Campus & Community

Virtual cases bring about real learning at HMS

8 min read

A year after having his arm blown off attempting to clear a land mine, Sgt. Jones is still in constant pain from the injury, despite taking many different precription painkillers and trying everything to numb the pain from experimental electric stimulation to a daily six-pack.

More information about ICON

A group of Harvard Medical School students are on Jones’ case study – which stumped his case doctors – using a recently developed suite of Internet tools that boost student-faculty interaction in an engrossing twist on traditional case-based teaching at the Medical School.

Called ICON, for “interactive case-based online network,” the cases are run by a faculty-student-IT specialist trio at Harvard Medical School, backed by extensive cross-faculty collaboration. ICON is revamping neuroscience case-based learning by engrossing both students and faculty in the plight of virtual patients struggling with real-world diseases.

ICON is in its first year of use at HMS and its second year for undergraduates as part of the Mind/Brain/Behavior (MBB) Interfaculty Initiative. It was designed and developed by the Harvard Interfaculty Neuroscience Program, a year-old program that includes faculty from the Medical School, the Faculty of Arts and Sciences, the Business School, the Derek Bok Center for Teaching and Learning, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Massachusetts General Hospital, and the Massachusetts Mental Health Center. It was developed with support from the Provost’s Funds for Interfaculty Collaboration and Innovations in Instructional Technology.

Assistant Professor of Neuroscience at the Medical School James Quattrochi, the program’s director and ICON’s developer and driving force, said ICON’s online case-based learning modules allow a greater level of student and faculty participation than possible in traditional, paper-based case learning.

Rather than presenting the entire case to the class, Quattrochi drafts the outlines of the case and presents them on ICON. He then participates through discussion and by providing additional information – such as academic papers, illustrations, neuroimaging, current clinical trials, and interactive online tutorials of pertinent topics. The aim is to challenge the students’ scholarship and thinking as they work through the case.

He reveals more about the case as students go along, giving the exercise a real-time student-centered approach. The case can also readily adapt to current events, like having a pain patient be unable to get his medication because of an oxycontin robbery at the local pharmacy, mirroring a similar wave of robberies last year.

The ability to adapt to such events, Quattrochi said, gives students a forum to explore and appreciate psychosocial and ethical considerations of the case in addition to the science. Understanding the impact of science on patients and the real-life pressures they’re under, he said, is critical in the training and development of the best doctors.

“The medical students said it instilled a vivid realization of professionalism in their responsibilities to the characters in the case,” Quattrochi said.

Quattrochi isn’t the only one involved with ICON. He has recruited other outside experts including writer Michael Crichton and Harvard faculty members to participate in ICON and even to assume the roles of the characters in the case using ICON’s virtual contact module where students get to ask questions of the case characters. In this way, faculty have direct involvement in shaping the students’ learning – adding information such as a new symptom or complication, or a cryptic comment that sends them in a new direction.

“It’s great,” said John Lester, information technology director for Massachusetts General Hospital’s Neurology Department, who handled the technical details of ICON’s setup. “Someone with expertise in epilepsy plays the role of the epileptic. It’s perfect casting.”

ICON’s virtual contact module proves not just educational, Quattrochi said, but also addictive. At least one faculty member, he said, had to be reminded to get some sleep by his wife because he was still up at 2 a.m. interacting with students in the case.

“It’s real for them,” Lester said.

Ronald Arky, Charles S. Davidson Distinguished Professor of Medicine and Master of the Francis Weld Peabody Society, said he has supported the project with office space at the Peabody Society because of an interest in new approaches to medical education.

Arky, who played a physician in one case, said the student-student interaction and the student-faculty interaction is really at ICON’s core. ICON strives to use technology to create a similar learning experience as that done in small-group settings.

S. Allen Counter, associate professor of neurology in the Faculty of Arts and Sciences, who is on the undergraduate committee for molecular and cellular biology, said he has watched ICON’s progress and even tried it out a few times. ICON appears to be a useful new tool, he said, but added that people shouldn’t think of it as a replacement for the traditional face-to-face time between student and faculty member.

Quattrochi agrees that ICON is not intended to be a substitute for face-to-face class time, and said, in fact, it enhances the quality of class time, by energizing a student-faculty synergy and ensuring that students are thinking about the subject between meetings.

“When you get students continuing to work on a case through spring break, it’s got to be working,” Quattrochi said.

Dean for Medical Education Daniel Lowenstein, the Carl W. Walter Professor of Neurology and Medical Education, said ICON fits in with the Medical School’s broader mission of improving medical education. He said the use of real people posing as characters helps ICON lend a real-life aspect to case-based teaching.

“By being able to have real people play the role of the characters of the case, it comes much closer to bringing life to the problem,” Lowenstein said.

ICON isn’t without its drawbacks, however, as the faculty involvement puts additional demands on already scarce time. But Quattrochi said he believes the energy, excitement, productivity, and learning that results for the students is worth it.

“ICON fosters a team approach to problem solving, with students engaging in active collaboration rather than competition,” said Arif Nathoo, a second-year medical student who helped bring ICON to HMS.

ICON, described in the March 2002 issue of the Journal of Science Education and Technology, was developed starting two years ago and first went into practice in 2000-01 with undergraduates in the MBB tutorial curriculum. This year ICON was also used for eight medical students of the Francis Weld Peabody Society enrolled in the Human Nervous System and Behavior tutorial led by Quattrochi.

What’s groundbreaking about ICON, Quattrochi said, is that it is driven by the student, not by fancy graphics and software tools. The software is in the background and the collaborative relationship between students and faculty working on the case is in the spotlight. It’s through the students’ desire to learn and faculty facilitating that desire with appropriate character roles and current relevant resources, that the transfer of knowledge takes place.

“ICON is student-driven, it’s not content-driven,” Quattrochi said. “This is a way to have a collaborative learning environment where students interact among themselves with the active participation of the faculty. It has revitalized a student-faculty synergy in learning.”

There are risks to this kind of collaborative online community, however: it might not work.

Being student-driven, the learning that results from making progress in the cases is dependent on the active participation of the students – discussing hypotheses, formulating diagnosis, and interacting with the characters in the case.

“A community of practice has its own group dynamic and has to jell,” Quattrochi said. “Students could resolve not to interact and do absolutely nothing and force me to put up all important information and transform it into a typical content-driven course. It’s a true synergy. If the faculty drops the ball, it dies. If the students drop the ball, it dies.”

Quattrochi, Lester, and Nathoo are already making plans for next year. They’re considering adding another component that would enhance the realism even further by making ICON patient-driven rather than student-driven. That would mean rather than the cases progressing as students figure things out, the case and its characters would move at their own pace. New characters will be introduced, such as nurses, physical therapists, social workers, emergency medical technicians, and managed care providers. The virtual patients could even page the students as new information develops.

ICON is potentially useful in other courses, but Quattrochi said it’s important for faculty to realize that ICON is more a new learning approach than a set of new software tools. While the software enables the collaboration that jells around the case, without the input from faculty, the software is useless.

“What ICON does is shine a bright light on the learning dynamics of a team of faculty and students,” Quattrochi said.