Sunday, May 29, 2022

Brief chart on time allotted, competencies tested and marks allocated for university PG summative assessment exam

PG DEGREE EXPRACTICALS & VIVA VOC

DEPARTMENT OF GENERAL MEDICINE

Table of Competences tested along with break up of total 60 minute time allotted per candidate and per examiner (of total four) :

Link to google Doc formatted table : 

https://docs.google.com/document/d/1aQxCC1ExlApAEZNznShwayll7wFdGgymZd_Q-bMSXOE/edit?usp=drivesdk



Preferred :


One of the short cases be the examinee's thesis case which can be further leveraged by him her to present his thesis in the viva. 

Also the critical appraisal paper should be an RCT in PICO format around the diagnostic sensitivity specificity or therapeutic efficacy of one of the cases presented. 



S. No

Regd. No

Practical Max. Marks (200)

VIVA – VOCE (100)



Long Case

(100)

Presentation of individual patient data: 


Competences tested :


 competency to collect , document, recall and analyze individual patient data to reach at diagnosis differentials and therapeutic plan 


Time alloted:

Total 20 minutes 


Presentation: 10 minutes 


Examiner questions:

2 minutes each  (8 minutes) 


Total time for long case


( 10+8+2 minutes )

Short Case (100)

Total Marks (200)

Pedagogy

Microteaching 


Competences tested :


Topic recall and conceptualization 


Delivery of topic to a learning audience 

Marks

(25)








Time alloted:

Total 5 minutes 


Presentation: 1 minute


Examiner questions:

1 minutes each  (total 4minutes) 


Total time for long case


( 1+4 minutes )


Thesis/Dissertation



Competences tested:


Research data collection, documentation analysis and impact 


Marks

(25)









Time alloted:

Total 5 minutes 


Presentation: 1 minute


Examiner questions:

1 minutes each  (total 4minutes) 


Total time for long case


( 1+4 minutes )


Log Book /Learning Portfolio

Competences tested


Individual clinical experiences documentation, reflection, sharing and analysis of past 3 years self work impact 

Marks

(25)





Time alloted:

Total 5 minutes 


Presentation: 1 minute


Examiner questions:

1 minutes each  (total 4minutes) 


Total time for long case


( 1+4 minutes )


Evidence based Medicine and critical appraisal of published data in PICO format


Tests competency to read, comprehend and analyze scientific literature toward optimizing individual patient outcomes

Marks

(25)


Time alloted:

Total 5 minutes 


Presentation: 1 minute


Examiner questions:

1 minutes each  (total 4minutes) 


Total time for long case


( 1+4 minutes )


Total

Marks

(100)

Case 1

Marks

(50)

Presentation of  individual patient data:


Competences tested:


 Competency to capture and analyze visual data in the form of clinical, radiological, electrophysiological and instrumental images to quickly reach at diagnosis differentials and therapeutic plan



Time alloted:

Total 10 minutes


Presentation: 5 minutes 


Examiner questions:

1 minute each  

(4 minutes) 


Total time for each short case 


(5+4+1 minutes)

Case 2

Marks 

(50)

Presentation of  individual patient data:


Competences tested:


Competency to capture and analyze visual data in the form of clinical, radiological, electrophysiological and instrumental images to quickly reach at diagnosis differentials and therapeutic plan



Time alloted:

Total 10 minutes 


Presentation: 5 minutes 


Examiner questions:

1 minute each  

(4 minutes) 


Total time for each short case 


(5+4+1 minutes)

1

2

3

4

5


The chart above is an updated version of what is available in the links below :

Hide quoted text
PG DEGREE EXAMINATION


PRACTICALS & VIVA VOCE


DEPARTMENT OF GENERAL MEDICINE


Table of Competences tested along with break up of total 60 minute time allotted per candidate and per examiner (of total four) :



S. No

Regd. No

Practical Max. Marks (200)

VIVA – VOCE (100)



Long Case

(100)

Presentation of individual patient data: 


Competences tested :


 competency to collect , document, recall and analyze individual patient data to reach at diagnosis differentials and therapeutic plan 


Time alloted:

Total 20 minutes 


Presentation: 10 minutes 


Examiner questions:

2 minutes each  (8 minutes) 


Total time for long case


( 10+8+2 minutes )

Short Case (100)

Total Marks (200)

Pedagogy

Microteaching 


Competences tested :


Topic recall and conceptualization 


Delivery of topic to a learning audience 

Marks

(25)








Time alloted:

Total 5 minutes 


Presentation: 1 minute


Examiner questions:

1 minutes each  (total 4minutes) 


Total time for long case


( 1+4 minutes )


Thesis/Dissertation



Competences tested:


Research data collection, documentation analysis and impact 


Marks

(25)









Time alloted:

Total 5 minutes 


Presentation: 1 minute


Examiner questions:

1 minutes each  (total 4minutes) 


Total time for long case


( 1+4 minutes )


Log Book /Learning Portfolio

Competences tested


Individual clinical experiences documentation, reflection, sharing and analysis of past 3 years self work impact 

Marks

(25)





Time alloted:

Total 5 minutes 


Presentation: 1 minute


Examiner questions:

1 minutes each  (total 4minutes) 


Total time for long case


( 1+4 minutes )


Evidence based Medicine and critical appraisal of published data in PICO format


Tests competency to read, comprehend and analyze scientific literature toward optimizing individual patient outcomes

Marks

(25)


Time alloted:

Total 5 minutes 


Presentation: 1 minute


Examiner questions:

1 minutes each  (total 4minutes) 


Total time for long case


( 1+4 minutes )


Total

Marks

(100)

Case 1

Marks

(50)

Presentation of  individual patient data:


Competences tested:


 Competency to capture and analyze visual data in the form of clinical, radiological, electrophysiological and instrumental images to quickly reach at diagnosis differentials and therapeutic plan



Time alloted:

Total 10 minutes


Presentation: 5 minutes 


Examiner questions:

1 minute each  

(4 minutes) 


Total time for each short case 


(5+4+1 minutes)

Case 2

Marks 

(50)

Presentation of  individual patient data:


Competences tested:


Competency to capture and analyze visual data in the form of clinical, radiological, electrophysiological and instrumental images to quickly reach at diagnosis differentials and therapeutic plan



Time alloted:

Total 10 minutes 


Presentation: 5 minutes 


Examiner questions:

1 minute each  

(4 minutes) 


Total time for each short case 


(5+4+1 minutes)

1

2

3

4

5



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Saturday, May 7, 2022

Links to UG and PG university exam presentations (more than 500 video links)

MD 2019 batch university exams :

MD 2018 batch university exams :

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Tuesday, April 5, 2022

Life style and nutrition management through integrative medicine practice and education

 

This project will be illustrated through patient centered case studies. 

Our prior similar projects are published here :



Two case studies of today 5/4/2022

Case 1 :


Case 2:


Integrative medical education and practice twist :

Life style choices 1:

Psychosocial component :

Even as we started trying to change Case 1's life style and nutrition, we also got Case 1 to look after Case 2 as part of our life style modification program related to deaddiction and other life style changes toward giving our patients a better psycho social and metabolic profile enhancing their individual leadership and scholarship driving better collective societal gains. Above mentioned medical education project has been conceptualized earlier in this book chapter here : https://medicinedepartment.blogspot.com/2021/06/draft-3a-scholarship-of-integration-and.html?m=0

We made Case 1 present the problem based requirements of Case 2 in our 11AM to 1PM morning academic session also attended by 100s of our graduate medical students. One of the medical students was already presenting one of her patients of alcoholic cirrhosis and following her presentation once our Case 1 finished his presentation around Case 2, we had a fruitful discussion around Case 2 as well as Case 1 where we tried to discuss the similarities between the alcohol addiction of Case 1 and the previously medical student presented Alcoholic cirrhosis patient in a non judgemental manner highlighting the complications the first patient suffered from alcohol addiction. 

Our objectives and expectations from this patient driven learning exercise was manifold :

1) Demonstrate harms of a particular life style 

2) Demonstrate the positive outcome possibilities of a changed lifestyle 

3) Build confidence in the patient currently experiencing the harmful lifestyle that s/he can change for the better 

Current life style challenges identified in Case 1 from the case report linked above :

1) Psychological debility due to tragic life events leading to attempted acute (organo phosphorus poisoning) self harm as well as chronic self harm (alcohol addiction) 

2) Medical complications of psychological self harm manifesting in metabolic syndrome (type 2 diabetes) as well as recurrent pancreatitis and possibly type 3 diabetes. 

Life style interventions instituted and ongoing along with expected outcomes:

1) Patient empowerment through practical hands on knowledge and learning of clinical problem solving that would enable scholarship and leadership and not only help to solve the patient's own life style challenges but also benefit many others facing similar challenges as demonstrated by Case 1 learning to help Case 2. 

2) "Guided patient driven learning by patients under supervision of their academic institutional caregivers" can generate participant empathy and collaboration toward mutual well being.

Above is a work in progress and we need to watch this space. 

Lifestyle choices 2:

Nutrition and physical exercise :

Current challenges identified in both the patients:

Lack of information : 

What has been their diet and exercise levels till date and what has changed since pharmacological interventions began? 

If their diet and exercise is suboptimal what are the factors responsible for it? 

Definitive lifestyle interventions instituted :

Positive psychosocial gainful workflow along with proper nutrition and exercise with adequate monitoring of metabolic parameters and regular positive feedback. 

Image based monitoring of patient nutrition where patient is asked to share an image of the pre and post meal plate regularly and offered feedback on the nutritional value of the plate consumed and suggested changes based on the nutrition image of the plate intake shared. 




Case 1 plate image of lunch at hospital today:




Case 1 dinner today :



Case 2 dinner today :






Self recorded blood sugar values on full dose sulfonylurea Glimeperide 4 mg twice daily :

Please watch their data grow in the mirror image case report blog that is likely to be located in our elective student's learning portfolio here :

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Sunday, March 20, 2022

PhD MD program through a case based blended learning ecosystem CBBLE

What requirement does this project address:


WHY? 

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. 

We have a very good case for opening a PhD MD program because the current MD PhD program as devised in US is full of loopholes https://en.m.wikipedia.org/wiki/MD%E2%80%93PhD

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 :


Image copyright with website linked below :


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Sunday, March 13, 2022

MBBS 2019 batch March 2022 internal assessment question paper prepared from patient data driven group learning with shared date and time links from the group

DEPARTMENT OF GENERAL MEDICINE

4TH SEM Ist - INTERNAL ASSESSMENT EXAMINATION

MARCH - 2022

Date:                       

Time: 10 am to 1 pm

Note: Answer all questions       

SET - A                  Max Marks: 100   


Long questions 2*15 = 30


1.Etiology ,pathogenesis , management, complications of acute pancreatitis 



2.Etiology, investigations and  management of ascites. 


Short questions 8*5 = 40

3.Etilogical classification of AKI 


4.Management of dengue 


5.Clinical features, investigations, management of iron deficiency anemia 



6.Causes of Chronic Liver Disease, Management of hepatic encephalopathy


7.Classification and etiology of seizures


8.Types of pulmonary edema , management.


9.Causes of pedal edema  and management? 


10.Clinical features and management of heart failure



Very short questions : 10x3 =30 


11.Mention the causes of chronic  renal failure.

12. hypersplenism

13.Scabies

14.Drug therapy of OP poisoning

15.Mention causes of secondary hypertension

16.Features of sickle cell crisis

17.Spontaneous bacterial peritonitis

18.Drugs used in Migraine.

19.Indications of hemodialysis 

20.Jugular venous pressure ?

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Wednesday, March 9, 2022

Usage and creation of E learning resources by our departmental local and global CBBLE

All the E learning resources used and created by our departmental local and global CBBLE (case based blended learning ecosystem) was done to meet the demands of our regular learning and patient care workflow. More details about our CBBLE (case based blended learning ecosystem)  available in this publication here : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163835/


Daily workflow of our case based blended learning ecosystem aka CBBLE (and links to E resources utilized) 


Our regular patient centered learning workday begins with our post graduate residents meeting our patients in the wards and ICUs from 8:00 AM to 9:00 AM while one unit batch of post graduates look after the outpatient that opens at 9:00 AM.  A tabular summary of our daily workflow is linked here: http://medicinedepartment.blogspot.com/2021/02/medicine-department-time-table.html?m=0
and below we also provide links to the E resources utilized. 

E learning resource 1: online discussion group 

Ours is a blended offline and online learning program with our offline interns and residents beginning the day by sharing our last night new admissions and overall inpatient data and their experiences in meeting those patient challenges in our local CBBLE, which is an online discussion group accessible only to group members where individual  case details are shared as individual  case report links after patient deidentification and signed informed consent. 

Some examples :



Quality improvement cycle :


E learning resource 2: online archived videos of ward rounds and flipped classroom sessions.  


Once the patients shared in the online group are discussed thoroughly by all departmental students and faculty, the rounds begin in the manner below :


(in the above example our rounds were archived as a youtube video learning resource for globally interested students) 

UG teaching learning workflow in medicine begins at 11:00 -1:00 PM post 8-10 AM- PG rounds and 10-11AM- UG case taking followed by 11:00-1:00 AM unit wise UG case presentation and discussion.

All videos of our teaching learning workflow beginning with theory lecture classes in flipped classrooms as well as practical case and procedural demonstrations are captured, created and archived here as an E learning resource : https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR





E learning resource 3: Online Learning Portfolios of every participant of our local and global CBBLE linked below as batchwise dashboards :


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