Tuesday, June 22, 2021

Introduction to evolution of human language, communication and scholarship

Scholarship is a cognitive endeavor in humans that enables shared learning through sharing of human experiences and experiments.


Ever since human evolution, communication has fostered learning and a major breakthrough in human communication happened in our cave dwelling ancestors thousands of years ago when they learned to code, initially using their vocal cords and tongue and palate to produce repetitive syntactical  sounds that could be replicated between humans to create meaning aka semantics. 

Kids globally and since time immemorial are hardwired to learn high level coding from the age of one and 99% of them do it very well as long as they can hear their parents or primary care givers speak. 

Using vocal cords to code and witness output functions as soon as they run a vibration on their vocal cords is innate in most kids who quickly learn to use coding aka language to navigate their world when they notice the vibration "da-da" brings in a moustached gentleman running at their beck and command while "ma-ma" brings a clean shaven person who satisfies their hunger and also makes the moustached man run around with commands. 

The next step in learning to code is at the age of 3-4 when they are introduced to hieroglyphs that become alphabets and code syntax when the audio visual "apple" becomes a syntax "a". 


Other than the evolution of language described above, the next major breakthrough in human cognition and communication was the development of asynchronous learning when our cave dwelling ancestors would log their daily events, experiences and experiments along with current location  using paint on their cave walls and the written alphabet was born. The journal space is a legacy of that period which has evolved from papyrus to print and finally into an electronic space shared globally in the cloud. 
Scholarship is an expression of this asynchronous communication utilizing the tools of reading and writing that are symbolic ways to transfer information to a large human audience without having to meet them face to face at the same time and was exemplified in early human history through letter writing as soon as humans made the transition from cave dwelling animals to using papyrus. 

Scholarship has evolved from the above humble beginnings of asynchronous communication in our cave dwelling ancestors to the current complex expressions in various media and yet remains at it's core a usage model of symbolic communication to transmit insights from one human to many. 

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Making connections between different ways of knowing and doing


In the above framework of what is just one stream of healthcare delivery among other delivery frameworks, we cite below a patient centered example of another closely related healthcare delivery framework that the British subjugated 200 years back and the following description of the patient problem representation has been shared in an empathic narrative format by a research scholar of that original Indian stream:

https://shanthanjodavula.blogspot.com/2021/04/empathic-narrative-of-35-year-old-uc.html?m=1

The above narrative reveals an Indian patient's 'quest' for cure taking him away from mainstream medicine and making him embrace other streams, including Ayurveda and finding a respite although short lived as it worsens again and makes him again having to approach mainstream medical practitioners who have the dominant hold on a large number of delivery modalities that are often related to non pharmacological engineering  technology for example putting an endoscope into the patient's colon or getting a diagnostic imaging and as a result of that hold they are able to also institute therapies that are manufactured by the ruling big pharma drug industry.

Here is another Indian patient narrative

https://medicinedepartment.blogspot.com/2021/04/empathic-narrative-in-inflammatory.html?m=1, this time by a doctor himself experiencing a chronic illness and eventually integrating on his own various ways of knowing and learning about his disease to eventually find a solution, similar to the global representation we had earlier provided to set the context to scholarly integration of medical education for it's primary beneficiaries aka patients. 

Conversational learning in the context of national medical integration : 


https://medicinedepartment.blogspot.com/2021/06/conversational-learning-illustration-in.html?m=1



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Evidence based medical assessments drive student learning outcomes

Here is a link https://medicinedepartment.blogspot.com/2021/03/2016-batch-mbbs-competency-driven.html?m=1to competency driven, evidence based formative and last summative assessment of the 2016 MBBS batch who are currently posed to graduate soon after their university final last month in April 2021. 


Capturing medical students procedural (non verbal) and verbal cognitive competency 

The evidence for each student's competency is reflected in the captured videos (open access herehttps://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR) of their procedural performance (where the assessment is subjective non verbal) and in the patient centered active learning verbalized by them in their patient E logs, both reflecting their online learning portfolios.

Some of the commendable student E logs (online learning portfolios) are shared in the links below:












We do also have a paper based log book that showcases sample case reports by past students and provides instructions on utilizing it as a competency enhancement and learning tool as detailed here : https://medicinedepartment.blogspot.com/2021/08/medicine-log-book-paper-printed-version.html?m=1


Below is a link to an archived list of the E logged textual presentations and videos of the same 2016 batch students physical presentation and viva during their recently concluded university exams in April 2021. 


https://mbbs2k16batchgmpracticals.blogspot.com/2021/05/2k16-batch-gm-university-practical.html


This is not just evidence based medical education with evidence of correlation between awarded marks (quantitative learning outcomes) vs process of assessment (qualitative data capture inputs to drive assessment) but also an attempt to integrate Medical education with practice by putting the patient at the center of Medical education.

The above annual MBBS  summative assessment evidenced by the 150-200 students assessments videos in the above link is based on our university summative assessment protocol here :

https://medicinedepartment.blogspot.com/2021/04/medicine-department-protocol-for.html?m=0

 which highlights the concordance between our "patient centered integration" goals and prior university competency assessment goals. 


Coming to post graduate summative  assessments of the students linked below is a detailed framework developed from pre-existing university assessment frameworks and maintaining previous competency assessment goals along with our scholarly integration of medical education goals:


https://medicinedepartment.blogspot.com/2021/08/workflow-for-md-university-final-case.html?m=1

 

medicinedepartment.blogspot.com/2020/05/re-final-university-md-medicine.html?m=0


We regularly connect with our students live during our 10:00 AM to 12:00 PM morning rounds as videoed and archived in the link below where we are presenting our cases to a global audience:




And here's a sample of our regular class videos of case presentation lectures during our 2-4 PM sessions. 







Here's a summary video of what we do 


Currently we are working on developing evidence based letter of recommendations for our students detailed here : http://medicinedepartment.blogspot.com/2021/07/evidence-based-letter-of-recommendation.html?m=1


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Peer to peer review/assessment of Online assignments in E logged learning portfolios exposes student plagiarism shortcomings

Unfortunately in our soon to be past (and largely current) offline system of medical education system we inadvertently reward students for stealing by giving the best marks in theory answer papers to the best copy pasted answers from memorized text books thus encouraging a hitherto unrecognized form of plagiarism but the real world of 'virtual shared learning' cannot tolerate sharing of unoriginal work. 

Conversational instructions from Faculty Coordinator FC to each student for peer to peer assessment of their monthly assignment for online summative assessment--

(For more about conversational learning check out the reference links below) 


"We are planning to start a peer to peer assessment of all the assignments for the month of May by some/all of you as assessors. 



More about the process here :https://teaching.cornell.edu/spring-teaching-resources/assessment-evaluation/peer-assessment



Will get one student to assess the answers to one question for all the batchmates answers shared here : https://onlineassessmentmay.blogspot.com/2021/06/online-assessment-may.html and provide inputs on tentative marks based on a standard answer. 



Let me know which question you would like to assess for all of your batchmates





Conversational learning from Student responses :


 illustration (Box) 




[6/11, 7:41 AM] 1st Peer assessor 2017 batch : Okay sir I would like to do question no. 1



[6/11, 7:45 AM] 1st Peer assessor 2017 batch


: Sir for how many marks am I evaluating each question?



[6/11, 7:45 AM]  Faculty Coordinator FC : Will be looking forward to one sample review of one question asap. 



One question is 10 marks



[6/11, 7:48 AM] 1st Peer assessor 2017 batch


: 1) for roll no. "n" for that question I would like to give a 9 sir. She has given beautiful illustrative pictures for a better understanding. Also all her answers are correct with proper explanation and images.



[6/11, 7:49 AM] Faculty Coordinator FC 


: Are you sure they are her original answers and there is no plagiarism? 🤔



[6/11, 7:50 AM] 1st Peer assessor 2017 batch


: Yes sir, it seems original



[6/11, 7:55 AM] Faculty Coordinator FC 


: What about answer 5? She has borrowed an image from some online resource without acknowledging it? What if someone sues her for copyright?



[6/11, 7:55 AM] Peer assessor 2017 batch


: Yes sir that’s true


[6/11, 7:55 AM] Peer assessor 2017 batch


: All her images are from online



[6/11, 7:59 AM] Faculty Coordinator FC 


: That would be plagiarism unless she acknowledges them adequately and adds disclaimers about her uncertainty of their copyright issues promising to remove them if anyone objects?



[6/11, 8:01 AM] Faculty Coordinator FC 


: But even with a disclaimer how can one be sure that one isn't infringing copyright? 



Also what is the evidence for what is displayed in those images? How can we take the images at face value unless they are supported with adequate data driven evidence?



[6/11, 8:02 AM] 1st Peer assessor 2017 batch


: Yes sir that’s there



For more reading on conversational learning and user driven learning please use the following open access references:



Bera, K., Seth, B., & Biswas, R. (2013). Conversational learning among medical students: harnessing the power of web 2.0 through user driven healthcare. Annals Of Neurosciences, 20(2).


www.ncbi.nlm.nih.gov/pmc/articles/PMC4117104/




Biswas, R., Sturmberg, J. P., & Martin, C. M. (2011). The User Driven Learning Environment. In R. Biswas, & C. Martin (Eds.), User-Driven Healthcare and Narrative Medicine: Utilizing Collaborative Social Networks and Technologies (pp. 229-241). doi:10.4018/978-1-60960-097-6.ch017


www.researchgate.net/publication/292652611_The_User_Driven_Learning_Environment

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Scholarship of integration driven by shared Online learning portfolios promoting formative, 'reading comprehension and creative writing' scholastic competencies

We are able to get 200 students in each MBBS batch to share similar data captured in their online learning portfolios as in the link here : 




This form of online portfolio based formative assessment of competency can be improved upon and rapidly scaled to all medical colleges in India. 

The assessment framework represented by the two monthly question papers linked here :


, is not a part of the university summative assessment but goes to build the formative assessment portfolio of each student and it's a given fact that internal examiners routinely rely heavily on the longitudinal formative assessment achievements of their students to weigh in on their summative assessment marks and the external examiner gets the cross sectional summative overview of that one day of the student's performance during the university finals. 

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Gradual integration of traditional with competency driven curricula in a patient centered learning framework

The definition of competency for a medilcal student health professional is: “habitual, consistent and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflections in daily practice for the benefit of the individual being served” 

This definition was shared by MEU India faculty member Prof TS and we would like to bring our attention to the last part of this excellent definition, "benefit of the individual being served," which reminds us again of the fact that the patient is the primary beneficiary of Medical education. 


The solution to the problem is to think of online formative assessments as a process of active learning by the medical student that puts the patient at the center of his learning portfolio. 

For example if someone is to learn Thyroid pathology and is to be assessed for it then the learner needs to share what active patient centered efforts she has undertaken in that process. 


Generally the process begins in understanding the life events of that real human being with the thyroid pathology and then capturing the palpable and investigational data acquired from that person's body with that pathology. 


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Student user driven, patient centred assessment prototype

 

This module is a continuation of the 


Working prototype of a scholarly integration of medical education and research framework shared here :


medicinedepartment.blogspot.com/2021/06/working-prototype-of-scholarly.html?m=1


The patient's problem described in the module above was part of a question paper of the month for the entire batch of 2017 and is accessible here in Q5B with 10 other questions: 

http://medicinedepartment.blogspot.com/2021/05/online-blended-bimonthly-assignment.html?m=1

Student SM's answer is available online around the patient question in Q5B here :https://drsaranyaroshni.blogspot.com/2021/05/assignment-patient-centred-learning.html?m=1 where they are derived from standard theory of clnical problem solving but very interestingly she makes a mention of the child's problem again in Q10 which is about sharing her learning experiences of the month where she presents artwork collected from the patient and also goes on to describe many more patients where she was a part of the data capture process for our CBBLE. Although the question paper for the month of May 2021 which she answered above wasn't meant to test empathy competencies (unlike that of April 2021 available here: http://medicinedepartment.blogspot.com/2021/04/medicine-paper-for-april-2021-bimonthly.html?m=1) yet she also managed to display her empathy competencies in her answer to Q10. 


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