McMaster University’s medical school was founded in 1965. One of its primary objectives was to help students become effective solvers of biomedical problems by understanding the principles essential to solving them and learning how to seek out and use the information required for solutions.

The nascent faculty was exploring new and hopefully effective ways of achieving its objectives. It aimed to replace the usual formal lectures with stimulated, problem-based, self-directed learning. Although many audio-visual aids were developed, whether for ethical, economical, or practical reasons, students were rarely exposed to labs and experimentation, a traditional stimulus to inquiry. Problems presented on printed paper alone often fail to trigger curiosity and active search for information.

In 1971, John Dickinson from St. Bartholomew’s Hospital in London was invited to McMaster as a visiting professor. He originated the idea of substituting actual lab experiments with lab experiments on computer models simulating the behaviour of living organs, thus allowing unlimited experimentation without causing ethical, legal, or economic concerns. With the support of the faculty, Dr. Dickinson developed MacMan, simulating the human cardiovascular system’s realistic behaviour under various user-posed conditions.

Because of the excitement triggered by MacMan, several colleagues at McMaster and St. Bartholomew’s joined John Dickinson, collaborating in designing further models and refining existing ones.

For a variety of reasons, this development gradually declined towards the end of the 1980s without ever finding wider interest. Because of the cumbersome user interface, before graphical user interfaces became standard, the students rarely made use of the models – a missed opportunity.

This website serves as a tribute to the early pioneering contributions to Medical Education by the McMaster Faculty of Health Sciences and an opportunity for viewers to experience this project fully.

In the summer of 1976, John Dickinson and David Ingram moved to academic appointments at the Medical College of St Bartholomew’s Hospital, in London – John as Chair of Medicine and David in a newly created lectureship in medical computing and physics. The story of the onward development of the Mac Series and numerous experimental educational and research initiatives based around them, up until 1989,  is told in Chapter Four of D. Ingram, Health Care in the Information Society, Open Book Publishers, Cambridge, 2023. https://openbookpublishers.com/books/10.11647/obp.0335

For example, in a years long collaboration with Dr. C.J. Hinds, MacPuf was used to model and match the respiratory management of acutely ill patients in the ICU at Bart’s, and predict the responses to alternative clinical management options. And the MacAid system was linked to the model to provide a core resource of teaching materials for postgraduate professional courses in anaesthetics. Likewise, MacPee and MacPuf were built into physiology student practicals, at Bart’s and more widely afield.

In a further years long collaboration with Professor Leonard Saunders at the London School of Pharmacy, the MacDope model was extended and used to model and match the pharmacokinetics of drugs and provide a simulation environment for undergraduate courses in the pharmacy curriculum.

This was the era of the advent and rapid evolution of microcomputers and the models were implemented at Bart’s and published by IRL Press to run on these, with copyright reserved to Bart’s and McMaster. These versions  introduced an early MS-DOS based graphics user interface, as now emulated as a Cloud resource on the simulator web site.

The serial obsolescence of software tools and microcomputer platforms made it difficult and time consuming to keep the models usefully accessible to its potential audiences, although there was growing awareness of their utility. As John Dickinson approached retirement and David Ingram moved on to leadership positions more widely in the accelerating health informatics domain – such as in the openEHR and OpenEyes now global initiatives in standardisation for health care records – the Mac Series endeavour came to a close. It is preserved and recorded here in recognition and respect for John Dickinson, McMaster and Bart’s for their founding contribution to a field that is still developing, under the banner of the Virtual Physiological Human Institute and the domain of In Silico Medicine, which are also profiled in David Ingram’s book.

As John Dickinson was appointed Chair of Medicine at St Bartholomew’s Hospital in London, the centre of further development and professionalization of the Mac Series moved with him. The advent of personal computers could have facilitated the dissemination of the Mac Series, though their prevailing archaic user interface proved to be a barrier to broader acceptance by students.

Computer models today play a very small role in medical education, except for training in endoscopy and minimally invasive surgery. The Mac Series of ‘medical educational computer simulations’ fell into oblivion.

From the dawn of civilization on, complex competencies have been taught by a coordinated combination of direct instruction, supervised practice, and corrective feedback. Both ‘in-vivo’ and ‘in-vitro’ practice tasks have been employed. The former are more authentic but raise ethical, practical, and economic issues; while the latter tend to be more readily available and carry little risk.

Based on realistic computer models, “video games” using modern graphical user interfaces could provide unlimited opportunities for stimulating ‘in-vitro’ practice. Computer models are highly scalable, as long as they do not require complex user interfaces. In fact, most will run in web browsers, as this website demonstrates. Similarly, social games could be developed to practice interpersonal competencies.

The cost-effectiveness of computer simulators to train pilots is attested by the fact that:

Flight simulator market size reached USD 6.90 Billion in 2021 and is expected to register a Compound Annual Growth Rate (CAGR) of 6.7% during the forecast period, according to latest analysis by Emergen Research. (Bloomberg, 3 January 2023)

In a similar vein, user acceptance of the video game paradigm by young adults is supported by:

The global gaming market size is anticipated to reach USD 504.29 billion by 2030, exhibiting a CAGR of 10.2% during the forecast period, according to a new report published by Grand View Research, (Bloomberg, 8 Aug. 2023)

These data suggest that catching up with missed opportunities by systematically developing and introducing practice simulators for medical education could result in significant gains in both the effectiveness and cost-effectiveness of medical education.

To be effective, the scope of practice simulators would have to cover the whole gamut of undergraduate, postgraduate, and continuing medical education. Their content would have to be both scientifically solid and didactically sound. Developing such a library would require a Herculean effort exceeding the capacity of any one individual medical school. Only a large national, or even better, international collaboration could fill the bill.

But it would not even be necessary to create a ‘Brick and Stone’ institute for this purpose. A virtual organisation, not unlike GitHub, would be perfectly suitable to fuse the required expertise from the staff of the partner institutions online.

• Realistic, user-friendly computer simulations,
• as potentially pivotal tools in Medical Education,
• an idea in search of leadership.