Within a short time span, we have added another substantive term to our new millennium preparation vocabulary just as quickly as we added such terms as "gopher," "Veronica," "Mosaic," and "Netscape." And just as the latter terms have symbolized the revolutionary change in information acquisition and dissemination, the impact of virtual entities is equally revolutionary. In fact, since the early 1990s, commentaries and projections of the various dimensions of virtual reality and the effect on learning and health care have mirrored the exponential growth pattern of the Internet itself.

Anyone who has seen or experienced virtual reality realizes that the potential of the interactive three-dimensional image technology can be quite dramatic to health-care learning and practice. The virtual anatomic dissection of the virtual frog project has "spared" the frog while presenting the learner with a dynamic hypertext image-based application.1 And in a somewhat comparable virtual trek as the frog, Mrs. Chase, whose origins as a psychomotor skill-training mannequin, data back to a much earlier period, has begun her virtual journey through collaborative work such as that occurring between High Techsplantations and SUNY Plattsburgh in the development of the virtual reality simulator for intravenous infusion.2 This project has implications for psychomotor skill practice of the future just as the clinically oriented projects such as the "Virtual Physician," a three-dimensional multimedia computersimulated patient being developed to train physicians in treatment prescription for emergency procedures,3 or three-dimensional image modeling and manipulation for surgery success at the Mayo Clinic have implications for clinical practice.4

In addition to the rather dramatic effects of virtual reality simulators, our way of "doing business" also is being affected by the emergence of virtual entities. For example, Simpson5 writes of the future of creating the "virtual hospital," which, as any "virtual corporation," is a network readily formulated and just as readily dissolved "...to take advantage of fast-changing business opportunities."5-20 Saltzberg and Polyson6 discuss the rapidly emerging development of the "virtual classroom" with the elements of online lectures, interactive textbooks, asynchronous and synchronous communications, multiple databases links, and on-line testing and assessment. DeLoughry7 dialogues on the evolution of this "virtual classroom(s)" segment to the "virtual university" concept composed of professors from traditional educational institutions and/or profit-seeking companies formulating degreegranting consortiums.

Yes, the impact of virtual entities are here and will continue to evolve at an even more sophisticated level as the technology and access improves. Today's virtual reality simulators are expensive and users occasionally suffer from "cybersickness"-motion sickness side effects.8 Pragmatic issues involved in the delivery of technological access to the health-care professional and consumer at the distant learner or home site still plague full implementation of the virtual learning and business environment.9-10 However, the impact of the rapidly improving and accessible virtual environment and applications are too important to ignore planning for how the concept will be actualized progressively and integrated in our educational and workplace environments.

Educational integration plans may begin as simply as exploration of some of the developing "virtual" entities: the Virtual Hospital at http://vh.radiology.uiowa.edu;11 the Virtual Frog dissection at http://www-itg.lbl.gov/vfrog;1 the virtual campus at the University of Maine: http://www.ume.maine.edu;12 or classes at Penn State: http://www_son.hs.washington.edu/vrc.html, or at Brown University: http://www.chem.brown.edu/chem31/.10,13 We need to become as Sherman and Craig14 have advocated: literate in the new and rapidly evolving communication medium of virtual reality. Read and think about the implications of the new communication medium, from the clinical health-care applications of laparoscopic simulator systems15 and virtual fitness equipment16 to virtual learning and business marketing.17,18

How will these entities merge or replace our current mode of operation? What are the economic, legal, social, and cultural implications of synchronous and asynchronous virtual classes and virtual universities? What are the personnel implications? Are there certain students or faculty who will or will not benefit from this virtual delivery mode?

Virtual reality action and integration plans might be conceptualized on a continuum depending on content application from a learning or marketing strategy to more pervasive practice application. For example, an institutional Instructional Resources area could conceptualize and implement a "virtual tour" as an instructional tool and an educational marketing strategy. An Instructional Resources Fair, once offered as an in-house strategy to promote technology use and development can now reside on a World Wide Web site of the institution and be available as a demonstration site to other academic and administrative units within the agency and external clinical sites, as well as serve as an introduction and electronic help connectivity point to the instructional resources service area for students and faculty.

Partnership formations among educational institutions, health-care agencies, and commercial, government, and advisory team entities may lead to design and development virtual reality project work or beta testing possibilities. There have been several examples of partnerships to expand scientific imaging into virtual reality.19 Other joint endeavors are investigating virtual learning applications. For example, Wilson describes a Foundation/University partnership to investigate higher education delivery using Internet tools such as the World Wide Web. Results of the 2-year project are contributing data to such issues as education delivery in networked environments, economic impact on institutions, and student-teacher interactions.13

Confronting the virtual entities revolution may seem rather formidable in terms of institutional expense and rapid technological change. However, failure to investigate and plan for the integration of this rapidly developing communication medium will leave us unprepared for the outcomes that will result from the application of virtual reality tools to health-care learning and practice. Mrs. Chase is not virtual yet and cyberspace learning is not here completely, but the journey has begun and we need to begin or continue to conceptualize and actualize the continuum of virtual entity applications that are leading to a much different way of "doing business" and delivering education. Hopefully, the "cyberspace" journey will lead to a positive "virtual" school: "... an arena of learning excitement, knowledge explosion, and global understanding, a virtual school with a virtual heart."20

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