UDLCO: AI LLMs and their current collaborative stance inspite of competing rival human creators?

UDLCO summary: AI LLMs in their routine responses are always courteous albeit they can start confabulating (aka hallucinations popularly but perhaps not the appropriate term) and mislead. In the sample taken from our morning PaJR session with one of our patients and meta AI, we notice a positive note of collaboration in their courteous stance that is again very unlike competing humans for now. At this juncture it's difficult to say how long our honeymoon with AI shall last before it quickly learns all our human follies!

Conversational PaJR transcripts on the morning of 9th October between different PaJR users, patient advocate, PaJR moderator and meta AI centered around the requirements of a 30 year old type 1 diabetic:

[09/10, 23:59] Patient DM1 MP Advocate 2: 6:30 pm drink 1 cup black tea without sugar 

7 pm insulin lantus 8.5 unit 

7:50 pm sugar 52

Trembling and shivering so I ate 1 sweet,3 chocolate and rice with bottle gourd curry and brinjal fry

[10/10, 08:34] Patient DM1 MP Advocate 2: Good morning sir 

10/10/24

8:30 am fasting sugar 146

[10/10, 10:41] PaJR moderator: How do we explain this episode of hypoglycemia at 7:50 AM yesterday, in terms of precipitating cause @⁨Meta AI⁩ ?

[08/10, 09:01] Patient DM1 MP Advocate 2: Good morning sir 

8/10/24

8:45 am fasting sugar 187

[08/10, 17:06] Patient DM1 MP Advocate 2: 9 am drink 1 cup black tea without sugar 

10:25 am before breakfast sugar 230

10:30 am 

Sprouts 

12:30 pm after breakfast sugar 235

2:55 pm before lunch sugar 166

3 pm 

Rice with cabbage fry and lentil 

5 pm after lunch sugar 143

[08/10, 23:53] Patient DM1 MP Advocate 2: 5:15 pm drink 1 cup black tea without sugar 

7 pm insulin lantus 8.5 unit 

9:25 pm before dinner sugar 140

9:30 pm 

2 roti with lentil and cabbage fry 

11:30 pm after dinner sugar 214

[09/10, 06:38] Patient DM1 MP Advocate 2: Good morning sir 

9/10/24

6:30 am fasting sugar 143

[09/10, 15:37] Patient DM1 MP Advocate 2: 8:30 am drink 1 cup black tea without sugar 

9:55 am before breakfast sugar 186

10 am 

Besan chila

12 pm after breakfast sugar 175

1:25 pm before lunch sugar 163

1:30 pm 

Khichdi, mix veg and kheer ( Prasad)

3:30 pm after lunch sugar 180

[09/10, 23:59] Patient DM1 MP Advocate 2: 6:30 pm drink 1 cup black tea without sugar 

7 pm insulin lantus 8.5 unit 

7:50 pm sugar 52

Trembling and shivering so I ate 1 sweet,3 chocolate and rice with bottle gourd curry and brinjal fry

[10/10, 08:34] Patient DM1 MP Advocate 2: Good morning sir 

10/10/24

8:30 am fasting sugar 146

[10/10, 10:41] Meta AI: The episode of hypoglycemia (low blood sugar) at 7:50 AM yesterday can be analyzed based on the provided data.

Precipitating causes:

1. Insulin dose: 8.5 units of Lantus insulin taken at 7 PM the previous evening. Lantus has a peak effect in 10-16 hours, which aligns with the hypoglycemic episode.

2. Timing of last meal: Dinner was at 9:30 PM, and the next meal wasn't until breakfast at 10 AM, resulting in a relatively long fasting period.

3. Physical activity: No significant physical activity mentioned.

4. Food intake: No significant carbohydrate intake between dinner and the hypoglycemic episode.

Contributing factors:

1. Possible insulin stacking: Taking 8.5 units of Lantus insulin at the same time each evening may have accumulated in the patient's system.

2. Inadequate carbohydrate intake before bedtime or at breakfast.

Recommendations:

1. Monitor blood glucose levels more frequently.

2. Adjust insulin dosing regimen or timing.

3. Ensure adequate carbohydrate intake before bedtime and at breakfast.

4. Consider a snack before bedtime or a late-evening snack.

Consult a healthcare professional for personalized guidance.

Please provide additional context or information, if needed.

[10/10, 10:43] PaJR moderator: @⁨Meta AI⁩ in error I mentioned 7:50AM. That was supposed to mean 7:50 PM, which is when the patient experienced hypoglycemia

[10/10, 10:43] Meta AI: Given the corrected time of hypoglycemia (7:50 PM), let's re-analyze the data:

Precipitating causes:

1. Insulin dose: 8.5 units of Lantus insulin taken at 7 PM, which is 50 minutes before the hypoglycemic episode. Lantus has a peak effect in 10-16 hours, but the patient experienced hypoglycemia within a shorter timeframe.

2. Recent food intake: Dinner was at 9:30 PM the previous night, and the patient had black tea without sugar at 5:15 PM.

Contributing factors:

1. Timing of insulin administration: Taking Lantus insulin at 7 PM may have coincided with a natural dip in blood glucose levels before dinner.

2. Inadequate carbohydrate intake between 5:15 PM tea and 7:50 PM hypoglycemia.

3. Potential insulin stacking or sensitivity.

Recommendations:

1. Consider adjusting insulin dosing timing to closer to dinner (e.g., 9 PM).

2. Ensure adequate carbohydrate intake between 5 PM and dinner.

3. Monitor blood glucose levels more frequently, especially before and after dinner.

4. Consult a healthcare professional to reassess insulin regimen and adjust as needed.

Additional questions:

1. What is the patient's typical physical activity level?

2. Has the patient experienced hypoglycemia at this time of day previously?

3. Are there any other medications or health conditions that could impact blood glucose levels?

[10/10, 10:49] PaJR moderator: @⁨Meta AI⁩ thanks for the valuable inputs.

Wish you could read the patient's entire data from few months, painstakingly archived in the URLed web based EHR content here:

 https://2patienthealthreport.blogspot.com/2024/06/patienthealthreport.html?m=1

Updated till 5th October. @⁨Patient DM1 MP Advocate 2⁩ can you update it till today?

I guess till meta AI learns to read URLs we can share the URL with Notebook LM for more insights from longer past data trends?

[10/10, 10:49] Meta AI: I'm glad I could provide helpful insights.

Unfortunately, I'm currently unable to access external URLs or scrape data from websites, including the patient's EHR data. However, I can offer suggestions:

*Short-term solution:*

1. Continue sharing relevant data snippets, and I'll provide analysis and recommendations.

2. Consider copying and pasting specific data periods or events for more detailed analysis.

*Long-term solution:*

1. Notebook LM: Share the URL with Notebook LM, as you mentioned, to leverage its capabilities.

2. Data export: Export the patient's EHR data in a machine-readable format (e.g., CSV, JSON).

3. Secure data sharing: Explore secure, HIPAA-compliant platforms for sharing and analyzing patient data.

*Future development:*

As AI capabilities advance, I may be able to:

1. Access and parse data from URLs.

2. Integrate with EHR systems.

3. Analyze larger datasets.

Until then, I'm here to assist with data analysis and insights based on the information you provide.

To update the data till today, please share:

1. Blood glucose readings.

2. Insulin dosages and timing.

3. Relevant medical events or changes.

4. Any new medications or lifestyle changes.

I'll continue providing valuable inputs.

Creative commons license: https://commons.m.wikimedia.org/wiki/File:RAG_schema.svg#mw-jump-to-license

UDLCO: Case based learning and a case study of the 2024 Nobel in medicine using critical realist pedagogy!

UDLCO conversational transcripts: 

[08/10, 06:48] medical education faculty: Good morning, could any one share literature clearly differentiating CBD and CBL

[08/10, 07:11] +60 ASM : The following video may help in understanding the concept and conduct of CBL

https://youtu.be/piaoHLMpTx8

[08/10, 07:49]  Prof Meu: Case-Based Discussion (CBD) and Case-Based Learning (CBL) are educational strategies used in medical and healthcare education. Both methods use cases to initiate/facilitate learning. However there are distinct differences regarding the purpose, outcome and process.

CBD focusses on analyzing a patient's case to develop critical thinking and decision-making skills while CBL focusses on  integrating knowledge, skills, and attitudes through real-life scenarios.

CBD is  Instructor-led, small group discussions with the objectives of

  developing diagnostic and management skills and enhance clinical reasoning while CBL is self-directed, and problem-based learning.

    Both foster collaboration and communication amongst learners and improve critical thinking skills.

In CBL, learners identify learning issues and address them.

3. Objectives: CBD targets specific clinical skills, whereas CBL aims to develop broader competencies.

4. Learner engagement: CBD involves group discussions, while CBL encourages individual or small group work.

CBD is a more structured, instructor-led approach focusing on clinical skills, while CBL is a self-directed, problem-based strategy emphasizing integrated learning and lifelong skills.

😁

[08/10, 07:49] SG : You can get more details, just ask Meta or Gemini..😜

[08/10, 07:53] +91: Yup

[08/10, 08:08]Physiology Prof Meu: 😆 One Health...one miRNA...

[08/10, 08:09] +91J: m bole to? 😂

[08/10, 08:13] b: And..

One skill..One miRNA..

One disease...one miRNA....

[08/10, 08:33] CBBLE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4013251/

👆This historical review article says, "miRNAs were discovered in 1993 by Lee and colleagues in the nematode Caenorhabditis elegans and Ambros was the last author and Lee is cited in 4 more papers in the same review article while Ambros is not. Wonder what happened to Lee!

The review article is dated 2013 and appears to have been written by an Indian who also cites his own work around miRNA in modulating fetal lung development in reference 13.

Ambros is again cited in reference 2, this time as a first author around his work on annotation of miRNA.

More about Ambros here:

https://www.nobelprize.org/prizes/medicine/2024/press-release/

[08/10, 08:51] VS: What should we make of it..?

[08/10, 08:57] CBBLE: It's a morning medical education exercise to activate thinking caps! Part of a critical realist methodology for medical education delivery!

[08/10, 09:31]K : Good morning madam. The basic difference between CBL and CBD is that while the former is a pedogogical/instructional tool (active learning) , the latter is a structured WPBA tool (formative). Though I could find (as of now) a peer reviewed article that discretely defines the difference between two, I am sharing two resources

[08/10, 09:34] CBBLE: 👆As per this, there doesn't need to be any difference and CBD is a subset or part of CBL

[08/10, 09:36] CBBLE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736264/

[08/10, 09:36] CBBLE: CBL would cover all the domains addressed in the image here 👇

https://medicinedepartment.blogspot.com/2024/10/critical-realist-pedagogy-and-theatre.html?m=1

While CBD could be restricted to the outermost domain

[08/10, 09:38] AD: CBD is a WPBA tool. Didn’t we all use it in summative exams also during Covid pandemic?

[08/10, 09:41] K: https://www.bjmp.org/content/critical-analysis-case-based-discussions

[08/10, 09:41] VS: In research articles, the first author is usually the student who did all the bench work and the last author is the senior professor, which is why Rosalind Lee is the first author..

Reference 2 in the article is a convention paper, where Victor Ambros came up with a system to name microRNAs. There is no original research there. It is only a suggested system for naming something new, which the field agreed to adopt…

Also it turns out, they married each other 😀👇🏾

[08/10, 09:42]VS : She continues to work with him in the lab https://www.umassmed.edu/ambroslab/LabMembersOnly/senior-scientist/

[08/10, 09:44] CBBLE: Full marks in our assessment of your active learning using a critical realist pedagogy! 🙂🙏

[08/10, 09:46] CBBLE: Good point AD!

Yes CBD is a subset of CBL and often used for summative assessment while CBL is an overall picture that only a longitudinal formative assessment can provide

[08/10, 09:46]: https://www.bmj.com/careers/article/wpba-assessments-what-are-wbpas-in-medicine-

keyword glossary:https://userdrivenhealthcare.blogspot.com/2023/11/glossary-of-user-driven-healthcare.html?m=1

Creative commons license:

https://commons.m.wikimedia.org/wiki/File:MiRNA.svg#mw-jump-to-license

Critical realist heutagogy and the theatre of oppressed in medical education: past celebrations and present failures

In his book, the pedagogy of oppressed, Freire calls traditional pedagogy the "banking model of education" because it treats the student as an empty vessel to be filled with knowledge, like a piggy bank. He argues that pedagogy should instead treat the learner as a co-creator of knowledge.

This was subsequently incorporated in the work of Augusto Boal in "theatre of oppressed" that is a form of "simulated education" where the audience learners (spect-actors) get to learn with the teachers (professional actors).

We often find simulations as an easy way of delivering medical education too and there are currently many tools and tactics to deliver these and yet most medical practitioners and practicing teachers tend to engage more with the primary beneficiaries of medical education (patients) in real time and perhaps even need their students and spect-actors to actually lend them a hand (as in a hands on approach to co-creating knowledge) and thus actually benefiting the primary beneficiaries of medical education, even creating a scope to correlate student and teacher learning outcomes with patient illness outcomes.

Co-creating emancipatory knowledge in real time:

We look back decades before "critical pedagogy" was founded and peer into the life of an Indian hands on Marxist anarchist revolutionary, Bhagat Singh, who for some time in his short existence of 20 years had been exploiting the power of drama as a means to inspire the revolt against the British, purchasing a magic lantern to show slides that enlivened his talks about revolutionaries. 

In 1929, he proposed a dramatic act to the HSRA intended to gain massive publicity for their aims. Influenced by Auguste Vaillant, a French anarchist who had bombed the Chamber of Deputies in Paris,^[36] Singh's plan was to explode a bomb inside the Central Legislative Assembly. The actual intention was for the perpetrators to allow themselves to be arrested so that they could use court appearances as a stage to publicise their cause. The Supreme Court of India established a museum to display landmarks in the history of India's judicial system, displaying records of some historic trials. The first exhibition that was organised was the Trial of Bhagat Singh.

https://en.m.wikipedia.org/wiki/Bhagat_Singh

https://consciousnotebooksequel.blogspot.com/2024/10/wiki-udlco-ultimate-role-play-in.html?m=1

Much has happened in the years since then with further evolution of critical pedagogy embracing critical realism that allows healthcare learners to 1) understanding complex outcomes, (2) optimizing interventions, and (3) researching biopsychosocial pathways. Such questions are central to evidence-based practice, chronic disease management, and population health.

https://en.m.wikipedia.org/wiki/Critical_realism_(philosophy_of_the_social_sciences)

https://pubmed.ncbi.nlm.nih.gov/37335625/

While we don't have a ©️ on the very useful figure of critical realist view of stratified reality shared by Hoddy et al : Source: https://www.researchgate.net/publication/342246458_Critical_realism_and_constructivism_merging_research_paradigms_for_a_deeper_qualitative_study/figures?lo=1, Full text: https://fenix.iseg.ulisboa.pt/downloadFile/281608120804971/Critical%20realism%20and%20GT%20Hoddy%202019.pdf, 

we would like to add our own diagram as a positive contribution to expand on their viewpoint from a medical cognition lens and the essence of it is all about the individual patient's and physician's cognition at the centre of the concentric circles corresponding to Hoddy's domain of the 'empirical' as in perceptions, experiences and observations of 'individual cognition' while the surrounding concentric circle forms a ring of 'actual collective cognition' that tries to tie together all knowledge elements into an 'ontology' many of which are unknown and form the connecting link to the next ring which is Hoddy's domain of the 'real' that contains all the structures and mechanisms that generate events that again feed back cyclically into the central concentric circle of individual perception of empirical events surrounded by the ring of collective cognitive interpretation of 'actual' events.

In our CBBLE and PaJR groups we witness daily in real time, a co creation of user driven learning community ontologies powered by Web 2.0 critical realist heutagogy through team based learning between multiple stakeholders such as health professional learners, faculty, patients and their relatives that is increasingly supported by Web 3.0 technology where all these stakeholders co create as online system users, with a username, something that has been labelled in the past user driven healthcare.

Ref 35: https://pubmed.ncbi.nlm.nih.gov/19018905/ and Ref 36: Biswas, R. & Martin, C. M. (Eds.). (2011). User-Driven Healthcare and Narrative Medicine: Utilizing Collaborative Social Networks and Technologies. IGI Global. https://doi.org/10.4018/978-1-60960-097-6

https://www.igi-global.com/book/user-driven-healthcare-narrative-medicine/41908#:~:text=User%2DDriven%20Healthcare%20and%20Narrative%20Medicine:%20Utilizing%20Collaborative,problems%20in%20healthcare%2C%20utilizing%20real%20life%20examples.

This co creation has enabled healthcare educator practitioners to not only remain focused on real patient care centred learning outcomes but develop realist ontologies for medical education and practice such as "real patient OSCEs" that retain whole patient clinical complexity rather than reduce it to smaller parts in order to optimize clinical complexity.

https://medicinedepartment.blogspot.com/2024/01/medical-cognition-cpd-jan-25-2024theme.html?m=1

Source: https://www.researchgate.net/publication/342246458_Critical_realism_and_constructivism_merging_research_paradigms_for_a_deeper_qualitative_study/figures?lo=1

Full text: https://fenix.iseg.ulisboa.pt/downloadFile/281608120804971/Critical%20realism%20and%20GT%20Hoddy%202019.pdf

Present failure:

"Many if not most students come to the university in order to gain access to and eventual enfranchisement in 'the establishment,' not to critique and reject its privileges."

Students want to gain, rather than to critique, positions of privilege, as encouraged by critical pedagogues."

https://en.m.wikipedia.org/wiki/Critical_pedagogy

Updated terminology:

[06/11, 09:50] Kmcq: Heutagogy!

Pedagogy is outdated

[06/11, 09:52]: It's a heutagogist's strategy of calling heutagogy as pedagogy but yes I realise it would be better to name it heutagogy

@⁨Meta AI⁩ how's heutagogy different from pedagogy?

[06/11, 09:53] Meta AI: Heutagogy and pedagogy are two distinct approaches to learning and teaching:

*Pedagogy:*

1. Teacher-centered

2. Focus on transmitting knowledge

3. Emphasis on instructor's expertise

4. Learners receive information passively

5. Assessment-focused

*Heutagogy:*

1. Learner-centered

2. Focus on self-directed learning

3. Emphasis on learner's autonomy

4. Encourages critical thinking, reflection, and meta-cognition

5. Flexibility and adaptability

Key differences:

1. Control: Pedagogy (teacher) vs. Heutagogy (learner)

2. Focus: Knowledge transmission (pedagogy) vs. Learning process (heutagogy)

3. Role of teacher: Expert (pedagogy) vs. Facilitator/Mentor (heutagogy)

Heutagogy fosters:

1. Self-directed learning

2. Personalized learning paths

3. Collaboration

4. Real-world applications

5. Reflection and meta-cognition

In heutagogy, learners take ownership of their learning, and teachers guide and support.

*Evolution of learning approaches:*

1. Pedagogy → Andragogy (adult learning) → Heutagogy (self-determined learning)

*Implications for education:*

1. Shift from standardized to personalized learning

2. Emphasis on developing critical thinking, creativity, and problem-solving skills

3. Integration of technology-enhanced learning

4. Redefining teacher roles and responsibilities

Collective cognition feedback Update:

[08/11, 08:51]drnr : It may be difficult for medical teachers to emulate Bhagat Singh's dramatisation: to allow or kill a patient for explaining the natural history of the disease, and then face the fury of the family, the MCI and the never ending judicial proceedings!

The medical student may not be left with many teachers, unless Hezbollah takes over medical education ((strictly for boys (pun intended))!

[08/11, 08:55]rb: That was an extreme case!😅

[08/11, 08:56]rb: But because of some Western Bhagat Singh's who cleverly designed the randomized controlled trial post pencillin, we can still reap it's benefits

[08/11, 08:59]drnr: You could always have a new GCP, with a slave act enabled

[08/11, 09:07]rb: The existing ones are just that! Slave acts! Yes that's the term to best describe most guideline based medicine vs true evidence based medicine 👏👏

[08/11, 09:10] rb: This makes me reimagine the randomized controlled trial participant as Bhagat Singh on trial (and to be true to medical ethics and patient autonomy, the patient has had a good role in it's design) although it's difficult to predict the random outcome for any of the participants in the trial as that's what equipoise should be all about! The patient Bhagat Singh just stands there, brave and strong ready to meet whatever the dice ordains!

Mahatama Gandhi's list of CBME competencies

From his autobiography and other's testimonies:

1) CBME procedural competence in surgical dressing and administration of medicines:

"His early experience in healthcare started when his father was suffering from a fistula; he was one of the attendants to his father. He had duties, which mainly consisted in dressing the wound, giving medicine to his father and compounding drugs whenever they had to be made up at home. Gandhi was thus initiated into  medical service!"

Unquote 

2) AETCOM CBME cognitive competence in helping patients and prompt referral for further help:

From his Autobiography, “The question of further simplifying my life and of doing some concrete act of service to my fellowmen had been constantly agitating me, when a leper came to my door. I had not the heart to dismiss him with a meal. So I offered him shelter, dressed his wounds, and began to look after him.” But later he was sent to the government hospital for indentured labourers. He further said, “I longed for some humanitarian work of a permanent nature."

Unquote 

3) AETCOM CBME cognitive competence in history taking and case presentation as well as perceiving healthcare as a calling and finding mental peace as a currency for job satisfaction:

"The work of dispensing medicines took from one or two hours daily, and I made up my mind to find that time from my office work, so as to be able to fill the place of a compounder in the dispensary attached to the hospital… This work brought me some peace. It consisted in ascertaining the patient's complaints, laying the facts before the doctor and dispensing the prescriptions. It brought me in close touch with suffering Indians…”

Unquote

4) CBME procedural competence in Obstetrics:

"There was no time to summon a doctor or nurse because Kasturba got the labour pain so suddenly and the birth came quickly. Once again the birth was difficult but this time Gandhi delivered the baby safely all by himself! Devadas, Gandhi's last son, was born on May 23, 1900. Gandhi said, “The birth of the last child put me to the severest test. The travail came on suddenly. I had to see through the safe delivery of the baby. My careful study of the subject in Dr. Tribhuvandas’ work was of inestimable help. I was not nervous."

5) AETCOM cognitive and procedural competence in Infectious disease epidemic management:

South Africa 1904 , Sjt. Madanjit sent a note to Gandhi saying, “There has been a sudden outbreak of the black plague. You must come immediately and take prompt measures, otherwise we must be prepared for dire consequences. Please come immediately.” The municipality thanked him for this prompt action and supplied him with disinfectants and also sent a nurse. He gave medical aid and cleaned the patient's beds, sat by their bedside at night and cheered them up."

Unquote 

5) CBME procedural competence in Patient transport and administration of medications:

"Gandhi recollected the services rendered in the Boer War, “We soon got work and that too harder than we had expected. To carry the wounded seven or eight miles was part of our ordinary routine. But sometimes we had to carry badly wounded soldiers and officers over a distance of twenty-five miles. The march would commence at eight in the morning, medicines must be administered on the way, and we were required to reach the base-hospital at five. This was very hard work indeed.” 

6) AETCOM CBME procedural competence in silent service driven empathic communication:

"The good Doctor told us that he could not induce Europeans to nurse the Zulus, that it was beyond his power to compel them and that he would feel obliged if we undertook this mission of mercy. We were only too glad to do this. We had to cleanse the wounds of several Zulus which had not been attended to for as many as five or six days and were therefore stinking horribly. We liked the work. The Zulus could not talk to us, but from their gestures and the expression of their eyes they seemed to feel as if God had sent us to their succour.”

7) CBME competence in actionable empathic buy in of a doctor patient relationship:

"Gandhi had a glum, ferocious, uncommunicative African jail mate attendant. One day, he was stung by a scorpion. He was screaming like anything and Gandhi saw this intolerable pain. He immediately took the African's hand and washed it clean and he started sucking the injured area. He was extracting the poisoned blood as much as he could and spitting out. He was relieved from pain. Gandhi applied tincture and bandaged his arm. He became Gandhi's devotee thereafter."

8) CBME cognitive competence in observing procedures (see one, do one, teach one, skipping the latter two):

"Noted in Gandhi's diary on May 15, 1947, “Manu has a severe stomach-ache, she also had vomiting and is running temperature. I therefore called in the doctors who examined her. Manu's complaint was diagnosed as appendicitis. I had her removed to the hospital immediately. She will be operated upon at night. Watched Manu's operation at the hospital. Mridula and Madu were keeping her company. But they were not allowed inside the operation theatre. I had put on a surgical mask and watched the whole operation."

Unquote 

9) CBME competence in medical decision making (such as to operate or not to operate):

In the letter to Jaisukhlal Gandhi, father of Manubehn Gandhi, on the next day, Gandhi said, “I had suspected even in Delhi that it was appendicitis. I had hoped that treatment with mud-pack would help her to get well. But it did not help her sufficiently. I, therefore, called in the doctors yesterday. They advised an operation, and I therefore got her operated upon.”

Unquote 

10) Competence in making career choices:

"It was Gandhiji's elder brother who dissuaded him from pursuing medicine because he said their father would have disapproved of the decision; since the Gandhis were Vaishnavas, they would have nothing to do with dead bodies. His brother suggested instead, it would be wiser to study law and become a barrister, which is what Gandhiji did."

"Later though, even as he practised law, Mahatma Gandhi continued thinking about visiting London to study medicine. However, in 1909, he wrote to a friend saying he had heard from certain doctors that they had killed about fifty frogs while studying medicine. He said, if so, he had no desire to do the same, because he neither wanted to kill nor dissect frogs."

Unquote 

11) CBME competence in enterprise and innovation:

"With the help of three colleagues, Gandhiji put all the patients in a vacant house and took on the role of both doctor and nurse. Even though they did not have the means needed to manage a situation of this magnitude, they did all that they could to help. The Council, on their part, provided a vacant godown for the patients; however, this building was unkempt and filthy. Gandhiji and his colleagues not only cleaned up the building, they also raised money to buy a few beds and other necessary things by reaching out to charitable Indians. Soon, an improvised temporary hospital was set up. The local authorities sent a nurse, who arrived with brandy and other hospital equipment. Instructions were given to provide frequent doses of brandy to the patients. Gandhi had no faith in the beneficial effects of brandy and, with the permission of Dr. Godfrey, who was the doctor in charge, he put three patients who were prepared to forego brandy under the earth treatment, which required applying wet earth bandages on their heads and chests. Two of these patients survived. The other twenty died in the godown. Gandhiji said it was impossible to ascertain how the two patients who had agreed to the earth treatment were saved, but this incident enhanced his faith in the earth treatment as well as strengthened his skepticism for the efficacy of brandy as a medicine."

Unquote

12) CBME competence in putting prevention above treatment:

"I overeat, I have indigestion, I go to a doctor, he gives me medicine. I am cured, I overeat again, and I take his pills again. Had I not taken the pills in the first instance, I would have suffered the punishment deserved by me, and I would not have overeaten again. The doctor intervened and helped me to indulge myself. My body thereby certainly felt more at ease, but my mind became weakened."

Unquote 

13) CBME Competence in designing rural medical learning and practice centers:

"He said the halls for treatment and experiment should be surrounded by huts that could serve as residences for patients and children who were being treated there. He also said the sanatorium should grow fruits, flowers, food grains and vegetables, that it should have cattle sheds and roads good enough for vehicles. He also suggested having a gymnasium, a tank for bathing and other facilities. Gandhiji said it was best to avoid procedures that required electricity, such as hot and cold water and steam regimens."

Unquote 

1-9 points above have been quoted from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515737/, which again has collated quotes from sources such as:

1. Bandopadhyaya A. Bahuroopi Gandhi. Popular Prakashan, Bombay. 1964 [Google Scholar]

2. Gandhi A. Mumbai: Jaico Publishing House; 2000. Untold Story of Kasturba. [Google Scholar]

3. Gandhi M. New Delhi: Publications Division, Ministry of Information and Broadcasting, Govt. of India; The Collected Works of Mahatma Gandhi; p. 20002001. [Google Scholar]

4. Gandhi MK. Ahmedabad: Navajivan Publishing House; 1927. An Autobiography or The Story of My Experiments with Truth. [Google Scholar]

10-13 have been quoted from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515724/

Notes:

Abbreviations used:

Competency-based medical education (CBME).

CBME is an outcomes-based approach to the design, implementation, and evaluation of education programs and to the assessment of learners across the continuum that uses competencies or observable abilities. The goal of CBME is to ensure that all learners achieve the desired patient-centered outcomes during their training.

Unquote:

https://www.aamc.org/about-us/mission-areas/medical-education/cbme

AETCOM: An Indian abbreviation coined by the Indian medical council, a medical education regulatory body, which stands for Attitude, Ethics and Communication and is designed as (AETCOM) modules to develop a foundation of positive attitude, ethics and communication in the Indian medical graduate.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9480674/#R11

"Gandhi was able to walk about 79000 km in his lifetime which comes to an average of 18 km per day and is equivalent to walking around the earth twice."

https://en.m.wikipedia.org/w/index.php?title=Practices_and_beliefs_of_Mahatma_Gandhi&wprov=rarw1

Past lectures on "Indian informal healthcare" , Patient centered CBME as a game changer, Generalism in medical education and The ultimate "role playing in education" in the search box in our departmental website here: medicinedepartment.blogspot.com

Creative commons license: https://commons.m.wikimedia.org/wiki/File:Gandhi_suit.jpg#