Center (BIDMC) will host a four-day session focusing on educational principles for the use of medical simulation in undergraduate and graduate training.

“Medical simulation is an area that has a tremendous potential to advance learning in an integrated fashion or, alternatively, to foster an approach to education that will consume large amounts of otherwise limited resources,” says Richard Schwartzstein, MD, executive director of the Shapiro Institute and vice president for education at BIDMC.

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.harvard.edu.

Faculty from nine medical schools will assess current medical simulation programs in light of educational objectives and institutional goals and will share past experiences. The key questions to be addressed include:

·How can medical simulation meaningfully contribute to the education of students and residents?

·How should experiences in simulation be evaluated?

·How should we develop a research agenda to evaluate simulation methodologies?

·How should simulation technologies be developed and managed within and across institutions?

Participants at the April 28-May 1 conference are: Baylor College of Medicine; Harvard Medical School; Indiana University College of Medicine; New York University School of Medicine; Pennsylvania State University College of Medicine; Stanford University School of Medicine; University of Louisville School of Medicine; University of Pittsburgh School of Medicine; and University of South Florida College of Medicine.

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.harvard.edu.