Medics in cyberspace

A revolutionary way of training doctors is about to come online. Benefiting students from around the world, it makes use of the latest technology and even offers virtual patients, says Lucy Hodges

Will the doctors of tomorrow be taught through distance learning in front of a computer at the click of a mouse? Yes, according to the organisers of the world's first global virtual medical school, launched this week. For much of their courses they will be able to dispense with the traditional approach of attending lectures, and instead study at home on-line, learning from virtual patients and gaining their practical experience in local health centres or hospitals.

The International Virtual Medical School (Ivimeds), a Scottish-led venture which has signed up 32 of the world's leading medical schools and institutions as partners, is expected to transform the training of doctors. "In 10 years' time medical education will be very different and we will be leading the way," says Professor Ronald Harden, the school's new director, and a former head of Dundee University's medical school.

His most high profile supporter is Donna Shalala, who used to be Bill Clinton's health secretary and is now president of the University of Miami, one of the universities involved. "It gives us an opportunity to take advantage of modern technology to strengthen medical education around the world," she says.

There are three reasons why a global virtual medical school is a good idea, according to Professor Harden. First, advances in e-learning mean that knowledge and skills can be taught in new ways. The intention is to combine distance learning with clinical experience and face-to-face education. Some students would have more distance learning, others less. Courses could be tailored to suit people's needs. Thus medical students in the developing world or in remote rural areas would be able to access high-quality material without leaving home. That would reduce the cost of medical education and perhaps ensure that they stay where they are needed on completion of their training.

Second, the venture enables medical schools to think about the curriculum in new ways. The idea is to use a range of e-learning techniques – the internet, CD-rom and DVD. An important part will be what the organisers call a bank of "reusable learning objects", anything from short video clips to pieces of text or animated diagrams. These are small self-contained chunks of learning from which courses can be built. They can be shared widely and updated easily.

Stephen Smith, the associate dean for medical education at Brown Medical School in the USA, is creating 200 virtual patients. Students will be like the junior partners in a virtual medical practice. They will be able to access the patient's notes electronically, decide what is wrong with them and resolve how to treat their symptoms.

They might encounter George Farmer, a patient who accidentally jammed a nail in his leg while mending a rusty fence. His wound is swollen and sore. Farmer hasn't had a tetanus injection in 15 years. So, the students decide to give one and arrange to see him again. When Farmer returns, the leg is doing better but his farm is not and he's feeling hopeless. The students get a lesson in depression and learn, it is hoped, to develop a sense of concern for the patient. "The students are learning about real problems in the real world," says Sir Alan Langlands, the principal of the University of Dundee and a former chief executive of the NHS in England.

These profiles become the focus for student learning, according to Professor Harden. At the moment students take classes in anatomy. Then, quite separately, they attend classes in physiology. They don't see how a problem in one part of the body can affect other parts. These virtual patients change that. They make medical training more authentic by integrating everything.

Finally, the virtual school will encourage greater collaboration between existing medical schools, which is increasingly important in a world where the schools are finding it hard to make ends meet. Many medical schools in the United Kingdom are in the red and are having to lay off staff. Yet the Government wants to increase the number of qualified doctors. The new Ivimeds will enable training to be expanded quickly and in a relatively inexpensive way, without having to construct buildings and buy new equipment.

Elements of the first courses will be pioneered from August 2003 at Hull York, one of the new medical schools established in the UK. The first students enrolled in Ivimeds will begin their studies in August 2004. The project is being led by Dundee University and all the Scottish medical schools are involved as well as the University of Queensland in Australia and the University of Florida in the USA. Other partners come from Germany, Italy, Ireland, Spain, Hong Kong, China, Syria and Malaysia.

A total of £1m has been raised so far, and another £1m is needed for the second phase. The school has got round the issue of standards and whether qualifications are the same level around the world by having the medical schools that are taking part granting the degrees. "We need to make sure that the 'reusable learning objects' are of a certain standard and quality," says Professor Jeremy Ward, the director of the Guy's, King's and Thomas' School of Medicine, which is also involved. As with traditional programmes, students in the virtual medical will spend their first two years immersed in an intensive study of science and the next two to three years applying their knowledge in clinical settings.

l.hodges@independent.co.uk