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Vital Signs

Pediatrics program is no CLIPP off the old block

By Tamara Steinert

Virtual patients—computer simulations that allow medical students to practice their clinical skills—have been around nearly as long as computers. But for all the technological sophistication in the rest of medicine, medical educators have struggled to effectively integrate simulations into the curriculum.

But a web-based pediatrics training program created by Drs. Norman Berman and Leslie Fall of DMS has shown it can be done. Their Computer-assisted Learning in Pediatrics Project (CLIPP), just three years old, is being used by 70 of the 125 U.S. medical schools. Berman and Fall, associate professors of pediatrics, received the Innovation in Clinical Medical Student Education Award from the Association of American Medical Colleges' Northeast Group on Educational Affairs.

CLIPP is "the most successful of the electronic case systems that I know of," says Dr. Suzanne Stensaas, a professor of neurobiology and anatomy at the University of Utah and organizer of a workshop on multimedia in medical education. The program has solid technology, but its real strength is that its creators generated ownership among potential users—pediatrics clerkship directors. "Anyone can write software," says Stensaas. "What they can't do is get the darned physicians to take the time to put in the information. And they can't get people to use it."

The clinical scenarios in CLIPP mimic life. Students in interview and examine

More than half of the nation's medical schools use CLIPP.

patients, order tests, consult experts, make diagnoses, and recommend treatments. After completing the simulation, students are tested on the material.

CLIPP appeals to clerkship directors because its 31 peer-reviewed cases are based on the curriculum established by the Council on Medical Student Education in Pediatrics. Most other clinical simulations reflect an author's particular interests or meet a specific need, which limits their use, says Stensaas. In contrast, Fall and Berman invited clerkship directors from across the U.S. and Canada to participate in developing the cases.

Track: Berman believes new accreditation standards—which require schools to offer a consistent educational experience and show evidence of what students learned—have also contributed to CLIPP's success. "Medical schools have to figure out how to do that. CLIPP solves that

problem," he explains, because it is standardized and can track student progress and results.

Despite its popularity, CLIPP faced a potential crisis a few months ago when its grant funding ended. The program had been offered at no charge, but the lack of funding made it necessary for CLIPP to start charging schools.

Fall and Berman turned to the Dartmouth Entrepreneurial Network for guidance in setting up a not-forprofit company to market CLIPP. In addition, DMS's dean, Dr. Stephen Spielberg, pledged to support CLIPP if it didn't garner enough initial subscriptions. But to Berman and Fall's happy surprise, 70 of the 80 schools that had been using CLIPP when it was free subscribed to the feebased program.

CLIPP's creators are now looking to develop similar programs for other specialties. There is also an initiative in the works to use CLIPP data for medical education research—studies that could potentially meet the same quality guidelines as clinical research, says Fall. She would ultimately like to apply what she and Berman have learned to creating CLIPP-like tools to prepare first-world physicians for working in developing countries.

The support from Dartmouth has been vital, say CLIPP's creators. "We've been able to incubate this here," says Fall, "in a way that maybe wouldn't be possible at some other institutions."

See www.clippcases.org for details.

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