Tuesday, July 14, 2020

Virtual case bank Gastroenterology

Gastroenterology  


66Y old man came with chief complaints of fever since 15 days and pain in right iliac fossa since 10 days

Patient was apparently asymptomatic 8 months back then he developed pain in right hypochindrium.


Dr Sapandana intern 2015  https://spandanatippireddy.blogspot.com/2020/08/multiple-liver-abscess.html?m=1

Dr Geethika 2015

55 year old lady from Nalgonda presented to the medical OPD with complaints of distension of abdomen and swelling of lower limbs since 3 months


 Presented by Dr Rashmita  PGY1: 

29 year old woman with abdominal distension after ceserian section  

 E log:

) Presented by Dr Ruchita batch 2015
55 Year old woman with abdominal distension since 10 days. 


Dr Raveena 2015

45 year old male came to opd with chief complaints of decreased appetite since 1 month and loose stools since 20 days


Abdomen (Oncology) 

Dr Sowmya 2015

65 year old man, was a driver in Dubai, hasn't been working the last 10 years, currently residing in nalgonda,  presented with the complains of 
Generalized weakness since 1 month 
Dyspnea on exertion since 1 month
Bilateral lower limb swelling since 1 month 
Difficulty in getting up from sitting posture since 1 month 
Urinary incontinence since 1 month
Black colored stools since 15 days
Difficulty in walking and sitting without support since 4 days 
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Virtual case bank Respiratory system


Respiratory system 

Presented by Dr Sambodhi 2015 batch:
A 54 year old male patient came with Pain in the left side of the chest radiating to the back side since 2 days, difficulty in breathing since two days.
Intern's E log:


Active learning around the same case in social media after deidentifying and obtaining informed consent: 

2) Presented by Dr Aditya 2015 batch
Dr Hitesh 2015

43year old female came to opd with cheif complaint of right side hypochondrial pain , stabbing type , non radiating.increasd with inspiration and on lying down on rt side 


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Sunday, July 12, 2020

Virtual case bank from global CBBLE elective student Vivek Poddar

More about Vivek Poddar here 
https://www.researchgate.net/profile/Vivek_Podder

His research journey began in one of the first case logs below sometime in early 2017 in one of his case logs below:

 https://bmjcaselogvivek.blogspot.com/2020/07/virtual-case-bank-from-global-cbble.html




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Virtual case bank Neurology

Quadriparesis:

Presented by Dr Sreeram 2015 MBBS batch 

45 year old diabetic with acute quadriparesis and dysphagia and squint 



Hemiparesis 

65 year old woman with transient hemiparesis and hypoglycemia 


40 year old man, farmer by occupation presented to the opd with the complains of 

Bilateral pedal edema since 20 days 

Dyspnea on exertion since 18 days

Tingling and numbness in lower limbs  since 1 week followed by tingling and numbness in his left forearm which he developed over the next 5 days


Dr Vineela Spandana 2015 intern 


https://vineelashambhavi.blogspot.com/2020/08/40year-old-with-aidp.html?m=1




Paraparesis 


Presented by Dr Anugna 2015 batch

18YEAR OLD MAN CAME TO OPD WITH CHIEF COMPLAINT OF WEAKNESS OF B/L LOWERLIMBS SINCE 20 DAYS

https://hitesh116.blogspot.com/2020/05/12may-2020-elog-medicine-intern.html?m=1st

https://srianugna.blogspot.com/2020/05/hello-everyone.html

PG intern offline Case presentation and discussion 18M with paraparesis proximal to distal and calf hypertrophy: https://youtu.be/3VVH7w3rWSM


2) Presented by Dr Vaishnavi 2015 batch

23 yr old male patient has   complaints of weakness of bilateral lower limbs since 5 days
complaints of tingling and numbness 
h/o vomitings 5days back


https://vaish7.blogspot.com/2020/05/medicine.html?m=1

Offline intern PG discussion around 23M with paraparesis

https://youtu.be/ClopCj2KwZc


Part 2 of offline PG intern discussion around 23M with chronic gluteal abscess and paraparesis: 

https://youtu.be/QhjiomY-S74

Part 3 of 23M with paraparesis case discussion

 https://youtu.be/g9CQKhxsXqY

Part 4 of Offline intern PG discussion around 23M with paraparesis

https://youtu.be/FL37cYp6ZqU


3) Presented by Dr Hitesh 2015 batch

A 18M with inability to climb and difficulty in walking

https://hitesh116.blogspot.com/2020/05/elog-13th-may-2020.html?m=1

Session video: https://youtu.be/VNq0rDdA-80

Presented by Dr Rakesh Kumar Intern 2015 batch:

65 year old man presented to the ER with a chief complaint of weakness in both his lower limbs since 15 days.

https://rakeshkumar04.blogspot.com/2020/06/medicine-blog_4.html?m=1

Presented by Dr Priyanka intern 2015 batch 

An 18 year old male patient came with complaints of tingling and numbness of both feet since 15 days, and both hands since 6 days.


Hemiparesis 

1) Presented by Dr Jaswitha 2015 batch:
A 45 Year old woman with headache since 2 years and right sided swaying of the body since one month: 

Same case by Dr A Vaishnavi PGY 2


Offline session video:




2) Presented by Dr Vaishnavi 2015 batch

A thirty five year old woman with sudden altered sensorium, speech and right hemiparesis:

Intern's E log:


Offline discussion session video: https://youtu.be/fx4Kygh6Nqc


3) Presented by Dr Sowmya and Dr Aditya 2015 batch: 
A 65F with right hemiparesis since October 2019 and sudden acute diarrhoea 

Intern's E log:


Dr Manisha 2015

57F with paraplegia 



Dr Geethika 2015

20 year old milk supplier from eklur nalgonda who is a known case of retroviral disease diagnosed 1 year back came to the casualty with altered sensorium

Dr Mahendran 2015

65 yr old came with the chief complaints of 
Vomitings since 5 days
 Altered sensorium since 4 days.





A few common questions for the students

1) Where are the different anatomical locations for the cause of the problem  for each of these patients?

2) What is the most likely pathology and etiology in that anatomical location?

3) What are the diagnostic and therapeutic options in such situations and what is the efficacy of each option/intervention?

4) Please share questions that come to your mind upon going through each of the cases.
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Friday, July 3, 2020

Post covid transformation of medicine summative assessments


In the current context one of the ways medical education and practice is insidiously or perhaps even dramatically being changed is through this new wave of virtual assessments as per the addendum to the MCI recommendations being circulated that encourages faculty to evaluate students using virtual patients rather than visit the bedside of real patients. 

Our interns have created a repository or sort of a question bank of virtual cases as shared earlier here https://medicinedepartment.blogspot.com/2020/07/virtual-clinical-long-and-short-cases.html?m=1 and we would be currently taking both the UG and PG exams in the traditional format offline as available here 



using our virtual case bank for each candidate. We may even take them through an online webex call as demonstrated in this linked video where we were taking the MBBS pre final today.

However if I had a choice I would do it very differently from the traditional format which is quite dated (maybe five decades allegedly). 


And our daily workflow described here https://medicinedepartment.blogspot.com/2020/06/daily-workflow-of-our-case-based.html?m=1 goes some way to achieve this. 

Also would like to incorporate live telemedical cases instead of just static virtual cases as previously described here 
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Thursday, July 2, 2020

Virtual Clinical Long and Short cases Online Question bank

For more about why this sudden epidemic of virtual assessments that have enormous endemic potential please see the link here https://medicinedepartment.blogspot.com/2020/07/virtual-case-based-assessment-post-covid.html?m=1

 We share below links to our virtual cases who are not simulations but deidentified real patients with whom our doctors are in regular touch through online Telemedicine virtually. We do this following a case report publication model after obtaining signed informed consent from every patient and ensuring anonymity. 

  
1) Where are the different anatomical locations for the cause of the problem  for each of these patients?

 2) What is the most likely pathology and etiology in that anatomical location?

 3) What are the diagnostic and therapeutic options in such situations and what is the efficacy of each option/intervention?

 4) Please share questions that come to your mind upon going through each of the cases.




Respiratory system 


Nephrology 

Cardiology 


Hematology 

Rheumatology:



Dermatology





Github Link to our global cases from multiple locations:



73 cases in this web based log book  from LNMCH courtesy, research assistant,  Kuldeep Gupta 

 globaludhc09.blogspot.com/?m=0
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Virtual case based assessment post covid

Why Virtual case based assessment post covid? 

What/Current status 

The final university MD Medicine summative assessments are the usual exit point and opportunity for residents to ascend to a higher hierarchy in the healthcare ecosystem with many becoming practicing consultants and many going ahead for further fellowships in organ based specialties. 

How/Proposed exam design 
(as per current Council guidelines) 

MCI guidelines for Clinical / Practical and Oral Viva examination quoted below verbatim from their website PDF document linked below:

"(i) Clinical examination for the subjects in Clinical Sciences shall be 
conducted to test the knowledge and competence of the candidates 
for undertaking independent work as a specialist/Teacher, for which 
candidates shall examine a minimum one long case and two short 
cases.

ii) The Oral examination shall be thorough and shall aim at assessing 
the candidate knowledge and competence about the subject, 
investigative procedures, therapeutic technique and other aspects of 
the speciality, which form a part of the examination."


Post covid the MCI has issued another addendum guideline that directs the colleges to conduct the exams in the virtual mode with virtual long and short cases. 

Image of whatsapp circulated letter below:



In view of the above we share below links to our virtual cases who are not simulations but deidentified real patients with whom our doctors are in regular touch through online Telemedicine virtually. 

Please click here

https://medicinedepartment.blogspot.com/2020/07/virtual-clinical-long-and-short-cases.html?m=1
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