Dangerous Ideas: Virtual GP

Virtual-GP (V-GP) is a groundbreaking mobile app with the potential to revolutionise the medical school curriculum, potentially making early GP placements redundant. Many of the basic communication and examination skills acquired by medical students at their GP placements can be replaced by this app, which simulates patient contact via interactive pair work with clinical ‘signs and sounds’. It has been designed to help medical students learn and perfect the two core skills of history taking and clinical examination.

It is usable by student pairs (with role play) or suitable for lone study. V-GP contains step-by-step guidance on how to take a structured patient history, highlighting key questions to ask to determine potential conditions and providing patient scenarios for pair work. The scenarios give the student acting as the patient key things to say under the relevant history headers to focus the student and mimic a real-life consultation. In the examination section, when working alone, V-GP will provide algorithms, videos, pictures, and detailed guidance on how to properly complete a competent examination. In the interactive clinical examination section, students are presented with clinical signs and prompted to play sounds dependent on the chosen examination, for example heart sounds. This will enable them to practise observing clinical signs (both normal and abnormal), rather than just methodically fixating on the examination steps. When students then examine patients in their clinical years, they will be more confident and competent due to practice with this thorough simulation tool. V-GP offers the same as a clinical contact experience and more by providing scores and detailed feedback. This means students are also able to save and track their performance.

We believe this app can replace early patient contact entirely, as little benefit can be gained from unfocused, unknowledgeable patient consultations in the pre-clinical years. It will allow students to develop skills for direct transfer to the clinical setting in the final years of study. This app will significantly reduce training costs and free up clinician time otherwise spent in training activities, although not all sectors of the health service would necessarily welcome this reduction in income!

This idea is dangerous because we, the developers, truly believe this form of e-learning can replace patient contact. This will inevitably become a real-life trend as developments in self-monitoring and e-health, coupled with spending pressures on the health service, drive the need for technology-enabled care. We do not see the value in exhaustive face-to-face patient contact in the early years of training without a prior understanding of the fundamental basics of clinical medicine, history, and examination, and believe modelling of professional behaviours by clinical staff is overrated and unnecessary. We feel that, more importantly, the quality of pre-clinical GP placements are inconsistent and V-GP will allow the standardisation of the curriculum and equity in learning experiences, putting all students on a level playing field.

This app should be integrated by all medical schools into the current programme. It is current, fun, and will not only engage students and benefit their education, but it will also save medical schools money, assist the public purse in directing expenditure to areas of greater need, and completely remove any risk to patients of encountering an inexperienced medical student. Any risks perceived by others in terms of clinical communication skills or patient-centred care are based on outdated concepts of care. The use of simulation to replace clinical contact is inevitable as simulation technology advances and now is the time to truly integrate this into undergraduate training.

• © British Journal of General Practice 2015