I hope this sparks new discussion in this forum and silences the assumptions and unfounded statements.

Steve
IUHS MS4

Hi Steve,

The IUHS grad who is licensed did not do his pre-clinical on-line. He was a transfer student. As well, IUHS does not display that the pre-clinical was on-line on their transcripts. Possibly a few grads could slip by, but I fear there will be trouble when it becomes known.

Some IUHS students do find a mentor and have exposure to hospitals, lab work, etc., but the vast majority of students have never done any lab work, dissected cadavers, etc. This school is lacking and I know that you want to defend it because you will be a grad soon.

I sincerely wish you good luck, but please don't try to defend this sham of a school!

Carmen

Hi Steve,

This issue has been around without any absolute conclusions. That is due to the fact that this issue is not front and centre with any problems at the moment. Just imagine if you will, the media frenzy when the first on-line student finds themselves in litigation, and I do expect it to happen for many reasons.

If you contact EACH AND EVERY STATE, ask them the question at hand, you will discover they will NOT license any student who has done on-line basic sciences. As Carmen states, the transcript does not display this fact. This will soon change as there are many states (to whom I have spoken directly) that will be asking for this information. When that happens, it will affect every previous student whose degree will then be in question. This is not my opinion, this is the opinion of the 50 states that I contacted when I was interested in this medical school.

You may well move along in the system that is not watching for this very closely at the moment. I am sorry to hear you that you have spent your time in on-line medicine rather than have applied to a regular local medical school.

This school is continuing because of the large population of people who desperately wish to enter medical school, and who do not have the educational credentials to compete with regular admission criteria.

As Carmen states, the school is a sham. Many students are in too deep, past the point of no return and basically hoping it works out for them. It might work out for them until the medical establishment turns its eye to the issue in a serious manner.

I truly understand your point and your bias against online basic sciences. I have previously stated here that done responsibly it is totally doable. In the case of IUHS it seens it is not been done responsibly, at prima facie.

As far as I know, there are no written rule or law that demands any school from explicitly stating in a school transcript that a program was completed onsite or online, ask any lawyer. Many reputable US academic programs have online components and the transcript does not reflect that either, of course not in medicine. As you point out, that might change in the future. I have spoken with several medical boards, and some of them have told me that they really look at their boards exams and do not pay much attention how they completed the basic sciences portion. We can discuss via PM which board said that, not here. Some have told me what they have told you, so we are , more or less on the same page.

Right now, when it is time for licensure, a medical board can simply ask a student for proof of residency at the site where he or she alleges completion of basic sciences, passport, visas, etc. No rocket sciences there.

Now, just to ask you the same question I asked Azskeptic and it was inetresting to notice how the question was dodged, and if you simply do not want to answer it, just say so, but try to be as honest as possible.

Hypothetically speaking, if a student presents to a board, passing USMLE Steps I, II, and III, excellent clinical sciences letters of recommendations, and excellent markings on his clinical studies, has completed a residency training in which he or she have been exposed to direct patient contact and completed their residency with excellent remarks, BUT the only sin the student committed was to complete his or her basic sciences online, will that make him a worse physician than one from a traditional basic sciences curriculum and ended up with the exact same academic performance?

How do you evaluate performance?

Just let me know.

As I said before, I am an advocate for technological change, technology and times change, so does medical education, it is not a sacred cow. However, I do understand it has to be done RESPONSIBLY.

Respectfully,

Maximillian Genossa

This is such an interesting topic, as we as American educators are now dealing significantly with how to get the basic and clinical didactic material to the students via technology. The latest I heard last week was that we should now be considering "podcasting", so that our material can be seen by the students and residents anywhere they are on "ipods". With the increase in Allied Health students, especially the physical therapy doctors to be (yes they get doctorates now too), and the rapid increase in nursing students (big nursing shortage in country), lecture rooms are at an all time premium. Nobody wants to build new lecture rooms, because they all want to build new laboratory space for researchers, and specialized outpatient/daysurgery clinics. Tight budgets are not replacing the retiring basic science professors, unless the new hires are fully funded researchers (that don't want to teach). Thus technology will be hitting us much faster than many of us thought. And of course as the lectures are becoming webbased, now all the involved professors want intellectual rights to any use of them. Some American schools are working hard to put out excellent approved web based series so that they can market them to other schools. You can see how fast this is moving in CME training. The basic science professors see this as a way to be entrepreneurial and bring dollars into their departments, so they can have less teaching duties and get more NIH research grants which has become the golden goose for all US medical schools now. State budget constraints and the high expense of training medical students at state institutions without much tuition reimbursement will create many novel education models in the next few years. The impending doctor shortage will likely force some states to start new medical schools, increase class size, or bring back the 3 year MD.

As a medical faculty member involved in using educational technology or the internet in education, I have to point out that there are some pitfalls and good uses of the internet in basic sciences for the first 2 years. Ron Harden at the Centre for Medical Education, University of Dundee in Scotland is trying to put together IVIMEDS, which is an internet version of medical education. He has already established a curriculum, which is not difficult given the standardization of medical education in the UK and elsewhere. Technically, the knowledge required can be acquired whether by lecture, problem based learning or group study or systems or regional based learning or independent self learning. However, in anatomy and pathology, one needs to see the human cadaver or the expanse of tumours and disease to gain an understanding of the extent of disease or the relationship of anatomical structures so one can build a 3D picture of the human body. It is really a matter of scale and relationships of anatomical structures before one truly understands anatomy. Pathology is not just what is found in Robbins et al but also the experiences and folklore you learn from academic and clinical pathologists. Seeing the pathological specimen very often helps you understand what the extent of disease can be and why it appears as it does in clinical presentation. I have taught medical, dental, nursing and occupational therapy students anatomy and physiology and the one aspect that they have remarked about upon seeing the anatomical specimens and some of the pathology is that they had a realistic scale and understanding about what the anatomical structures or pathology actually was and how they are related 3D. Also, lacking through the internet version of basic sciences medical education is how to do history, physical examination, diagnosis and prognosis or the various aspects of a medical interview. What philosophy of medicine is being taught? If it is patient centered, you need to see it in action and unfortunately, the internet does not and can not really convey this aspect very well. Having an independent study method where one links with a physician would be good but you actually need to link with many physicians so students can take the good aspects of these physicians and dispose of the bad habits they see in them. If you train with only one physician, you only see one way of doing the medical interview or HPE and thus you do not develop your own methods. Let me side track, I was a soccer referee who reached the national or professional levels for a few years. I learned my craft from working with many excellent, top notch or top level referees and assistant referees. I used some of the things, such as player management or awarding a penalty kick without being hassled or questioned, I saw from these referees because they worked for me but I had to discard some of the other techniques because they did not work for my personality or myself in general. The same is true in medical communications. You will be given a method for delivering bad news such as a cancer diagnosis or a diagnosis of terminal disease to patients, however, you will need to develop your own method that works with a variety of patients for yourself. If you are uncomfortable with handling this situation, patients will pick up on this and be uncomfortable as well and then the situation can totally breakdown with no resolution. This is not a good outcome for anyone. Some physicians in training develop a thick skin like "House" on TV and think this is good--personally I think "House's" manner stinks as he is a self absorbed a--hole and gives physicians a bad reputation. Others try having a caring attitude such as "****" on ER. But TV aside, you, the individual physician in training, need to develop your own style. The internet is not a place to do this nor is having a single mentor a good approach either. This is why stand alone institutional medical schools associated with a particular area are important because it is the variety and not the singleness of one's approach that adds to the educational experience. IUHS program really needs to be more in line with IVIMEDS and use many mentors and be properly monitored and administered. This takes time, effort and money, but in the long run can contribute greatly to the future of medical education if done right!!

I agree with all of you regarding some merits to distance education. Taking pathology on-line at Harvard is fine, but doing your entire pre-clinical education without labs, hospital experience, patient interaction, simulated patient exams, etc. is deficient.

Ming is correct in what all medical licensing facilities will tell you. If you call and say "I attend Harvard and took Pathology on-line", they will probably welcome you. But if you state "I attend IUHS and I stayed home and worked while I did my medical education at night without ever attending the island of St. Kitts or mentoring in a hospital", they will tell you to stay away.

The issue of IUHS is much bigger than simply on-line education. Students are sent to write the USMLE exams without ever meeting their professors, Registrar and other students. I think this is a little scary. A reputable medical school can incorporate on-line very well, but a school that has only 4 or 5 professors teaching, it is impossible to gain a proper education.


Carmen

"IUHS program really needs to be more in line with IVIMEDS and use many mentors and be properly monitored and administered. This takes time, effort and money, but in the long run can contribute greatly to the future of medical education if done right!!'

I couldn't agree more with you and that is why I emphasize the phrase ..DONE RESPONSIBLY.

Thanks for your valuable input.

You hit the nail on the head..."State budget constraints and the high expense of training medical students at state institutions without much tuition reimbursement will create many novel education models in the next few years."

The discussion is moving the way I anticipated. Your input is valuable and I appreciate it.

Thanks

Max

I truly understand your concerns and I have to reaffirm that I am not defending IUHS practices, I am simply advocating for technological advances in the teaching of basic sciences for the 21st century and I see online basic sciences education as an excellent example on a curriculum that can be improved and delivered using cyberspace with certain limitations, like anatomy guy and prof point out. I have always emphasized and will emphasize done responsibly and I do not believe IUHS is doing it responsibly, I have said that before.

Now, my question remains unanswered about the case I presented, here it is again to stimulate the discussion further...if a student presents to a board, passing USMLE Steps I, II, and III, excellent clinical sciences letters of recommendations, and excellent markings on his clinical studies, has completed a residency training in which he or she have been exposed to direct patient contact and completed their residency with excellent remarks, BUT the only sin the student committed was to complete his or her basic sciences online, will that make him a worse physician than one from a traditional basic sciences curriculum and ended up with the exact same academic performance? How do we measure performance?