Friday, June 17, 2022

Medicine lectures archived over the years

Medical education  lectures:


Medical Education Curriculum: How do we change the game? http://www.pitt.edu/~super1/lecture/lec54091/001.htm,

Generalism in Medical Education:  What and Why? http://www.pitt.edu/~super1/lecture/lec54101/001.htm

Assessment of Generalist Learning Competency: http://www.pitt.edu/~super1/lecture/lec54111/002.htm

Bangalore BMJ lecture (July 2015) How to write a Case Report: http://www.pitt.edu/~super1/lecture/lec53671/002.htm

Bhopal Patient centered outcomes research 2014: http://www.pitt.edu/~super1/lecture/lec53081/001.htm

Lecture on “Case Study approach to healthcare” delivered on June 25 2013 at KMC Manipal through web conference organized by BMJ group UK. Link to lecture power points: http://www.pitt.edu/~super1/lecture/lec50421/001.htm


AMU : Clinical research in individual patients 
2013:

Delhi Lecture (Banga Bhawan,  June 2015) Revitalizing Informal healthcare: http://www.pitt.edu/~super1/lecture/lec53961/001.htm

Chandigarh June 21, 2016, Yoga and Medical education : http://www.pitt.edu/~super1/lecture/lec54621/001.htm
Lecture video : https://youtu.be/MmbRbKj-7yE (starts at 34 minutes). 

Kisch island 2016: Evidence based medical education : http://www.pitt.edu/~super1/lecture/lec54941/001.htm

Understanding Complexity of Clinical Experience through Online conversational learning networks: http://www.pitt.edu/~super1/lecture/lec42161/010.htm
Medicon 2011, Mumbai, India

Hyderabad BMJ conclave 2019:

Flipped classroom lecture videos :

Case based blended learning ecosystem (flipped classrooms):


Narketpally 2022 Clinical problem solving (participant action narrative with videos) :



Patient Centered Lectures:

Patient as a teacher :


Non resolving pneumonia :
Patient centered biochemistry: Bioclinical markers (Alkaline Phosphatase): http://www.pitt.edu/~super1/lecture/lec54121/001.htm

Patient centered biochemistry: Statins: http://www.pitt.edu/~super1/lecture/lec54131/001.htm










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Saturday, June 11, 2022

Learning competency objectives and outcomes in "Third World" theory lectures

Theory lecture classes are still taken in the "third world." 


The third world exists across the Atlantic and Pacific of the united First World. By theory lectures, the third world understands something like a copy pasted power point full of factual content that should act as a morning sedative to counteract the strongest cup of coffee a student may have inadvertently tried to poison herself with. 

Here are a few quick bullet points taken from a theory lecture that was prepared for the First World (rewarded with $$) and the video of that lecture is also linked at the end although this post is mostly about "how to" design a competency based medical education "lecture class." Unfortunately this is a "patient centered lecture class" something that is still anathema in the third world but it is and has been practiced in isolated pockets for quite a few decades. 


Learning Objectives:

By the end of this session the participants will be able to learn the following points around this patient:-

1.Significance of History taking in diagnosis

2.Thorough Clinical Examination

3.Auxillary examination findings in narrowing down the differential diagnosis

4.Summary of events in patient’s life

5.Graphical Timeline

6.Global Health Challenges to rule out diagnostic uncertainities

7.Solutions to these challenges


Learning objectives and expected competency outcomes:


1. Significance of meticulously capturing patient event data aka clinical history and achieve competency in the documenting and analyzing the same around the clinical problem mentioned in the title. 

2. Significance of meticulously capturing patient body data through body surface examination (clinical signs) and achieve competency around documenting and analyzing the same. 

3. Importance of capturing patient body data through imaging and laboratory diagnostics and achieve competency in documenting and analyzing the same. 

4. Importance of summarizing, analysing and sharing the patient timeline of events along with captured data. 

5. Understand the global health challenges in resolving diagnostic and therapeutic uncertainties 

6. Brainstorm impactful global solutions to the above patient centred challenges. 

7. Summarize competencies attained at the end of the session by generating for themselves similar formative patient centered learning portfolios toward impactful sharing.

Learning points-

1. A thorough ,chronological history, serves the main basis of identifying the differentials


2. Meticulous glance of the Patient carves ways to important signs of diseases.

3. Mastering Clinical skills in narrowing differentials , further limits Overtesting ,hence Over or Under treatment of patients.

4. Physicians always must pay attention to a persisting ,modern Pandemic- Antibiotic resistance.

5. Developing Low cost tools for diagnosis and management of patient


6. Efficient follow up and precise Management can be a strong step in harnessing the certainties to the uncertainties of dignosis and therapy.

8. A Top Down approach , can serve a significant technique to resolve certain uncertainties where we arrive as a retrospective diagnosis when there’s response to a certain therapy.

Learning Summary 

1. We shared a patient with a clinical problem such as cough and hemoptysis and tried learning from the different steps toward solving the patient's problem. 

2. We discovered particular events in the patient's life, recent and past that pointed towards the root cause of her illness 

3. We learned how clinical skills to capture  data from the patient's body can afford valuable clues to the root cause of the problem. 

4. We learned how laboratory diagnostic imaging and sampling of body fluids and tissues can allow us to penetrate deeper into the clinical problem. 

5. We understood that there are many challenges and uncertainties to diagnosis and therapy in low or mixed resource settings 

6. We understood that these uncertainties can resolve over time and informational continuity with the patient is of paramount importance 

7. We understood that a student can document and share his "patient centered learning" experiences through his online learning portfolio and create global cognitive impact while locally benefiting positively the lives of their patients.

Link to the entire video of the lecture :

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Friday, June 10, 2022

Linking students, faculty and global citizen scientists to our departmental current ongoing research projects to help them decide their own topic work areas

Abstract (summary of the current ongoing projects in medicine department) :
Every individual clinical problem solving exercise is a unique valuable contribution to global literature as each and every individual illness trajectory that has been completed is a potential predictive match for an individual illness trajectory that has just begun but days, months or years away from completion. Our case based blended learning ecosystem (CBBLE) aims to gather all these concrete individual experiences and use reflective, qualitative, thematic analysis tools on the data  to generate conceptual abstractions toward further active experimentation. It proposes to do so under separate global project teams based on themes centred around problem solving clinical complexity at organizational as well as organ system levels. The list  of our current projects linked in detail below is also an invitation to all our department team members (as well as global citizens and system users with an interest in contributing to health research) to join our CBBLE that exists primarily online and yet remains blended to our regular day to day hospital based offline physical workflow. We share below many online links to our past and current work thematically divided into organizational and organ systems complexity along with links to joining  user driven healthcare UDHC  discussion forums for our PGs and department members  along with global citizen researchers to join and start contributing their questions and solutions online along with their regular physical contributions offline in our regular work location.  Users are free to start newer project groups and add our key members to guide them online (and offline blended) once they get used to our collective quest for improving health outcomes locally and globally. 

Key words : Medical cognition, clinical complexity, case based blended learning ecosystem, user driven healthcare, case based reasoning, conversational learning, qualitative ,non probability, snowball sampling 

Some prior references to understand our above keyworded research thrust areas are linked below :


CBBLE : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163835/


UDHC : https://pubmed.ncbi.nlm.nih.gov/19018905/


Case based reasoning :


https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/15533257/


Research sampling techniques used:


Non probability sampling :


https://www150.statcan.gc.ca/n1/edu/power-pouvoir/ch13/nonprob/5214898-eng.htm


Snowball sampling :


https://www.statisticshowto.com/probability-and-statistics/statistics-definitions/snowball-sampling/#:~:text=Snowball%20sampling%20is%20where%20research,and%20becomes%20larger%20and%20larger.



Specific projects in progress :

Broad categories : 

Organizational systems and Organ systems driven projects 



Organ systems driven :


Cardiac :

Clinical organizational complexity driving management of diagnostic and therapeutic uncertainty in pulmonary hypertension and heart failure.

Work done around this project so far : 

Work in progress :


Completed :


ASYMPTOMATIC LEFT VENTRICULAR (LV) DIASTOLIC

Vascular organ systems :

Outcomes in macro and microvascular pathologies driven by metabolic derangement: https://manikaraovinay.blogspot.com/2022/04/dissertation.html?m=1

24 HOUR URINARY SODIUM EXCRETION IN NEWLY DIAGNOSED HYPERTENSIVE   PATIENTS :

https://drive.google.com/file/d/1hHGJ1olrFIM-tlFCdq-wwzyT2ViG8-0_/view?usp=drivesdk



Project discussion WA group invite link:


Neuro systems project :

Problem Representation 


The repercussions of paralysis/weakness are enormous, both personally to the individual and to their family; and have huge economic costs to society. Paralysis takes many forms with multiple disorders causing paralysis, and multiple body systems often affected.


Work in progress :


Motor paralysis outcomes :


Project discussion WA group invite link:


Behaviour analysis project :

Content development of behavioral analysis strategies in an original manner given our contextual settings and patient requirements and not as illustrated in predominantly Western scenarios. 

WA group discussion invite link :



Renal organ systems :

1) Factors influencing clinical decision making around therapeutic interventions for critically ill renal failure patients 

Work done so far :



2) Clinical organizational complexity driving superinfections in chronic renal  failure. Work done around this project so far : 



2019-20 CHRONIC KIDNEY DISEASE PATIENTS:
MARKER FOR EARLY DETECTION OF CHRONIC KIDNEY DISEASE:



3) Predictors of outcomes in patients of Chronic kidney disease


Project discussion WA group invite link:



Gastro organ systems :

Outcomes in Ascites :

Work done so far :


SERUM ALBUMIN ASCITIC GRADIENT IN THE ETIOLOGICAL DIAGNOSIS OF ASCITIS:


Haematological abnormalities in decompensated chronic liver disease.

https://drive.google.com/file/d/12XMxwb15KzuxlSQP8B-wJEShr_BhMGmT/view?usp=drivesdk

MORTALITY AND INTERMEDIATE MARKERS OF SEVERITY IN ACUTE PANCREATITIS” 


Project discussion WA group invite link:


Multiple organ systems projects :

Communicable (Infectious) diseases:

Tuberculosis diagnostic and therapeutic uncertainty :

Problem statement :

Private and government centers in India indulge in a lot of empirical antitubercular therapy due to clinical complexity (diagnostic and therapeutic uncertainty) surrounding it's management and how we may be able to reduce this overdiagnosis and overtreatment of tuberculosis at the same time taking care not to undertreat using hitherto unknown tools and it also builds on the theme of how we in the past tackled clinical complexity surrounding poorly differentiated fever using simple tools such as fever chart patterns and checklists (another updated publication on our fever project is also long overdue given the four year case report data on fever we have). 

More about the fever project here :


Past publications (patient centered) around tuberculosis clinical complexity :

Non communicable diseases NCDs:

Life style disorders : Visceral Fat, Diabetes , hypertension, vasculopathy 

Past project formulations :


Past published work (patient centered) :

Here are two sample case report links of our current patients where the regular diet and activity is being followed :





Patient Journey Record Systems (PaJR): The Development of a Conceptual Framework for a Patient Journey System. In R. Biswas, & C. Martin (Eds.), User-Driven Healthcare and Narrative Medicine: Utilizing Collaborative Social Networks and Technologies (pp. 75-92). Hershey, PA: Medical Information Science Reference. doi:10.4018/978-1-60960-097-6.ch006http://www.igi-global.com/chapter/patient-journey-record-systems-pajr/49246

Whatsapp Group for 
 diet and exercise lifestyle medicine project :


Alcohol use disorders and diet exercise life style medicine intervention project :


Resolving diagnostic and therapeutic uncertainty in patients with hyponatremia

https://medicinedepartment.blogspot.com/2021/02/medicine-department-project-on.html?m=0


https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006006-thesis.html?m=1


Organizational systems driven :


Theme 1: clinical complexity, diagnostic and therapeutic uncertainty, medical cognition) 

1) Resolving organizational clinical complexity through quality improvement tools in a case based blended learning ecosystem CBBLE 

Project discussion WA group invite link:


Work done and conversational learning around this project so far 


Past work by our department on this project : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163835/

(2012). Understanding Clinical Complexity through conversational learning in medical social networks: Implementing User Driven Health care. In J.P. Sturmberg and Carmel.M. Martin (Ed.), Handbook on Complexity in Health (pp. ). New York, NY. Springer.



Organizational systems driven :

Theme 2: scholarship of integration, medical education and research, Integrative medicine, clinical complexity, diagnostic and therapeutic uncertainty, medical cognition) 

Project details:


Project discussion WA group invite link:
https://chat.whatsapp.com/JJ4FLpvpIAN3xN9vjJ0mbg

3) Medical education project done by our senior resident post MD and the "work in progress" is linked below :


Once our PG students do their thesis well during MD, they may realize that it could become a life long passion where they would continue to do various thesis in various directions as a part of life long self directed learning. 

This one may be titled, 

"Clinical complexity drives learning outcomes in health professional online learning portfolios, a quality improvement in medical education project."

There is a summary of our findings at the bottom of the link.

A QI cycle 3 will be run at the end of the 2016 interns batch academic year. Online learning portfolios from June 2021 to May 2022 will be included.

And our CBBLE dashboard here : https://medicinedepartment.blogspot.com/2022/02/?m=0, contains thousands of "online learning portfolios" of our medical students from five and more batches  with their logged and regularly evaluated patient narratives (thousands of case reports links that keeps growing everyday) toward their formative assessment that goes to formulate their internal assessments marks. 


Past projects of Medicine department :





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Monday, June 6, 2022

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


 

For more about the university and NMC (regulators body) guidelines for conducting the final MBBS practical viva exams click here : https://medicinedepartment.blogspot.com/2021/03/final-university-mbbs-medicine.html?m=0

Quoting from the above link :

"Emphasis should be on candidate’s capability to elicit history, demonstrate physical signs, write a case record, analyze the case and develop a management plan.

Viva/oral examination should assess approach to patient management, emergencies, attitudinal, ethical and professional values. Candidate’s skill in interpretation of common investigative data, X-rays, identification of specimens, ECG, etc. is to be also assessed."


MCI examination guidelines PDF linked below:


Finally we come to how exactly we wish to conduct the examination here locally so that 

1) There is minimal intrusion in the local patient centered workflow thus not harming patients 

2) There is maximal utilization of this additional learning in the regular workflow thus actually benefiting patients."


Link to the recordings of our Medicine MBBS and MD university exams 👇


Link to our CBBLE dashboard here : https://medicinedepartment.blogspot.com/2022/02/?m=0, which contains thousands of "online learning portfolios" of our medical students from five and more batches  with their logged and regularly evaluated patient narratives toward their formative assessment that goes to formulate their internal assessments marks and is also an evolving question bank for the university final and NEET exams. 

CBBLE stands for case based blended learning ecosystem first described here : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163835/
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