VIPS and the medical education paradigm shift

Medical practice is an error-prone activity with potentially tragic consequences. Providing medical care can easily be compared to the operation of a commercial aircraft. Indeed, both pilots and physicians know that failure to address a particular question or a bad decision can lead to injury, death and devastating financial losses.

It is common knowledge that the use of flight simulators is a major contribution to the safety of commercial aviation. Yet, the vast majority of simulators that are available to physicians address solely highly technical aspects (surgical simulators and other computer-assisted procedures). They do not train physicians to ask the right questions or decide what decisions ought to be made. VIPS does.

For many centuries medicine has progressed thanks to countless efforts to accurately describe medical situations, diseases and patients. This science is referred to as clinical epidemiology. Clinical epidemiology is invaluable to prove the efficiency of a treatment and define the natural course of a disease. Diagnosis is a descriptive act in clinical epidemiology. Classical medical training is based of such a descriptive paradigm.

However, today, the practicing physician is faced with a different problem: he or she must continuously evaluate choices and make decisions. The real professional context is operative and not descriptive. In a clinical situation the degree of competence of a physician is not only related to his or her capacity to interpret the answers but also to ask the right questions. VIPS is a software tool designed to specifically teach and evaluate the physician's capacity to ask the pertinent questions, interpret the answers and make the right decisions.

In the recent years, physicians have seen the emergence of Evidenced Based Medicine (EBM), which relies on randomized controlled trials, systematic reviews, meta-analyses and ultimately integrates the individual clinical expertise with the best available external clinical evidence. Naturally EBM has flourished on the Internet. However, EBM in itself offers a poor substrate for Internet-mediated education. Indeed, it provides only validated answers to a potentially incomplete set of diagnostic or therapeutic questions. It does not deal with the questions themselves.

Because VIPS does address the relevance of the questions the physician may ask of his patient, it creates the appropriate context wherein the answers also become highly relevant. In a sense VIPS can be seen as a medical knowledge browser, a tool that enables the CME student to access otherwise dormant medical knowledge bases available on the Internet or elsewhere.