Saturday, November 28, 2020

CBBLE 2 and an introduction to its information granularity

 


Just to share an example from our regular workflow, "information granularity" in the medical curriculum may be also guaged by online assessment links where if you click on this link here below: https://medicinedepartment.blogspot.com/2020/11/blended-bimonthly-assessment-oct-nov.html?m=0, you may find links to both formative and summative assessment of each individual student, intern and PGs of different years. 

Once you open those links you will find links to the log books of each student that can show the details of each patient they have cared and learned from as a part of a formative assessment of their verbal competency and you will also find links to their offline presentations in the form of online videos as a reflection of their subjective non verbal competency that can be guaged from their body language. 

In our medical education workflow, information granularity appears to begin with the student's online learning portfolio reflecting students learning outcomes and continues (unendingly as learning is a never ending stream) with the patient's healthcare outcomes as the primary beneficiary of Medical education is the patient? 

And then once we dig deeper into the patient's report there are different layers of information granularity about the patient beginning in the macroworld captured by our senses and standard current radio imaging as well those in the microworld of the patient's cells captured through the microscope and the molecular world captured in biochemical tests. 

More here in the link below on the origins of CBBLE2 and I quote:

"Slowly the realization dawned that individual case based experiences were different from the average data being  represented in Clinical trials where each of these individuals was just a number.

2002: Contrary to what trial data projected, every individual was unique and had unique life trajectories and it was found that medical students were best suited to unearthing these trajectories as documented here: https://www.eubios.info/EJ124/ej124j.htm

Some of these medical students who were now academic faculty, revisited this idea in the last CBBLE paper here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163835/


2007: It was gradually becoming clearer that current evidence based medicine needed a more meaningful methodology to answer individual patient requirements here: https://pubmed.ncbi.nlm.nih.gov/17683292/

2008: And soon the first conceptual model for current CBBLE was shared here: http://www.ncbi.nlm.nih.gov/pubmed/19018905

It was called "user driven healthcare" UDHC and described a prevalent phenomenon evolving with the internet and the only difference with the later CBBLE appears to be that the term "blended learning" got added to the same process suggesting that the CBBLE had a strong component of offline connection and locality that was blended to requirements of online users. 

The CBBLE idea as a subset of the UDHC phenomenon was to build a Case based reasoning database that could offer any individual patient data a platform for obtaining comparisons between other individual patients who had similar data patterns and then see if near matches of individual trajectories would offer similar outcome trajectories in those group of patients and this was inspired by a seminal paper on case based reasoning linked here: https://pubmed.ncbi.nlm.nih.gov/15533257/

The pursuit of clinical problem solving using online user driven learning was a polymathic pluralistic activity and we derived a lot of lessons from other fields as illustrated in chapters of the UDHC book here 


2009: The model could be scaled to the last mile primary care and act as an efficient bridge between primary and tertiary, individual home, community collaborative center and academic institutions as proposed here:   https://pubmed.ncbi.nlm.nih.gov/19811603/

2010-2020--

Many such cases started getting logged by last mile workers in various parts of India particularly West Bengal and they were processed by a CBBLE that fed case based problems to a global forum for conversational learning as shared here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117104/

The forum was made by global medical and engineering  students and there is more about them in the above article as well as in the UDHC book and journal issues here https://www.igi-global.com/journal/international-journal-user-driven-healthcare/41022 as well as their own web pages."


Tuesday, November 24, 2020

Blended bimonthly assessment Oct-Nov 2020 results

 Following are the links to the submitted assignments by the students (interns, PGs year 1 and year 2) for the the assignment posted for 7/10/2020 here: https://medicinedepartment.blogspot.com/2020/09/medicine-paper-for-october-2020-first.html?m=1  and the assignment posted for 16/11/2020 here:https://medicinedepartment.blogspot.com/2020/11/blended-learning-bimonthly-assignment.html?m=1 


and in the links below one can find that the summative has been also accompanied by a numerical formative assessment of their online learning portfolios using both verbal and non verbal cues. 

Interns from 2015 MBBS batch posted in the department of Medicine from 
23.09.2020 to 22.11.2020



PGY1s from the 2020 MD General Medicine batch 



PGY2s from the 2019 MD General Medicine batch :



The formative assessment has been divided into non-verbal which assesses their competency in procedural domains including empathic communication and body language and verbal which assesses their ability to communicate their work through their day to day E logs.


Most students have done reasonably in the formative assessment in both verbal and non verbal communication domains although a lot remains to be improved on. 


Most students haven't done well at all in the summative assessment as they are still trying to get a hang of how to express themselves in an online open access world where their answers are meant to create a societal impact rather than impress just one examiner who may end up giving good numerical scores in appreciation of their ability to answer from rote memorized facts as per tradition. It's possible that in the current phase of evolution we may find that many have not only plagiarised blatantly from articles on the internet (inspite of express instructions on how not to resort to that) but also copy pasted from each other's log books. 




Sunday, November 8, 2020

Blended learning Bimonthly assignment for November 2020

Answer all questions                                                      

Max Marks: 100 

Submit by:                                

Date: 16/11/2020 9:00 AM 

Below is an online formal question paper to be answered online using all available resources at your online disposal over a period of days and E logged in a manner demonstrated by past examinees in the link here https://medicinedepartment.blogspot.com/2020/09/blended-bimonthly-assessment-september.html?m=1


Please go through the patient data in the links below and answer the following questions:


1) "55 year old male patient  came with the complaints of 

Chest pain since 3 days

Abdominal distension since 3 days

Abdominal pain since 3 days and decreased urine output since 3days and not passed stools since 3days 



a) Where are the different anatomical locations of the patient's problems and what are the different etiologic possibilities for them? Please chart out the sequence of events timeline between the manifestations of each of these problems and current outcomes. 

a1) Added 17/11/2020 Mention the optimal diagnostic interventions in the patient done and that you may further order in a low resource setting to fathom the etiologic possibilities. 

b) What are the pharmacological and non pharmacological interventions used in the management of this patient and what are the efficacy of each one of them? 

Past 2-4 PM discussion videos 

Intern's presentation: https://youtu.be/Pn5tidICB8A

PGs discussion:


2) A 55 year old male, shepherd by occupation, presented to the OPD with the chief complaints of fever (on and off), loss of appetite, headache, body pains, generalized weakness since 2 months, cough since 2 weeks and vomitings and pain abdomen since 2 days. 



a) Where are the different anatomical locations of the patient's problems and what are the different etiologic possibilities for them? Please chart out the sequence of events timeline between the manifestations of each of these problems and current outcomes. 

b) What are the pharmacological and non pharmacological interventions used in the management of this patient and what are the efficacy of each one of them? 

Past 2-4 PM discussion videos 

Intern's presentation: 

PGs discussion:


3) 51 Year old man with complaints of B/L pitting pedal edema from 5 to 6months,abdominal distension from 2 to 3 days,SOB from 3days.



a) Where are the different anatomical locations of the patient's problems and what are the different etiologic possibilities for them? Please chart out the sequence of events timeline between the manifestations of each of these problems and current outcomes. 

b) What are the pharmacological and non pharmacological interventions used in the management of this patient and what are the efficacy of each one of them? 

Past 2-4 PM discussion videos 

Intern's presentation: 


4) 31 yr old man with B/L pedal edema with scrotal and penile swelling since 2 months



a) Where are the different anatomical locations of the patient's problems and what are the different etiologic possibilities for them? Please chart out the sequence of events timeline between the manifestations of each of these problems and current outcomes. 

b) What are the pharmacological and non pharmacological interventions used in the management of this patient and what are the efficacy of each one of them?