Web Medicine
By Carl Heintze

Taking a thorough medical history, ordering laboratory tests and conducting an adequate physical examination are keys to good patient diagnosis for physicians in training.

But there’s one drawback. These procedures usually require the use of living human subjects as patients. It also helps if the patients presented for such training purposes in a teaching hospital have diverse medical problems. The more diverse, the more the student is likely to learn about different disease entities. And diverse patients with diverse problems are often hard to find.

Now, however, a new web based program developed at Karolinska Institute and under field testing in Sweden and at Stanford University Medical School offers the possibility of instructing medical students in diagnosis using electronic “ patients” through a software program that can simulate symptoms and physical conditions on the Internet, thus giving medical students an interactive way to learn how to use physical examinations, laboratory tests, and medical histories to become skilled clinicians.

The program is called Web-SP and is a joint faculty venture of Sweden’s Karolinska Institute, Uppsala University, and the Stanford University Medical School, with funding from the Wallenberg Global Learning Network (www.wgln.org) The principal investigators for the project are Dr. Uno Fors of the Karolinska Institute, John Kerner of Stanford University and Brita Winsa of Uppsala University.

The program is being used and evaluated this year in a nutrition course required of all Stanford Medical School students, but in Sweden it already is a teaching tool in four different disciplines.

As a medical education tool it opens to a “waiting room,” where portraits of “patients” are available to the student. The student selects or is assigned a patient from whom he or she is able to obtain a medical or nutritional history. The program also permits students to conduct physical examinations and to obtain a variety of laboratory test results.

Web-SP matches the lab results to the patient’s condition. The same is true of the patient’s medical history, obtained like a live medical history gathered by a physician questioning the patient and noting his or her answers. The results of the physical examination also fit the patient’s case and offer clues to the student as to the cause of the symptoms presented.

Any of these factors can be changed to fit the individual case under study at the instructor’s discretion. The present program offers students and instructors thirty cases from which to choose, with differing problems, symptoms, laboratory and medical exam and history results.

Web-SP can be presented in a classroom or used by a student individually. All the student has to do is log into the web site, sign on and go through the case studies.

Instructors can manipulate the program to allow different sets of patient criteria to be used in successive lessons. This means it is potentially adaptable to almost any educational program that lends itself to case studies -- social work, nurse training or dentistry, for example. It’s also possible to use the program as a performance assessment of student learning.

The effectiveness of Web-Sp is being evaluated in the nutrition course at Stanford. A “control” group begins the course with conventional case studies, while the other half of the class uses the Internet site for its cases. The results are being compared to see if there is any advantage or disadvantage in using the electronic cases.

Web-SP has its own site on the Internet (http://websp.lime.ki.se) and can be accessed on by educators, provided they have a password and identification.

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