Roxann Mouratidis, MSLIS, AHIP 
Head of Scholarly Communications 
Maguire Medical Library 
Florida State University College of Medicine 

Content 

Aquifer Internal Medicine is a collection of virtual, interactive clinical cases intended for third-year medical students. These patient cases were designed to meet the learning objectives of the Clerkship Directors in Internal Medicine’s General Internal Medicine Core Medicine clerkship curriculum. However, any health sciences student seeking to gain more experience with patient encounters could benefit from this content. Since these cases are presented in a virtual environment that simulates real-world patient scenarios, they are particularly beneficial to students with limited exposure to patients in a physical practice or hospital setting. 

Aquifer’s Internal Medicine course collection contains 36 cases that are available via an institutional subscription. These cases are designed to be completed independently, allowing students to navigate patient scenarios using an evidence-based approach. All cases are accompanied by a case synopsis, a list of learning objectives, and a printable case summary that includes a list of medical references. These medical references are used throughout the case to support clinical reasoning and provide opportunities for further exploration. 

All Aquifer Internal Medicine cases are written, reviewed, and maintained by Aquifer’s Internal Medicine Course Board. Members of the board include faculty, clerkship directors, and deans of medical schools. These members aim to ensure that the cases are current, accurate, and are aligned with national curriculum standards. 

Features / Functionality 

Accessibility 

Students may access Aquifer patient cases online using a computer or a mobile device. When using a computer, students must log into the Aquifer website with their institutional email address. If students choose to download the Aquifer Clinical Learning app onto their mobile device, they can complete cases offline. Any offline completed case work will be synched to their desktop or laptop computer on the next wi-fi enabled login. 

Student Progress and Evaluations 

Instructors have access to Aquifer’s faculty dashboard. This dashboard allows faculty to track student case completion progress. Faculty can quickly see how much time each student spent working through the case, view student case summary written work, and see which students opted to reset and complete the case again. Most Aquifer cases include self-assessment questions that students may use to check their knowledge. To provide a safe space for student learning, student answers to these self-assessment questions are not visible on the faculty dashboard. 

Browse and Search Functionality 

Faculty and administrators can browse or search the Internal Medicine case collection. The list of cases can be sorted by title or date updated. Faculty can also find cases that address specific topics or medical conditions by entering keywords into the search box located on the Aquifer Internal Medicine homepage. This basic search will identify keywords found in case titles, case synopses, and learning objectives. 

Internal Medicine is one specialty that has its own distinct collection of cases within Aquifer; other specialties include Family Medicine, Geriatrics, Pediatrics, and Radiology. An institution’s subscription may include access to all or one of these collections of specialty cases. If an instructor has access to multiple case collections, they can search for cases across collections using Aquifer’s Case Library. Using this advanced searched feature, faculty have the option to search for cases that address a specific condition, diagnosis, age group, discipline, organ system, among others. Searching across these collections allows instructors to pick cases from different clinical specialties and create their own custom collections of cases within the Aquifer platform. 

In addition to the subscribed content, Aquifer provides access to several free cases that support professional health education. These cases are available to faculty and students without an institutional subscription. Faculty with institutional access are able to find these cases using Aquifer’s searchable Content Library, and subsequently build them into a customized course or use them independently. 

Business Model 

Aquifer Internal Medicine cases are accessible to users that have an institutional or individual subscription. Institutional subscriptions may be purchased for a single-accredited program at an institution. The institutional pricing structure is based on the total enrollment for the program (including preclinical through clinical years). Institutions are billed annually. The subscription period runs from July 1 to June 30, and prorating options are available. 

Once an institutional subscription has been purchased, affiliated faculty and students are invited by the institution’s designated Aquifer course administrators to create a log-in account using their institutional email address. Faculty and students must use their log-in account to access the Aquifer Internal Medicine Course Collection. In addition to the 36 internal medicine cases and administrative reporting features, each subscription package includes access to The Aquifer Internal Medicine Clinical Decision-Making Exam. This exam uses national benchmark validation to assess the third-year internal medicine curriculum. 

Those without access to an institutional subscription have the option to purchase an individual subscription, which costs $75 per year. Students may purchase a subscription directly from Aquifer, or the student’s institution may purchase the subscription on the student’s behalf. 

Breakthrough 

Aquifer Internal Medicine’s collection of peer-reviewed, interactive patient cases provides students with an opportunity to practice their clinical reasoning skills in a virtual environment. The cases include sample lab values and audio and video components that simulate many aspects of a physician-patient encounter. Future iterations of these cases should incorporate additional interactive components to make them more engaging to students. 

Aquifer has also implemented several features to assist faculty in the development of their courses. Aquifer Internal Medicine has an easy-to-navigate platform that allows faculty to search and find cases on specific medical conditions, topics, or patient populations. Instructors can also track student progress by accessing their Aquifer faculty dashboard. This dashboard provides a quick view of each student’s case completion status, time spent, and their student summary reports. 

As with any licensed resource, there are challenges with providing seamless access to Aquifer. The process of granting access to instructors and students involves multiple steps that could be confusing to users at first. However, the quality of the resource and its benefit to the medical education community far outweigh any challenges with initial setup.