Current gap in translational research where bench researchers need to be driven by bedside questions to bridge patient requirements that often go unaddressed.
Currently most questions generated at the bedside by individual patients are handled by bedside MDs who may be able to deliver ready made solutions only if made available by bench researchers Phds.
However PhDs are currently not available at the bedside so that many questions that are generated uniquely through individual patient requirements are often ignored building up needless apathy detrimental to the learning ecosystem.
If PhDs are to spend more time at bedside gainfully toward developing precision medicine that caters to unique requirements in individual patients, it's very important to provide PhDs with skills that enable them to handle patients and make them equal partners in patient care.
HOW?
Proof of concept hypothesis :
The proposed PhD MD program can enable potential trainees to achieve all the competencies that currently are possessed by general physicians in 3 years. This can be done in a patient centered manner, which will enable these trainees to achieve the same competencies in three years that currently Indian Medical graduates take 5+3 years of MBBS (5y) and MD (residency 3y). In effect they will be working as apprenticed residents from day 1 of their MD training and learning certain essential basic sciences on the job contextually rather than spend time learning them out of the patient context as is the current norm in mbbs. All this is currently functional as part of a published elective program and case based blended learning ecosystem (referenced here :
Inclusion eligibilty criteria :
Masters in any discipline with strong commitment to healthcare research and practice
PhD in any discipline
Proof of concept evaluation after completion of the first pilot :
The trainees after completion of three years of the MD training phase along with regular daily formative assessments available for transparent and accountable audit, will be finally evaluated in a blinded summative assessment that will be performed by clinical MDs (Professors from institutes of national importance again in a videographed patient centered interview that can be archived for future reference).
Once the final summative assessment is cleared by the PhD MD trainees at the end of three years, the Masters candidates will move to the PhD leg of this program for another three years where they shall integrate their bedside training with their masters level bench training. For the PhD candidates who enter this program, the PhD MD degree will be awarded and the newly passed out PhD MD will be employed by the institution where the candidate will continue to practice their bench and bedside skills as a part of the institutional CBBLE that they had gotten used to during their MD training phase. At no point will they be allowed to practice medicine outside their institutional CBBLE but this cohort of scientist physicians will be followed up on their bedside and bench achievements, which will be duly made transparent with full accountability to the public.
WHAT?
Expected outcomes :
Creation of a high value human resource cohort of scientist physicians with predictably high value achievements in their future years in bench and bedside translational research working within their institutional CBBLE.
Attrition of trainees unable to take the first leg of the program that is residency as they may not be able to develop the aptitude for it.
Project plan :
Step 1:
Ethical committee review and approval
Step 2:
Participant selection with a three month probation and trial run, allowing for significant number of drop outs that would be expected given the current novelty of the program that necessitates polymathic survival skills.
Step 3:
MD training phase along with regular daily formative assessments available for transparent and accountable audit begins toward completion after 3 years
Online learning portfolios for formative assessments available in current CBBLE dashboard here here :
Step 4:
Final evaluation in a blinded summative assessment that will be performed by clinical MDs (Professors from institutes of national importance again in a videographed patient centered interview that can be archived for future reference) at the end of the first leg of the program, which is three years (out of total six years for those who entered after their masters).
Sample final summative assessment (actual formal university assessment conducted and videographed last year :
Step 5:
Masters candidates will move to the PhD leg of this program for another three years where they shall integrate their bedside training with their masters level bench training. For the PhD candidates who enter this program, the PhD MD degree will be awarded and the newly passed out PhD MD will be employed by the institution where the candidate will continue to practice their bench and bedside skills as a part of the institutional CBBLE that they had gotten used to during their MD training phase
SWOT analysis
SO WHAT?
Strengths:
Creation of a high value human resource cohort of scientist physicians with predictably high value achievements in their future years in bench and bedside translational research working within their institutional CBBLE.
Weaknesses :
Expected attrition of trainees unable to take the first leg of the program that is residency as they may not be able to develop the aptitude for it as this program would require polymathic skills. More about it here :
http://www.pitt.edu/~super1/lecture/lec54101/001.htm)
Outcomes are dependent on the commitment of all CBBLE participants including not just trainees and immediate supervisors but all stakeholders taking care of the patient including hospital administration and considerable improvement will be necessary in all the stakeholders to be able to achieve our project objectives.
Opportunities:
Creation of high value solutions developed by this cohort of bench-bedside scientist physicians that can be utilized globally
This approach can be scaled to various institutions in the nation resulting in improvement in the local research and learning ecosystems of those institutions
Threats:
This is a potentially disruptive innovation with considerable leverage being transferred from a traditional healthcare training that thrives on retail of available solutions alone to a scientific evidence based precision medicine approach to also developing innovative solutions for individual patient requirements. This may immediately alienate multiple stakeholders such as traditional non evidence based, non transparent solo practitioners who may not be able to thrive in an ecosystem that values self directed life long learning and real time evidence based clinical audit of practice.
Further notes (formative reflections) on initiating this project :
What I have been reviewing here is astounding.
Although it's limited to Wikipedia and what we may be reviewing is just a tip of the iceberg we have only a few illustrious MD PhDs and one of them is serving a life sentence! 😨
Again currently the blame is on this individual but it's likely to be the faulty market driven US education system that gave rise to that monstrous failure (and we must remember that there are perhaps many that are unreported).
The biggest issue is how did they allow him to pass the training program?
In our proposed system we shall have our PhD MD program connected to a CBBLE aka case based blended learning ecosystem with full transparency and accountability in training and practice from day 1 and we can pilot it here with IIT PhDs or MScs if we can set up a collaborative project.
Further reading and further thoughts :
We are not the first to embark on this journey :
Image copyright with website linked below :
