News Articles – i-Human Patients, by Kaplan Comprehensive simulated patient encounters for medical education. Fri, 20 Jul 2018 21:03:33 +0000 en-US hourly 1 Medical college makes learning interactive Fri, 16 Feb 2018 15:44:09 +0000 UCMS students use simulated virtual patients to practise clinical reasoning skills


Aimed at providing an opportunity to engage students in a manner that would improve learning, the faculty at the University College of Medical Sciences (UCMS), Delhi, has developed two Simulated Virtual Patients (SVPs) for medical students to gain clinical experience with simulation tools.

“Medical students in India are using computer-simulated virtual patients (SVPs) as a learning tool for clinical skills and are becoming more enthusiastic about their studies. SVPs allow students to interact with and perform procedures on pretend patients that are programmed to exhibit symptoms of illness or injury,” said Dr. Satendra Singh who supervised this project on i-Human Patients platform. READ MORE…

Medical students gain clinical experience earlier with simulation tools. Wed, 14 Feb 2018 20:00:21 +0000 The American Physiological Society Press Release | READ FULL ARTICLE

Bethesda, Md. (February 14, 2018)—Medical students in India are using computer-simulated virtual patients (SVPs) as a learning tool for clinical skills and are becoming more enthusiastic about their studies. SVPs allow students to interact with and perform procedures on pretend patients that are programmed to exhibit symptoms of illness or injury. The article is published in Advances in Physiology Education.

Due to a tight program structure, medical schools in India typically do not expose students to real patients until the second year of study. Text-based cases teach clinical reasoning in the first year but do not provide the opportunity to practice clinical examination or develop the skills to take patient medical histories. In addition, the lack of early clinical exposure has been shown to reduce students’ enthusiasm when they begin clinical studies. Faculty at University College of Medical Sciences in Delhi, India, developed two SVPs to “provide an opportunity to engage students in [case-based learning] with greater frequency” and improve learning in endocrine physiology. READ MORE…

EARLY CLINICAL EXPOSURE – Development and validation of simulated virtual patients to impart early clinical exposure in endocrine physiology Tue, 23 Jan 2018 18:14:27 +0000 How we teach | Generalizable Education Research READ FULL STUDY


In the country presently, preclinical medical students are not routinely exposed to real patients. Thus, when they start clinical postings, they are found to have poor clinical reasoning skills. Simulated virtual patients (SVPs) can improve clinical skills without endangering real patients. This pilot study describes the development of two SVPs in endocrine physiology and their validation in terms of acquisition of clinical knowledge and student engagement. Two SVPs, Nandini Sharma (unintentional weight gain) and Sunil Yadav (polyuria), were created and published on the i-Human Patients platform through an iterative, interdisciplinary, and transdisciplinary collaborative process using the conceptual framework of Kim et al. (Kim S, Phillips WR, Pinsky L, Brock D, Phillips K, Keary J. Med Educ40: 867–876, 2006). After internal and external peer validation, the SVPs were piloted on 40 students (20 students per virtual patient) over 2 wk. A cognitive pretest was conducted before exposure, and a posttest soon after. Faculty and student feedback were collected. Faculty found SVPs authentic, helpful as teaching-learning tools, and useful for giving feedback and for assessment. Students found SVPs more engaging than paper cases and helpful in developing clinical reasoning and in imparting clinical exposure. Pretest and posttest scores indicated knowledge gain (P < 0.01). Although challenging to create, SVPs created on the i-Human Patients platform improved learning in endocrine physiology and were well accepted by students and faculty as a means to provide early clinical exposure. More SVPs can be developed through collaboration between stakeholder departments and integrated into the curriculum for greater benefit.


The Nurse Practitioner, forum discussion Fri, 28 Jul 2017 19:22:35 +0000 New and Noteworthy

Drexel University NP students use virtual patients to hone skills, by Jamesetta (Jamie) A. Newland

Students at Drexel University’s College of Nursing and Health Professions are using the i-Human Patients Case Player, which simulates a complete medical patient encounter with animated avatars, human physiology and pathophysiology, virtual histopathology, and 3D anatomy to help improve patient assessment and diagnostic reasoning skills. The patient simulator provides practical clinical experience to students prior to training with actual patients.  Read full article

Drexel University uses i-Human Tue, 11 Apr 2017 17:55:34 +0000 6abc Action News

Click to view full story & video on 6abc Action News

From WPVI-TV 6abc Action News in Philadelphia, PA

It’s the medical training version of the old joke about getting to Carnegie Hall – “practice, practice, practice.”

Technology has changed the way we learn on every level of schooling.

At Drexel University’s College of Nursing and Health Professions in Philadelphia, a new system is giving some medical pros in-training practical experience, through a unique collection of ‘patients.’

And it enables them to practice hundreds of cases, above and beyond what any student could see in a clinic.

You can clearly hear a human cough as you walk near Kevin Nusspickel, a student in the Nurse Practitioner program.

But it was not coming from Nusspickel.

It was from the i-Human program he uses in his training.

i-Human is the latest twist on a patient simulator.

Instead of the animated mannequins that have been the mainstay of medical training for decades, Drexel is using computer-generated patients from a cloud-based system.

“i-Human brings the textbook to life for our students,” says professor Jennifer Olszewski.

Each week, they’re assigned one of 350 patient cases.

They do a head-to-toe examination, just like they would on a real person.

They listen to the heart.

“Not only are you listening to the heart tones, but you’re learning what you’re listening to,” says Nusspickel.

They assess breathing, check pulses, examine the throat, and…

“You can go into the eyes,” he adds.

“This is the one I found most helpful. You can look at what you would see with an ophthalmoscope, when you look inside the eyes,” he notes.

Students can also ask the patient questions, order tests, and read the results.

Plus, they can study anywhere, anytime, with professors reviewing their work and giving them feedback.

“It lets them make mistakes on a computer screen, before they hit real patients, and they get to learn from that,” says Olzsewski.

i-Human’s developers can add new cases, to respond to changing needs in the real patient world.

Last year, a zika virus case was added, so practitioners could learn to recognize and treat the emerging health threat.

Nusspickel thinks it’s already made him better in his current job as a registered nurse.

“I’ve become more systematic in my approach, and I definitely feel more thorough,” he notes.

One graduate told us he really learned how to ask the right questions, to get useful information from his patients.

Several other nursing schools are also using i-Human, which was developed by i-Human Patients, Inc., on Sunnyvale, California.

Drexel’s program reaches its students in 31 states.

Diagnostic Errors Are More Common Than You Think, by Norm Wu Thu, 23 Feb 2017 18:28:31 +0000 Read on The Doctor Weighs In

According to a seminal 2015 report on diagnostic error by the Institute of Medicine,

It is likely that most of us will experience at least one diagnostic error in our lifetime, sometimes with devastating consequences.”

Indeed, studies on diagnostic error in the U.S. have suggested overall misdiagnosis rates range from 5% to 15%, and are sometimes as high as 97% for certain diseases like celiac disease.

Misdiagnosis results in poor patient outcomes and excessive healthcare cost. A Johns Hopkins study concluded it is also the single largest cause of medical malpractice lawsuits, accounting for 35.2% of payouts and an estimated 80,000 to 160,000 potentially avoidable deaths and significant permanent injuries each year. The misdiagnoses stem from delays or failure to treat an underlying disease, or from treating diseases that are not actually present. That would make diagnostic error the third leading cause of death in the U.S. after heart disease and cancer. A study published in BMJ reports that approximately half of all diagnostic errors with adult outpatients are potentially harmful.

An inconvenient truth

If diagnostic error is such a big deal, why don’t we hear more about it?

Overall, diagnostic errors have been underappreciated and under-recognized because they’re difficult to measure and keep track of owing to the frequent gap between the time the error occurs and when it’s detected,”

says Dr. David Newman-Toker, leader of the Johns Hopkins study. He goes on to say, “These are frequent problems that have played second fiddle to medical and surgical errors, which are evident more immediately.

Indeed, accurate data on diagnostic error rates is exceedingly hard to come by, so no one knows the actual number for sure. Even the definition of diagnostic error has been the subject of much discussion amongst those who follow the topic. Nevertheless, physicians I’ve spoken with agree that it is much more common than the public realizes.

In addition, Newman-Toker suggests that experts have downplayed the scope of diagnostic errors because they are afraid to open a can of worms they can’t close. He says,

Progress has been made confronting other types of patient harm, but there’s probably not going to be a magic-bullet solution for diagnostic errors because they are more complex and diverse than other patient safety issues.

It should also be noted that, traditionally, physicians and other clinicians have been reluctant to report their colleagues’ diagnostic errors when noticed due to a culture of mutual support. They’ve also been reluctant to self-report mistakes in fear of malpractice liability. Similarly, hospitals and other provider organizations have an incentive to protect their reputation and finances by not drawing attention to diagnostic errors. It’s also natural to believe that while such errors may be more common than generally appreciated, the problem lies with others.

What is diagnostic error?

Diagnostic error can be thought of as a failure to accurately identify and communicate on a timely basis the cause of a patient’s health problems. Not surprisingly, effective treatment plans—from both patient outcome and cost perspectives—depend largely on accurate and timely diagnoses.

The Society to Improve Diagnosis in Medicine suggests that there are three subcategories of diagnostic error:

  • Wrong diagnosis. An example would be when a patient who is having a heart attack is diagnosed as having acid indigestion. The accurate diagnosis may be identified from a post-mortem study. This, of course, isn’t always done. And when it is, the data isn’t necessarily flagged and reported as diagnostic error, making actual data hard to quantify.
  • Delayed diagnosis. The most common is cancer. If it isn’t detected early, it usually becomes much harder to treat. However, many illnesses aren’t suspected until symptoms persist or worsen.
  • Missed diagnosis. Sometimes, the causes of patients’ complaints are simply not identified. Examples might include chronic headaches or fatigue or loss of appetite.

Why do we have so many diagnostic errors?

The causes of diagnostic error are many, and can be attributed to cognitive issues driven by the complexity of diagnosis and to system issues driven by the way healthcare is delivered.

With almost 70,000 diseases represented by ICD-10-CM diagnosis codes, but less than 200 presenting symptoms, it is impossible for any physician to know about every disease and its associated signs and symptoms. Even with clinical decision support tools and access to expert databases, getting to the right diagnosis requires a strong foundation in the diagnostic reasoning process—what many would describe as the “Sherlock Holmes part of medicine.”

It’s critical to understand why one would ask certain patient history questions, conduct certain physical exams, consider certain diseases (“differential diagnoses”), and order certain tests from thousands available to efficiently evaluate the most likely or most harmful diagnoses. Of course, one must accurately interpret those findings to get to the right diagnosis so the right treatment can be provided.

To err is human, and the potential for cognitive error is significant when time and cost pressures make it difficult to be as comprehensive as one would like. A physician may resort to pattern matching—perhaps, he saw this combination of symptoms in a patient recently and quickly concludes it is, therefore, the same disease. While efficient in time, the diagnosis may, in fact, not be the same. He must, therefore, know when it’s critical to investigate other possibilities. Or he may have failed to ask questions, conduct physical exams, or order tests that might have been pivotal in narrowing the differential diagnoses. Adding to the challenge, the patient may not have accurately described her symptoms. Any of these issues can lead to premature—and incorrect—closure.

Less experienced physicians may exclude an important hypothesis simply because the patient doesn’t exhibit all the classical symptoms. Yet, patients seldom exhibit all “classic” signs and symptoms. Learning time and cost naturally limit the variety of patient encounters and presentation during apprenticeship training and residency.

System infrastructure and process issues also contribute to the problem. Critical diagnostic tests must be available and affordable. Data must be accurate and results must be communicated on a timely basis. Operational, communications, or collaboration breakdowns might get in the way. Specialists must be available when consultations are necessary.

As clinician shortages and value-based reimbursement put pressure on the length of time available for appointments, adequate patient-provider face time for the critical patient history and physical exam becomes increasingly difficult to obtain. Inadequacies in these areas are present in 56% and 47% of missed diagnoses, respectively. While electronic medical records provide an important repository of information that helps make collaboration and follow-up more effective, the data entry and other paperwork, which can take 50% of a physician’s time, makes it even harder to get adequate patient-provider face time.

While any one of the cognitive or systems issues can lead to diagnostic error, research has shown that oftentimes multiple issues come into play.


The first step in addressing any problem is to acknowledge that the problem exists. While it has been difficult to accurately quantify the scope of our nation’s diagnostic error rate, there is growing recognition that it is a large issue that must be dealt with. Patient safety, of course, is paramount. And, it is core to the Hippocratic oath.

Leading researchers on diagnostic accuracy like Dr. David Newman-Toker of Johns Hopkins, Dr. Hardeep Singh of Houston Veterans Affairs Center for Innovations in Quality, Effectiveness, and Safety, Dr. Mark Graber of the Society to Improve Diagnosis in Medicine, and many others have long reported on the estimated magnitude and causes of diagnostic error. The Institute of Medicine report was an important validation of their work and has brought even greater national attention to the issue. More recently, the Agency for Healthcare Research and Quality announced the availability of grant funding to understand and improve diagnostic safety and Johns Hopkins announced a new Center for Diagnostic Excellence.

But perhaps the greatest catalyst for addressing diagnostic error on a broad scale will be the rapid shift in healthcare from a volume driven fee-for-service reimbursement system to an outcomes and cost-effectiveness driven value-based reimbursement system. With this new payment environment, diagnostic error rates will directly impact provider revenue and financial stability.

No provider organization wants to waste money on treating the wrong disease while the real disease escalates to the point where it is much costlier to deal with or the patient dies—both of which are bad under value-based reimbursement. And provider organizations are looking at ways to leverage more nurse practitioners and physician assistants, who may be more available and less expensive than physicians, but also have less training.

Thus, health systems are getting serious about diagnostic accuracy. They will experiment with real-time clinical decision support tools and artificial intelligence systems that prompt the clinician to consider certain diagnoses. And they will make sure that they utilize advances in broadly scalable online simulation technology to evaluate their new and experienced clinical staff on diagnostic reasoning, and to remediate or provide continuing education as appropriate.

NURSING NOTES – Advances in Simulation Technology Improve Learning Wed, 03 Aug 2016 15:03:12 +0000 View NURSING NOTES ARTICLE

The words “nursing school” can invoke mental images of textbooks, lecture halls, heavily highlighted class notes, late night study sessions and shiny new stethoscopes. An integral part of the modern nursing classroom, however, is the use of simulation technology to teach nursing skills.

No longer static anatomy models or whole-body mannequins, simulation technology has developed into a suite of high tech tools including virtual software and human patient simulators. After acceptance from the National Council of State Boards of Nursing and top-tier research backing up its potential to positively impact patient outcomes, simulation technology is being incorporated into nursing classrooms across the country. Nurse educators are striving to adopt strategies that incorporate simulation technology into their curriculum, better preparing their students for their first day on the floor.   

One such school is the University of South Alabama (USA) in Mobile, Ala. Mike Jacobs, DNS, RN, director of the USA Simulation Program, noted that the program is interdisciplinary and serves the educational needs of students from the College of Nursing, as well as the College of Allied Health and the College of Medicine. More than 35,000 students study in the simulation labs at USA each year. According to Jacobs, simulation technology provides many benefits for the modern nursing student.

“Simulation provides the opportunity for both undergraduate and graduate students to actively engage in high-risk clinical scenarios where students may not be ready to respond to in an actual clinical setting,” he said. “This allows students to be more than observers as they learn the necessary skills to safely, competently and confidently succeed in the nursing role.”

Simulation also enables students to develop important skills in an environment that does not risk patient safety. For nurse practitioner students, Jacobs said simulation training gives students the opportunity to learn key skills such as suturing, central line placement, chest tube insertion, paracentesis or abscess drainage – before even beginning clinical rotations.

“These hands-on experiences mimic an actual clinical environment where students can learn in a low-stress, low-risk setting with an opportunity to evaluate performance and correct deficits through repetition,” he said.

Although USA uses virtual technology, such as i-Human Patients, and high-fidelity models, a study published in The Online Journal of Issues of Nursing  provides a breakdown of the large variety of simulation methodologies, including high- and low- fidelity mannequins, virtual environments, and unfolding video case simulations.

According to Jacobs’ colleague at USA, Pam Johnson, DNP, RN, simulation technology is just one example of how nursing education has changed to reflect evolving nursing practices. New learning strategies have impacted the way educators like Johnson and Jacobs approach nursing education as a whole.

“We have seen a tremendous shift toward learning strategies that center toward the individual student,” she said. “These new strategies focus on interprofessional education using a team-based approach in the classroom and simulation labs. The role of the educator is changing from being a ‘pure’ teacher to being a facilitator of deeper learning, including the development of critical decision making skills.”

For example, during lessons in the USA lab, the faculty divides students into small, interprofessional teams and gives an introduction to a clinical scenario or skill. After the lesson, the faculty monitors and interacts with the students, providing coaching and feedback to promote mastery of the scenario or skill.

Although technology is deeply rooted in the USA curriculum, it did take time and effort from the faculty. According to Jacobs, using simulation technology often increases the preparation time for faculty, since they have to spend time before the lesson creating scenarios, but that tradeoff is greater student engagement. Johnson noted that the biggest challenge toward incorporating simulation technology into the USA curriculum was gaining faculty buy-in. In the beginning, many faculty members were intimidated by the technology associated with the simulation tools.

“To overcome this, our motto became ‘Keep It Simple,’” she said. “As faculty started to become successful with simple simulation scenarios, we began to build in more complexities for richer cases and student learning opportunities.”

In addition, the USA Simulation Program hired and trained faculty and staff to assist college faculty with scenario development and running the simulators. This permitted college faculty to focus on the facilitation and evaluation of student learning.

Although nursing education tools have evolved in the years since Johnson and Jacobs started, some elements have remained consistent. They both agree that even though teaching tools may change, the biggest reward of nursing education remains the same: watching the “rapid growth of knowledge and passion for the nursing profession in our students.”

VIEW ARTICLE on Nursing Notes

]]> Fri, 08 Jul 2016 20:08:29 +0000 View Kellogg Magazine

Physician, heal thyself

When Craig Knoche was diagnosed with cancer 20 years ago, he didn’t go through the classic stages of denial and grief. “I decided to completely reorient my life,” Knoche said.
So he left his job to focus on doing something that would make a big difference — a system to improve medical diagnostic skills that could scale to the world.
“According to the U.S. Institute of Medicine, the best estimates indicate that all of us will likely experience a meaningful diagnostic error in our lifetime resulting in approximately 40,000 to 80,000 avoidable deaths each year,” Knoche said.
i-Human Patients is a revolutionary cloud-based training program that simulates all the cognitive activities involved in a patient encounter — from taking a patient history, assessing vital signs, performing physical exams, to ordering and evaluating tests. Along the way, it provides individualized evidence-based feedback and coaching to help improve and assess diagnostic competencies.
More than 10,000 clinical students in the United States now use i-Human. With the support of former Kellogg Dean Dipak Jain, i-Human will be distributed by the Reliance Foundation throughout India, where there is presently a shortage of 1.6 million physicians and 2 million nurses, and the diagnostic error rates are significantly higher than in the United States.
“Kellogg didn’t just broaden my horizons,” Knoche said. “It also gave me the confidence to build a company and to interact with people who’ve made a huge impact on the world.”

i–Human Patients Announces Library of High Fidelity Cardiac Auscultation Sounds Wed, 01 Jun 2016 13:57:51 +0000 SUNNYVALE, Calif.—May 31, 2016 – i–Human Patients, Inc. (IHP), a technology company for the health care professional development and assessment market, today announced the June 6 availability of approximately 300 high–fidelity cardiac auscultation sounds and phonocardiograms. With this addition, IHP seeks to improve the practice of cardiac auscultation, patient assessment, and diagnostic reasoning skills.

These sounds and phonocardiograms are incorporated into existing IHP cardiac-related cases, and are also available for inclusion in new cases by users of their point-and-click authoring systems.

What is unique about these sounds?

The sounds are edited from a library of over 30,000 sounds recorded over Dr. W. Proctor Harvey’s lifetime. The sounds represent a broad range of cardiac pathologies, are of high fidelity, and were recorded at multiple patient precordial sites – thus providing an accurate representation of how given pathologies sound at different sites. Other available cardiac auscultation recordings provide only a limited range of pathologies, at only one precordial site and are often synthesized.

Why is cardiac auscultation still important?

A cardiac examination includes observation (for example, of skin pallor, jugular veins, etc.); palpation of the precordium and arterial pulses; and auscultation of the heart. Despite advances in technology such ultrasonic and Doppler imaging, cardiac auscultation still provides important clinical information not obtainable by other sources. Moreover, experienced examiners can make a definitive diagnosis based on cardiac auscultation without resorting to more expensive testing modalities.

 What sounds and phonocardiograms are available?

Sounds represent the following conditions, and include recordings from up to five different precordial sites for each condition:

  • Aortic Ejection Sounds
  • Aortic regurgitation – bicuspid Aortic valve
  • Aortic regurgitation (AR) – mild, moderate, severe, and with bicuspid aortic valve
  • Aortic Stenosis (AS) – mild, moderate, severe; and include carotid, clavicular, supraclavicular, and suprasternal notch locations
  • Atrial Septal Defect (ASD)
  • Austin Flint murmurs
  • Bruits – abdominal, carotid
  • Ebsteins anomaly
  • Hypertrophic cardiomyopathy (HCM)
  • Innocent systolic murmurs S2, Stills murmur
  • Left bundle branch block (LBBB) with split S2
  • Loud S1
  • Mitral regurgitation (MR) – moderate, severe, advanced with pulmonary hypertension, ruptured chorda tendinea
  • Mitral stenosis (MS) – Loud S1 normal 3rd, with opening snap, with rumble
  • Mitral valve prolapse (MVP), with click in late systole, click murmur syndrome, inspiration versus expiration, late systolic murmur without click, clicks in mid–to–late systole, click then murmur and more clicks, whoop, with arrhythmia
  • Normal Heart Sounds
  • Normal S3 – High Cardiac Output
  • Normal S4 – High Cardiac Output
  • Normal Splitting of S1
  • Normal Splitting of S1 and S2
  • Normal Splitting S2
  • Patent ductus arteriosus (PDA)
  • Pericardial friction rubs, knock sounds
  • Pericardial knock sound
  • Pericarditis
  • Pericarditis stenosis
  • Physiologic S3, swimmer
  • Pistol Shot with Quick Rise Pulse
  • Pulmonic stenosis, with ejection sound
  • Right bundle branch block (RBBB) with wide fixed split S2, with first degree AV block
  • S3 Gallop, S4 Gallop, S3 and S4 Gallops
  • Several patients with coarctation of the aortic
  • Soft S1
  • Summation Gallop
  • Systolic murmur secondary to fever, hypertension, hyperthyroidism, pregnancy, conditioned athlete, thyrotoxicosis
  • Tetralogy of Fallot
  • Tricuspid regurgitation (TR)
  • Tricuspid stenosis (TS), Tricuspid stenosis (TS) with mitral stenosis (MS)
  • Ventricular septal defect (VSD) – small, medium

 The sounds are licensed from Laennec Publishing Co., Inc. and David C. Canfield, W. Proctor Harvey Teaching Professor, Professor of Medicine and Cardiology, Harvey Society, the Georgetown University School of Medicine.

About W. Proctor Harvey

Dr. W. Procter Harvey was a professor of medicine at Georgetown University where he led the cardiology division for 32 years. He was considered the most skilled practitioner of auscultation during his lifetime, and he could diagnose a broad range of common and complex cardiac pathologies through cardiac auscultation, history and physical examination alone. His patients included four presidents and many diplomats and members of congress. He trained hundreds of cardiologists who now practice at leading medical centers across the United States.

Together with colleagues David C. Canfield and Dr. Julius Bedynek, they recorded, edited, and produced the world’s largest and highest quality library of auscultation sounds. David Canfield worked with Dr. Harvey for 45 years.

 About i–Human Patients, Inc.

 i–Human Patients, Inc. develops educational and competency assessment technology for the student and practicing health care professional market, including its flagship i–Human Patients® platform, launched in November 2012. Cloud–based and interactive, the i–Human case player improves and evaluates competencies using active learning strategies and content developed by almost 100 leading educators.

IHP is collaborating with the Reliance Foundation, an Indian not-for-profit organization that has provided generous support to enhance the i-Human platform and add numerous new simulated patient encounter cases. The partnership aims to provide high-quality virtual health care training to students and clinicians, and equip health care professionals to achieve greater standards of excellence. IHP has also received financial support from the American Medical Association and the National Science Foundation. i-Human Patients, Inc. is based in Sunnyvale, California.


Priss Benbow
Benbow International PR

 i–Human Patients is a registered trademark of i–Human Patients, Inc.


Anne Knoche: Developing a better virtual diagnosis method Mon, 23 May 2016 20:06:22 +0000 Read more about Anne on Brown Alumni University Magazine

Anne Knoche, VP of Product Management

It was a wilderness medicine class that planted the seed for her high-tech startup, i-Human Patients, which provides online learning for healthcare providers. Her computer expertise also came about in a slightly unusual way. At Brown, Knoche was a history major. But senior year she took a history class where she used a punch-card computer. Next semester she enrolled in a computer science class. She says it was a “unique Brown experience,” where the open curriculum allowed her to try something that turned out to be life-changing.

For Anne Knoche ’78, it was, ironically, a wilderness medicine class that planted the seed for her high-tech startup, i-Human Patients, which provides online learning for healthcare providers. Her computer expertise also came about in a slightly unusual way. At Brown, Knoche was a history major. But senior year she took a history class where she used a punch-card computer. Next semester she enrolled in a computer science class. She says it was a “unique Brown experience,” where the open curriculum allowed her to try something that turned out to be life-changing.

Knoche’s newfound interest in computer science led her to work at IBM, where she met her husband, Craig Knoche, who was a manager there. It wasn’t long before the pair moved to California and to the frontier of Internet technology, where they were part of the startup team—Craig became CEO—at Walkabout Software, a company that created an early version of HTML5.

Knoche and her husband also began exploring the frontiers of nature. They began high-altitude mountaineering. As part of this new hobby, they took a Wilderness First Responder course, which was taught through a combination of classroom and hands-on training. The Knoches aced their exams, but then found that what they had known so well in the classroom suddenly went out the window when they were faced with the difficult and often unforgiving reality of medical practice. In simulations, Knoche recalls, their classroom training was all but useless. It was only through repetitive practice in those simulated situations that they really learned wilderness medicine. “Maybe that’s why they call it the practice of medicine,” she says. Though they felt classroom learning fell short, they were incredibly impressed by the potential of simulation for teaching about medicine and felt it should be introduced much sooner in the learning process. Knoche decided that this was an idea she wanted to pursue, but a busy work life got in the way.

Then in 1999 Craig was diagnosed with cancer. He survived and is cancer-free, but it was a wake-up call and renewed the couple’s interest in advancing medical education.

The Knoches packed their bags and moved to the Sierra Nevada Mountains, determined to find a better way to integrate simulated practice into medical training. In 2000 they founded Summit Performance Group, which became I-Human Patients (IHP). Over the past fifteen years they have worked with many of the nation’s top medical educators to build a platform that simulates a complete patient encounter. The product enables educators to integrate clinical experience much earlier into medical education and makes top-notch medical education available online.

Knoche gets excited talking about how i-Human Patients is on a mission to take on two of the most challenging problems in healthcare today. “In the United States there are approximately 80,000 avoidable medical deaths every year,” she says. “At the same time, by 2025 we will have a shortage of 90,000 physicians. The scale of the need in both cases is staggering, but we think we can help solve both problems.” By providing active e-learning in healthcare, Knoche believes that the company can help to ensure that there is an adequate supply of providers who are fully trained in patient assessment and diagnostic reasoning. This year Knoche and IHP will take a big step toward accomplishing their goals: in 2016, 20,000 clinicians across five countries will study medicine using i-Human Patients.