I hope if I have the misfortune of requiring the services of EMS, you are not the individual dispatched to respond to my emergency. If you believe SecondLife has any place in the training of physicians, you obviously haven't used the simulation. Walking around in a virtual world "chatting" with patients will teach an individual nothing. If anything, it will harm students by dumbing down the medical environment to the point where the consequences of actions appear cartoon-like and unrealistic. As you astutely pointed out, there's nothing quite like performing chest compressions on a dying human being (I've had the misfortune of doing it many times in my brief medical school career). SecondLife cannot duplicate that. Hunting for a vein on someone who is bleeding out... where is SecondLife's simulation for that? Instead, it's designed to help students interview patients and diagnose diseases based on a set of prompts. Most patients don't present with those textbook symptoms. You're missing the entire category of physical diagnosis, too - no stethescope, no palpation. Heck, you can't even tell if the patient's pupils are dilated or their skin is dusky, clammy, cool, or hot. The body language, if any utilized, is exaggerated and unrealistic. The interview is carried out how... microphone and headset? While you look at a cartoon avatar on your computer screen. So much for realism. What's the point? To waste students' time and drum up publicity.

I'm tired of the publicity stunts. Medical education works. And for the record, I'm not surprised by your attitude. Virtually every EMT I've spoken with thinks they're God's gift to medicine; humility is not in your ride along duffel bag, I guess. Your experience riding around in an ambulance transporting grandma to her dialysis clinic every MWF, interspersed with the occasional "true" emergency makes you super-qualified to talk about in-hospital training... particularly in-OR training, which was specifically mentioned in the summary as a feature of this simulation.

1. Medical students do not perform "open heart surgery." Interventional cardiologists and cardiothoracic surgeons, who do perform surgery on the heart, have at a minimum 4 years of college, 4 years of medical school, 5 years of supervised residency training (where they are required to complete a large number of cases under the supervision - in the OR - of attending physicians who have years of experience in the field), and a year or two of specialized fellowship training. No. A simulator is not what I want the surgeon working on my heart to be trained on. I want him to have thousands of past surgeries on real people - both observed and performed under supervision - before he is allowed to fly solo and operate on me.

2. No simulator created in second life or any other "virtual realm" can accurately reproduce the complexity encountered in operating room or emergency situations.

3. If, as the article says, the idea is to teach students interviewing and diagnostic skills, they're doing this with both hands tied behind their backs: the basis of medical diagnosis is a thorough history and physical. The history is usually obtained through discussion with the patient... much of what is communicated is non-verbal and cannot be represented in Second Life. In fact, some studies estimate that more than half of human communication in a healthcare setting is communicated non-verbally. In addition, without the ability to actually touch the patient, listen to their heart, their lungs, palpate their abdomen or a wounded extremity or injured joint, their is no furtherance of physical diagnosis skills.

In short, this program is useless nonsense intended to capture media attention. It implies that the art and science of medicine can be simplified to the extent that all we need are computer simulations for people to become physicians. I can't wait until I hear about the daytime TV advertisements: "Stuck in a dead end job, need more money? Become a doctor - online! - in just 6 to 8 months through Kaplan College or University of Phoenix online! We'll teach you all you need to know through our SecondLife patient simulation system!"

You're welcome to see a doctor trained with these tools. I prefer a doctor who knows how to interact with real human beings in real situations and who has taken the time to read the books, perform the self-examinations, and complete the continuing medical education training necessary to be prepared "for [a] much greater scope of training." If you don't know enough of the science to be safe in real life - even as a third year medical student (when most schools permit their students to see patients full time) - and you need additional training in SecondLife to supplement your skills and keep you safe, I postulate that your medical school has failed in properly educating you... and they should lose their accreditation.

Lastly, I don't know what you think goes on in medical school, but there is rarely a situation in which real-life patient contact is either expensive or risky. Seeing a patient in the ER with chest pain... I know enough to get the attending... the nurses know enough to get the attending if I'm too dumb to do so... the unit secretary even knows enough to get the attending if both the nurses and I fail to pick up on something (and the secretaries usually have just a high school diploma). Risky situations tend to come later on - in residency. By that point, one would hope you've had enough real-life training under the close guidance and supervision of licensed physicians to be competent enough to know when to ask for help and admit you're in over your head. Then again, if you got your medical school training in SecondLife... who knows how you'll do.

I'm currently a 4th year medical student and can tell you from personal experience that nothing... absolutely nothing... can replace face-to-face training with real-life patients. SecondLife is a fun playground, but it's not a place to learn to practice the art of medicine or the scientific basis for diagnosing disease. Talking to virtual avatars or playing in a virtual OR is nothing like real life. For instance, in a real-life OR, you must vigorously scrub your hands for 2-3 minutes with special cleanser before you're clean to "gown up." When you're standing around waiting for the procedure to start, you have to have your hands crossed in front of you in a special position to avoid touching anything that isn't sterile, including your own face, sides of your gown, etc. Good luck reproducing these intricate details in Second Life.

Virtually every medical school in the US has a "patient simulator" laboratory where mechanical / robotic dummies are used to train future physicians. These labs also host "simulated patients," - actors, usually from the community, who are trained to play the part of a patient with a specific disease. It isn't cheap for schools to do this, but it's a lot more realistic to perform your first vaginal exam or rectal exam on a real person than in a SecondLife virtual world. Same goes for performing other aspects of the physical exam. How is a student to put their stethescope to the patient's chest, carotid arteries, abdomen, or back in order to arrive at a diagnosis when there is no mechanism to do so in SecondLife? These are things that must be experienced to learn.

If you want to learn to be a doctor - go to a real medical school, interact with both real and trained patients in real life, and learn the intricacies of the art of talking to a patient, sharing your compassion with them, and working through their problems or concerns under real conditions. When a patient with depression and suicidal ideation shows up to the Emergency Department and there are 13 other patients waiting to be seen, I have to make a decision about how much time I'll spend with them. Do I talk them through their concerns? Do I let Social Work handle it? Do I call for a psychiatry consult? Doing these things in second life are easy and have few repercussions. Calling for a psych consult at 3:00 AM on a Tuesday for simple SI and depression will get my head ripped off by the poor psychiatrist who has to come in to do what I should have been able to do myself.

All this will do is build barriers and put "blinders" onto future physicians. "It couldn't have been a heart attack - he didn't have left sided chest pain radiating to the arm and jaw. He had no shortness of breath! That's how I was taught MI's all present in Second Life!" Med schools need to stop cutting corners and trying to implement these ridiculous ways of trying to be "cutting edge." Want to be cutting edge? Implement a computerized medical record system that actually works - for starters - and institute a system by which patients evaluate their physicians in a publicly available forum so that we can see which docs should be doctors... and which shouldn't. That would do more for patient care than any of this Second Life nonsense.

You're totally wrong in thinking that lowering the bar for admission to medical school will have any impact on the number of doctors graduating from medical schools in the USA. In this document, released by the Association of American Medical Colleges (which runs the unified application program for all but a handful of American) you can see on page 3 that while the number of applicants to medical schools is about 45,000 per year as of 2007, only about 17,800 students actually got into medical school (less than 40% of applicants). This isn't because 20,000+ students mis-read the requirements or didn't pass organic chemistry. Every medical school in the country fills its incoming class, 100%, every single year, meaning enough qualified candidates exist to populate our medical education system (with 20,000+ left over!) We have plenty of people interested in becoming doctors, but there simply isn't the CAPACITY for all students who want to become doctors to do so. Since 1982, the number of open positions at American medical schools has increased from 16,567 to 17,759. That is an increase in number of accepted students per year of just 7% - over the course of 25 years!

There simply are not enough spots for willing applicants. We need more medical schools in the US (when was the last time you heard of a new medical school opening anywhere?) Almost all of the 45,000 applicants each year will have completed all of their pre-med requirements, including organic chemistry. Organic chemistry is not the barrier to having more doctors in our country. The statistics prove that the real barrier is a lack of funding for new medical schools and a lack of expansion of existing medical education programs.