Future Directions

Highlights of a Conversation with Dr. Burkhoff and Dr. Dickstein:

CCNMTL: CCNMTL believes 1st-year medical education could be dramatically changed/improved through the use of multiple system tools like simulators. Do you agree, and if so, how?

Dr. Burkhoff: Yes. Simulations make text and concepts come alive. Thoughtful integration of text and simulation on the Internet will become the new standard for textbooks of medicine. We should lead the way in developing this new standard. In addition to enhancing self teaching, simulations will allow students to participate in experiments they would ordinarily have no access to.

Dr. Dickstein: Absolutely. I have already used the heart simulator to teach cardiac physiology to the 1st year medical and dental students this year. Rather than simply describing important relationships, I could demonstrate them. And rather than simply reading about important principles, students could discover them for themselves. In medicine, we make observations about patients and relate that to what is going on in the body. The simulator allows students to learn in the same way.

CCNMTL: Could you foresee running the entire course through simulators? If so, how might it work?

Dr. Burkhoff: Simulations could be incorporated into most aspects of physiology teaching. Courses of cardiovascular physiology and probably some other organ systems can be built around simulations. I ran a grad course in the past. The way it worked was that I would give a lecture during the course and the lab course consisted of students working in small groups designing experiments, executing them in the simulation, collecting and analyzing data, and making conclusions. This sort of paradigm could be expanded.

As an example, what are a 2nd and 3rd body system that could/should be modeled with a similar simulator. I think the lungs would be the next example. There are graphs similar to the cardiac PV loops that could be implemented in a similar manner. Kidney is another obvious target.

Dr. Dickstein: I think that many physiologic principles would be more easily understood with the use of a simulator. It is incredibly valuable to interact with a system in order to understand it. Starting from the building blocks, such as molecular transport mechanisms, osmotic forces and the Nernst equation, all the way to homeostatic mechanisms that allow us to stand up and not pass out, would all be more accessible to students with the aide of computer simulations.

CCNMTL: How might a kidney or other system simulator work? What would the variables be? Would it be used similarly?

Dr. Burkhoff: Blood flow and content are the inputs; the simulation is of the glomerulous with its various anatomic locations showing movement of ions, molecules and fluid at various parts. The outputs are the urine volume and content, and blood content of the venous blood leaving the kidney. There are at least a dozen molecules/ions to keep track of, which is why renal physiology is so confusing. The simulation, I predict, will markedly enhance students' understanding of this complex organ.

Dr. Dickstein: The unifying principle in all of the simulators is that the student would be able to change certain parameters and observe the impact of those changes on the system's behavior. The kidney, for example, would be an ideal organ to simulate. It is easy to describe individual relationships; what is daunting is trying to describe the interplay of perfusion pressure, proximal and distal resistances, membrane permeability, oncotic pressure, ion concentrations, renal blood flow, renal plasma flow, and filtration fraction on the production of urine.