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When Stephen Smith first heard about the creation of a virtual medical school, he thought the idea was crazy. As associate dean of education for the Brown Medical School, Smith helps decide what training Brown doctors receive, but he couldnt envision how the hands-on classroom experience could be re-placed by computer programs.

He remained skeptical even after attending a conference in June at which he discussed the idea with representatives from an international consortium of medical schools and institutions who wanted to create the International Virtual Medical School (IVMS), an ambitious attempt to combine the strengths of various medical schools online. But a short time later, while mulling over the concept at the beginning of a six-month sabbatical, Smith woke up one night with an idea of how the IVMS program might actually work.

Might it be possible, he wondered, to design a virtual medical practice where students could evaluate medical histories and electronic charts of imaginary patients and devise treatment plans for them? Professors would then evaluate and critique the students work. The medical students, he thought, could manage the cases just as they would in a regular practice.

Smith dedicated his sabbatical to building a roster of virtual patients for his virtual clinic. So far, he says, hes created more than sixty profiles, including a farmer with an infected leg wound, a diabetic with food poisoning, and a baby with cystic fibrosis.

To bring his idea to life, Smith is recruiting Brown computer-science students to design the clinics electronic interface. His hope is to complete his project in time for it to be adopted by the Hull York Medical School in England, which is admitting its first class in October. Brown may follow suit in 2004.

Eventually, Smith envisions displaying pictures of the ficticious patients maladies or adding video clips of them giving their medical histories. Were trying to create a human drama for the students, he says. One of the problems of distance learning is the lack of a social environment.

Smith now believes that the real promise of IVMS is in bringing medical expertise online to schools in developing countries. Distance learning, he thinks, could eventually constitute up to 80 percent of the first two years of medical training. Despite the potential, however, he says a traditional medical education will never entirely disappear.

You cant learn to do physical examinations completely online, Smith says. You cant learn to interview patients online. You can learn to some degree on a computer.

But eventually you have to do it.





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