Key features of a good case simulation program

• The blank sheet paradigm. A study conducted in collaboration with the UDREM (Unit of Development and Research in Medical Education, University of Geneva)* has clearly shown that clinical reasoning has two stages:
  - the first stage is to decide what is the appropriate question that needs to be asked
  - the second stage is to interpret the answer .
  By providing two similar groups of physicians with identical problems that emphasize one or the other aspect, drastically different results were obtained. A good consultation simulator must therefore avoid all situations where the user has the possibility to choose between a set of predefined questions or answers.
  
  VIPS provides information only in response to specific demands and requires the user to formulate natural language statements.
  
  
• Time and uncertainty. Most educational tools merely address the physician's capacity to formulate a diagnosis. However, the real challenge in ambulatory medicine is different: the physician often has to make a decision without being sure of his diagnosis. A good simulator must therefore place the user in a position of having to make decisions in a context of uncertainty.
  
  In any given VIPS session, the user must make a decision at the end of each consultation. The consequences of this decision become knwon only at the onset of the following consultation.
  
  
• Evidence based knowledge. All medical evaluations made by the program (such as "this is a good question", etc.) must be validated via direct links to the relevant literature (for example via PubMed). This allows instant access to the evidence for the assertions within each case.
  
  In creating a VIPS case, the author is required to provide references and links that justify the value of any pertinent information entered in the case database.
  
  
• Scoring. A standardized evaluation of the user's performance must be automatically generated at the end of each session according to the criteria established by the teaching authority or accreditation agency. This feature allows automatic CME certification on user's demand.
  
  VIPS scores automatically the user at the end of a session and can keep a detailed log file that can be used to generate custom CME certificates and perform fine statistical analyses.
  
  
• Internet capability. Medical education is often difficult to implement in areas removed from medical schools or medical Institutes. Internet represents the perfect means for distance CME.
  
  VIPS is a fully functional Internet program requiring an industry standard web browser and a regular Internet connection.
  
  
• Versatility and growth. The generation of new cases should be made as simple as possible. Once the pedagogical goals are defined and a typical case constructed, only a few entries in the database should be changed in order to generate a new case.
  
  The unique data structures in the VIPS knowledge base allow almost unlimited customization and new case generation.

* Nendaz, MR., Raetzo, MA., Junod, AF, Vu, NV. Use of different case formats in teaching diagnostic skills: clinical vignettes or chief complaints ? Adv. Health Sciences Education, 2000, 5, 3-10