Significant changes in the health care delivery system over the past two decades have profoundly strained traditional medical education. Scientific knowledge and the skills needed to practice medicine are expanding and changing rapidly. At the same time, physician teachers are increasingly obligated to focus their time seeing a higher patient load, at the expense of quality teaching time with students and residents. Shorter inpatient stays and increased outpatient care have also resulted in the dispersion of trainees to distant off-sites for their clinical apprenticeships, resulting in disorganized and disparate education and isolated learning experiences. In 2002, these concerns led the Liaison Council for Medical Education (LCME) to institute accreditation standards which require all medical schools to provide and document a consistent education for all medical students, regardless of training site or time of year. The LCME also highly encouraged schools to look to technology, with its promise of timely, self-directed and collaborative education, for solutions. While computer-assisted learning (CAL) has been shown to be an efficient, effective and cost-effective method for teaching and learning, medical schools and national medical education organizations have struggled to effectively develop and integrate CAL into the traditional curriculum.
Our first solution to the problem began in 2000 through two federal grants to develop a series of 31 Web-based virtual patients to teach core pediatric curriculum for medical students. Through a strong collaboration with the national pediatric medical education organization and an iterative team-based development process we created the Computer-assisted Learning in Pediatrics Program (CLIPP). Since dissemination of the cases in 2004, CLIPP has become the most utilized computer-assisted learning program in medical education anywhere in the world, with the majority of US and Canadian medical students completing over 250,000 cases sessions annually. The broad use of our virtual patient cases has ensured that all students receive a high-quality, consistent, and comprehensive education in the fundamentals of pediatric medicine. Working through the cases assists students in linking their factual knowledge to their clinical experiences and deepens their understanding. In addition to core medical knowledge, the cases also focuses on concepts of preventative care, physician-patient communication, professionalism and patient advocacy. Effective integration of the cases into the standard curriculum allows students and physician teachers to exploit their limited time together for quality one-on-one teaching in the clinic and at the bedside. In May 2008, CLIPP was awarded the prestigious national Outstanding Teaching Award, given by the Academic Pediatric Association, in recognition of our innovative success.
In 2006 we founded the Institute for Innovative Technology in Medical Education (iInTIME), a 501(c)(3) non-profit corporation, to sustain the cases beyond grant funding and to grow our vision beyond pediatrics. iInTIME's mission is to advance medical education through collaborative national development, maintenance and research of innovative and comprehensive computer-assisted instruction programs. Through iInTIME, CLIPP cases are now available by modest subscription to all medical schools and use of the cases has continued to increase. Building on our success in pediatrics, we have expanded to include collaborations and case development with medical educators in internal medicine, family medicine, and surgery. With the larger case series complete, in July 2010 over one hundred virtual patient cases are available through iInTIME. Our interdisciplinary advisory board, discipline-specific editorial boards, and over 100 individual case editors will allow us to respond quickly and directly to changing medical knowledge, practice standards and curricular needs at a broad and collaborative level never previously achieved in medical education.
The broad use of our cases positions us in a unique space. At present, almost all of the medical students in the US, and over half of the current physicians-in-training, learned much of pediatrics in medical school through CLIPP. By July 2010 we estimate that half of all of the medical students in the US an Canada in their clinical training year will be on our web site, learning, every night.