Real Clinicians Meet Virtual Clients

by Judith Maginnis Kuster - Minnesota State University, Mankato (judith.kuster@mnsu.edu).

My first meeting with a "virtual patient" on the Internet was in the mid-1990's at the University of Iowa's Virtual Hospital. I was in my office with a virtual patient on my computer screen presenting a medical complaint. On the basis of the case history, information provided by the patient, answers to questions asked relating to a virtual examination, and the results of the diagnostic tests, I was to formulate a diagnosis and treatment plan. Not being a very good physician, I think my virtual patient may have died, but I had experienced an exciting learning/training potential.

"Virtual patients" are now part of many medical training programs. Typically very time consuming and expensive to produce, most virtual patients are marketed on CD ROMs or are on password-protected sites for medical students. However, some examples are freely available online and exploring them provides an opportunity to see their potential both for training and continuing education.

Some virtual patients are more interactive than others. The least interactive provide opportunity to follow a patient through diagnosis and treatment, such as on "Cases at the Texas Virtual Clinic", where you are a silent observer in a doctor's office. The site is designed to help consumers understand gastrointestinal problems and the steps taken to solve them. Speech-language pathologists may be especially interested in the patient with dysphagia.

Other virtual patient sites allow more interactivity, such as the cardiology cases prepared by medical students. FamilyPractice.com has several interactive cases, some of which allow you to "interview" the patient. Results of the physical exam and diagnostic tests are presented and, you are asked to make a diagnosis. A treatment plan is then suggested. Virtual Internet Patient Simulation (VIPS) was developed for continuing medical education. The user is presented with an online clinical case. The physician's input consists of statements, a simulated physical examination, and diagnostic or therapeutic decisions.

There are also interesting case studies on the Internet, which can augment clinical knowledge and assist in clinical training. The Voice Clinic of the University of Iowa provides a series of several voice disorders case studies.

Individuals in speech-language pathology and audiology are also exploring the potential of virtual patients and case studies online. In 1997, Scott Bradley created an audiometer simulator that provides a virtual audiometer and five "patients" with hearing impairments. The audiometer simulator is a hypercard stack that needs a MAC system. It is a shareware product, but can be tried free for 30 days. Anthony Caruso describes his use of virtual clients in clinical training for fluency which links to a sample demo of one of his training modules.

The most extensive interactive virtual case database in our discipline that is currently online is PATSy (Patient Assessment Training System). The main goals of PATSy are to provide an inexpensive cooperative facility to support students learning how to reason diagnostically and to provide a resource for clinicians and researchers. PATSy currently contains over 60 cases in speech and language, medical rehabilitation, neuropsychology, and dyslexia. The language disorder cases include adult acquired speech and language disorders and child delayed language and phonological development cases. The dyslexia cases include additional children with both language and reading problems. An audiology section is planned for this summer.

PATSy provides a list of patients fitting specific criteria and, depending on the user's mode of access, patient information including over 550 tests. It offers different levels of access (guest, student, examination, researcher/clinician, and administrator), all of which are password controlled for ethical and security reasons. Educators can "personalize" PATSy by submitting their own references, comments about the cases, and tutorial questions as well as case material to demonstrate specific clinical conditions. Researchers may submit test results and multimedia data to supplement their journal publications about reported cases. North American users will be able to access this Web site when a suitable mirror site is found to serve PATSy locally. Members of interested universities should email Dr. Carmel Lum (carmel@cogsci.ed.ac.uk) to discuss possible collaborations.

Judith Kuster is in the Department of Speech, Hearing and Rehabilitation Services at Minnesota State University, Mankato. Contact her by email at judith.kuster@mnsu.edu. All of Kuster's Internet columns are on the ASHA Web site in html format with active links, although URLs change and there is no guarantee that links from previous articles are still functional.


Kuster, JM, Real Clinicians Meet Virtual Clients, ASHA Leader, April 30, 2002, p. 8.