Canadian Medical Association Journal 1996; 154: 1731-1732
© 1996 Janice Hamilton
The idea of putting medical courses into a computerized format is hardly unique, says Fleiszer, McGill's assistant dean of medicine for medical informatics. However, this is the first attempt in Canada to do so in such an organized and professional manner.
Many clinicians and researchers have seen the advantage of interactive multimedia for teaching and have moulded their medical expertise into programs. But they aren't experts at computer programming or instructional design. Fleiszer's idea is to buy high-end software and hardware, and enlist experts to turn lecture notes into solid multimedia teaching programs. The project's multifaculty advisory group includes experts in computer science, biomedical engineering, library science, education and even music.
The first step is to put McGill medical-class lecture notes on line. Coloured diagrams, animations and other material are being linked to the txEvaluation tools are also being included to ensure that students cover all the required material. Eventually, this basic material will be built into case scenarios. Material can be added or updated as medical knowledge evolves. Fleiszer expects to be working on various aspects of this project over the next 5 years.
Fleiszer hopes this project will lead to the creation of a consortium of Canadian medical schools, "a central repository where we all put in the best teaching materials and then share them." He explains that "there are lots of people working in different directions, but there is no map." He is anxious to start on a coordinated venture before people are too far down their own roads.
If everyone continues to work independently, he warns, some programs will be available for the Macintosh, others for IBM-based computers, and students will have to learn a new set of commands to navigate each program. There may be no way to track and assess what each student has done. Also, one program may cover part of a curriculum, while another program will cover another aspect. Some material may be redundant, while other parts of the curriculum are incomplete.
Fleiszer admits there will be political hurdles "but I think there is enough enthusiasm that we might just pull it off." Toward this end, McGill is already collaborating with Canada's three French-language medical schools at the universities of Montreal, Laval and Sherbrooke.
Dr. Robert Kearney, chair of the Department of Biomedical Engineering, says the usefulness of a personally marked-up text will never diminish. But a new medical curriculum, now being implemented at McGill, puts more of the onus on students to pursue self-directed learning. "The volume of medical information is so enormous, nobody can try to learn it all. So we pose problems and have the students explore. Computers are excellent tools for this type of learning."
Traditionally, adds Kearney, medical teaching has been linear and oriented to departments, but patients don't care if their problems fall under different departments; in medical practice, therefore, links between fields are important. With computerized teaching resources, it becomes possible to make valuable links between different approaches to a topic. Students can link with a library of histology slides, a set of videos on motor disease or a rotating three-dimensional image of the brain. They can call up the 10 most important papers on a topic from the campus medical library, or check databases at other locations, such as the National Cancer Institute.
Several McGill teaching hospitals have high-speed optical cable links with the downtown campus, so curriculum material will be available on line at computer terminals in hospitals. Residents about to transfer to a new service will be able to review updated notes on line during free time.
Computerized storage of medical information is useful not only for formal teaching but can also serve as a resource for clinicians, provide continuing medical education and assist physicians living in rural or remote areas.
Fleiszer suggests several ways medical informatics can improve clinical care. Today, for example, when a patient arrives at a hospital clinic with a skin rash the physician may scribble a paragraph of notes describing the rash. Tomorrow, the doctor will take a picture of the rash and store the image in the computer. The computer can also be used to record a complicated heart murmur and the audio clip of the murmur will become part of the patient's record. For teaching purposes, that clip can be displayed as an audiogram.
Another application would involve videotaping someone with a particular type of limp. The video clip would become part of the patient's record and could be emailed to an expert in another city for help with the diagnosis, or be shown to students. Fleiszer dreams of the day a physician could send a video clip of a patient with a curious gait to a repository at McGill, where the computer would match it to a similar gait and send the physician online information on that condition.
Fleiszer, who directs the Surgical Intensive Care Trauma Unit of the Montreal General Hospital, is also working on computer simulations of medical situations. "When residents first come into the surgical trauma ICU and see all those machines, they are scared to death," he says. "Wouldn't it be nice to put them on a computer simulator for a few days first -- you can simulate almost all machines and patient conditions with a computer."
The McGill team is already collaborating with industrial partners to develop clinical simulations. The partners include CAE Industries, which is known for its flight and medical simulators, and Kodak, which has offered its new line of digital-imaging equipment.
Computers could also be used to alert students -- and even seasoned clinicians -- when certain combinations of symptoms appear. "A student might not recognize the signs of septic shock, but the computer could be programmed to pick up that set of parameters and wave a little flag," says Fleiszer. "Then we've not only taught the student something, we've facilitated patient care."
Fleiszer plans to recycle the online curriculum material for patient information. For example, as coordinator of the Diagnostic Breast Centre at the Montreal General, he is developing an interactive program to help women evaluate their risk of breast disease.
Meanwhile, Kearney and his colleagues have done a pilot study of the best way to undertake this vast project. "We need to put everything in the same style," says Kearney. Spelling has to be standardized, for example, so topics can be cross-referenced, and indexes are being constructed so students can find information quickly. They are also doing an evaluation to find out whether the students feel the material is valuable.
"Medical students are very efficient learners," says Kearney. "Any way we can give them content in a more comprehensible, usable form is helpful."