The history of the invention of VIPS

1. The creation of the ONEX MEDICAL GROUP

The emergence of the theoretical and practical framework that led to the development of VIPS dates back to 1989. At that time, Marc-André Raetzo, the inventor of VIPS, co-founded the Onex Medical Group, a Geneva-based multidisciplinary health center owned and managed exclusively by member physicians.

He was immediately faced with a critical problem: the freshly graduated young physicians that the clinic was recruiting had certainly received a quality medical education but absolutely no training in the practice of a medical consultation. Dr Raetzo and his colleagues thus had no choice but to find efficient means to transfer their operational skills to the younger generation of doctors.

The methodology that was applied was unusual for the medical world at that time: GMO member physicians were required to attend weekly quality circles: peer-to-peer meetings where they would share concrete problems they faced with their patients and criticize each others' operational skills by linking them to data available in the literature.

Over the next years, this methodology was refined to include an expert from the University hospital and a psychologist to enhance peer-to-peer interactions during each meeting. It also proved to be very effective: today, the Onex Medical Group is composed of over 40 physicians and 100 staff, has catered to over 120'000 patients and is a certified teaching center for physicians, medical assistants and radiology technicians. It is reputed to have a very high patient satisfaction rate.

2. An original view of the medical consultation

The experience gained with these quality circles led Dr Raetzo to elaborate an original view of the medical consultation that emphasized decision analysis: underneath the (very important) subjective aspects of a consultation, lied a strictly analytical process of asking the right questions and making the right decisions in the context of uncertainty. If so, this process could only be taught if it were made explicit.

This seemingly simple idea led to scholarly work that culminated in the publication in 1995 of a physician reference book "Doctor I have" which analyzes the 35 most common chief complaints in terms of the minimal sets of questions and decisions required for optimized management of possible underlying pathologies.

"Doctor I have …" quickly became a best-seller in Switzerland and France, the book was translated into German and Italian and a second, updated edition was published in 2001 .

The success of "Doctor I have …" is also illustrated by the fact that the book won the first prize in EDIMED 2002 , the first international medical book competition.

3. From a reference book to a computer simulator

Thousands of physicians and other healthcare professionals use "Doctor I have …" on a regular basis in much the same way as airline pilots use check-lists prior to take-off . The problem is that one does not learn very well from reference materials.

Dr Raetzo realized that in order to engage a dynamic learning process, the learner had to be put into a situation of uncertainty where he or she had to make decisions without any a priori information. The decisions would then be evaluated in terms of the best medical evidence available. The idea of a simulator of medical consultations was born.

The VIPS prototype was initially released as a combined Internet /stand alone application in May 1999 *, using the best software technologies available at that time . Over the next 4 years, the prototype underwent numerous evaluations, tests and revisions.

From a web engineering perspective, VIPS is a very demanding application. It is only with today's sophisticated server-side technologies (such as JAVA) that we can realize the full potential of VIPS as an Internet-enabled distributed e-learning system.

* VIPS (VIRTUAL INTERNET PATIENT SIMULATION), UN SIMULATEUR DE CONSULTATIONS MÉDICALES SUR INTERNET.M.- A. Raetzo,V. A. Loroch,G. Klioutchnikov et D. Mironov.Med Hyg 1999 ; 57 : 1032-8
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