Is there a Virtual Medical School on the horizon?

Medicine and Health Rhode Island, Sep 2003 by Smith, Stephen R

To what degree should students be allowed to define their own learning objectives rather than having the faculty define them? Allowing students to discover what they need to know for themselves may be the most powerful means of learning, but runs the risk that important areas may be overlooked.4 A compromise may be to define the learning objectives for an entire segment of the course rather than for a specific case and have the students check those objectives as they near the end of the segment to make sure they haven't missed anything through their own self-directed learning.

RLOs might be considered by some to be "spoon feeding" of students. On the other hand, no one would cast such an aspersion against a textbook. In one sense, RLOs are the twenty-first century version of textbooks. Nevertheless, students should become more adept at using information resources that they will rely on as practicing physicians. One way to do this would be to utilize RLOs more intensively in earlier cases when students are just beginning to build vocabulary and concepts, and expect students to use more general information resources for later cases.

Some of the fundamental basic science concepts, especially those at the molecular and cellular levels, are not easily represented in common clinical cases. Rare diseases can be used, but then the verisimilitude of the virtual practice becomes diminished. Study questions might be used to direct students to these topics.

Differences in local epidemiology, practice styles, health care systems, medical records, and even units of measurement pose additional challenges to creating a global medical curriculum. These issues are easily surmounted by allowing each school to add cases that represent local epidemiology, such as a case of Lyme Disease in the U.S. and Queensland tick typhus in Australia. The computer can be programmed to represent the data in different formats depending on the location of the learner. In the U.S., the problem-oriented medical record format can be used, while in Britain, a more traditional consultation note can be presented to the students. Likewise, U.S. "traditional" units of measurement (e.g., mg/100 ml) can be easily converted to standard international (SI) units.

New approaches to teaching and learning also demand new approaches to assessment. Closed-book, time-limited examinations do not mesh well with the goals of having students learn to use the power of computers to quickly access information, properly evaluate the utility and quality of the information, and apply it to the problem at hand. The manner in which students work through a case, defining their own learning objectives and investigating them can be captured by the computer, thus creating a virtual portfolio of the students' effort. Faculty supervisors can review these portfolios at frequent intervals, providing constructive formative assessment to students. Students can be given new cases that cover material addressed in previous cases in an "open-computer" examination. Other performance-based methods of assessment, such as objective structured clinical examinations (OSCEs) can also be used that can simultaneously measure knowledge and skill.