Medicine Department : February 2019

Project Title: Utilizing mobile user driven E logs of patient data to improve hospital and community healthcare services through real time patient centered clinical audit with a collaborative blended learning ecosystem of patients, students and health professionals

Introduction:

There is a striking deficiency in medical learning competencies attained by medical faculty and students that are hardly ever reflected on or brought to notice in the course of caring for their patients. A biochemist may not know how the HbA1c values that s/he regularly facilitates in his lab is actually utilized by the clinician and patient and the clinician may not realize how the HbA1c values are actually generated in the lab.

All medical students, doctors and health professional faculty need to have cognitive competencies to take care of primary requirements of a rapidly growing patient population but our current curriculum may not allow it's participants to realize why they need to learn what they are learning, how this knowledge may be applied by them to meet their patient requirements and if their training can allow them to answer queries that arise naturally and not as a result of an outdated curriculum that compels them toward non-contextual rote memorization.

This dichotomy and gap between health education and practice badly affects current day healthcare where a large proportion of health professionals are in danger of becoming apathetic to patient requirements.

To resolve the above mentioned problems in current medical education and healthcare, Medical council of India MCI has recently proposed a focus on developing competency in medical students is a small step to move forward in the direction of producing doctors confident and competent enough to meet the needs of our population.1

Building on it further, we propose a patient-centered E log project with a ‘learning team’ comprising of Medical students and experienced faculty engaged in blended collaborative learning around ‘individual patients.

Methods:

We shall utilize a mixed methods study design. In the course of a learning session for 3 years, a team of faculty and students from various departments in the hospital will be exposed to regular 'patient encounters' in the inpatient and outpatient wards of Kamineni Institute of Medical sciences, Narketpally. This team shall capture deidentified patient-data at the 'point of care' (in the form of history, images of clinical findings as well as radiology and lab data) and then subsequently share them to the online E-log platform specially created to facilitate communication and discussion to learn around the patient.

The patients selected will have a sufficient level of clinical complexity likely to generate maximum learning outcomes in terms of patient centered learning questions which is detailed here.2

The collected 'patient data' after processing in the discussion forum can be published online as a 'patient centered online health record' PCOHR in freely available publishing platforms suggested by our past published "online patient records" linked to our student's "online learning portfolios" here.3,4,5,6

Subsequently the prepared 'online health record' web link for each individual patient is shared on to our online social-media based processing forum that has a current global membership of 1500+ members, many of who actively participate in solving patient problems posted to the forum.

All this patient centered 'data collection and processing' activity shall be subsequently documented in 'patient centered online health records' PCOHRs such as the one's shared above and this online record 7 and demonstrates how research publications are generated from them such as this.8

Results/Expected Outcomes:

This mixed methods study design will document results through qualitative thematic analysis of student-faculty learning insights, qualitative insights on patient-health-outcomes and quantitative estimates in terms of the number of validated participatory learning inputs contributed by each student and faculty and quantitative estimates of patient health in terms of QoL. The results of the impact evaluation of our PCOHR educational intervention strategy will be validated as per currently known paradigms. 9 An additional feature of note in our project is the utilization of online learning portfolios of students and faculty, which are generated partly automatically online from their documented participatory learning conversations in our currently active online case based blended learning ecosystem CBBLE. These portfolios will be thematically analyzed to assess the results/learning-outcomes of each faculty and student's learning activity. The portfolio based quantitative learning points generated around each patient will be compared with the results/outcomes obtained in terms of their respective patient improvement using quantitative QoL estimates (SF36 etc.).

Discussion and Implications for Practice:

The 'patient-centered learning' process will further involve learning feedback provided to the patient's primary caregiver by our 'case based blended learning learning ecosystem CBBLE managers and then noting the results in comparison to a 'control group' of patients whose providers receive no CBBLE feedback. Our hypothesis toward the expected outcome of this project is that the CBBLE team as well as their patients will have respectively better learning as well as QoL outcomes than the control group-team. A CBBLE nurtured and scaled in an appropriate patient centered manner can go a long way toward improving health professional learning as well as improving patient outcomes and the combination of the two will be instrumental in augmenting national capacity building and transforming healthcare.

SWOT Analysis:

Strengths: Promising solution to current felt need that can bridge gaps in healthcare learning competencies as well as address patient outcome complexities.

Weaknesses: Quasi-experimental and complex study design and consequent potential of study sample selection bias. (Workarounds: ensure transparent and accountable online documentation of entire process that is naturally subject to external peer review in real time)

Opportunities: Potential to scale into a sustainable model of practice based learning toward

improving patient outcomes.

Threats: Participant motivation leading to study attrition, patient privacy and confidentiality (Workarounds: regular motivational meets with participants of both groups with real-time transparent documentation of the interaction that transpires between all the stakeholders)

References: