Sunday, November 16, 2025

UDLCO CRH: Kena upanishad Shloka and Shukrat

 Summary:


The conversation revolves around the nature of wisdom, knowledge, and the limits of human understanding. The quote "The only true wisdom is in knowing you know nothing" attributed to Socrates sparks a discussion about the importance of humility in learning and the dangers of claiming absolute knowledge.

Key Words: Socrates, Kena Upanishad, wisdom, knowledge, questioning, philosophy, spirituality, humility





Conversational learning Transcripts:

Hu1: 

"The only true wisdom is in knowing you know nothing."

Attributed to Socrates, a classical Greek philosopher.

[28/09, 13:12] hu3 : Not sure whether he said this himself but people around him certainly realised that. From a man who created a watershed moment in Philosophical understanding of this World into pre-Socratic and Post-Socratic world!

As you all know apparently there is no question he hasn’t asked about our existence and understanding our human condition. We are still grappling with answers to those questions.  

No wonder West has done well following his and his disciples writings. We will do well as a country if we can decipher the man behind the questions. The questions themselves would not trouble a GCSC student, but the answers will whatever our age!


[28/09, 13:31]hu4: You must be a scholar in both eastern and western philosophies to be able to decipher the differences...

In Indian philosophy, the proponents never claimed any fame or name for themselves.

They realised how insignificant they are as compared to the infinite vastness of God's creation.


[28/09, 13:58]hu3: That’s the point actually. I am not an expert on anything. 

Thinking that our philosophy has deciphered everything and answered every problem has catapulted us into darkness, from which, we are trying to crawl back most times unsuccessfully. Internet is changing things a bit with spread of knowledge. Hope the momentum continues with some good results.


[28/09, 14:31]hu4: That is because we got caught in the destruction of our culture through the idea of the superiority of one philosophy over the other (read - religion), gave in to accepting all things eastern as inferior (matter vs mind), and struck a truce through so-called secularism.


[29/09, 20:25]hu2: Socrates got it from the kena upanishad?

"It is not known by those who know It; It is known by those who do not know It."

यस्यामतं तस्य मतं मतं यस्य न वेद सः ।
अविज्ञातं विजानतां विज्ञातमविजानताम् ॥ ३॥

yasyāmataṃ tasya mataṃ mataṃ yasya na veda saḥ .
avijñātaṃ vijānatāṃ vijñātamavijānatām .. 3..


Hu5: Counterpoint: One of the best ways that religion has used to establish authority over human mind is to make itself indecipherable, and as a consequence, unquestionable. Science doesn’t tell the humans, you can never understand quantum physics, space, human body, physical phenomena, etc. If it can’t explain, it strives to. If it offers an incorrect explanation, and someone offers a better one, it accepts it. That is often shown as a weakness (esp by charlatans like B M Hegde and likes), but it is its biggest strengths.

Religion, existence of God, His nature, all these have been kept out of questioning. You cannot know this through questioning and logic, says every scripture in the world. Only if you surrender yourself (basically meaning, only if you stop questioning), and give your intellect to a Guru, you will be able to ‘know’. 

As Kenopanishad says, more you question, less you understand, and vice versa. 

यस्यामतं तस्य मतं मतं यस्य न वेद सः ।
अविज्ञातं विजानतां विज्ञातमविजानताम् ॥ ३ ॥

‘Those who think they can understand God with their intellects have no understanding of God. Only those who think that He is beyond the scope of their comprehension truly understand Him.’

Game, set, and match. Discussion over. Ghar jaao.

Thematic analysis:

- *Humility in Learning:* Recognizing the limits of one's knowledge is a sign of true wisdom. This theme is echoed in the Kena Upanishad's verse, "It is not known by those who know It; It is known by those who do not know It."

- *The Limits of Intellect:* The conversation highlights the limitations of human intellect in understanding the divine or ultimate reality. The Kena Upanishad's verse suggests that those who think they can understand God through intellect have no understanding of God.

- *The Importance of Questioning:* The discussion also touches on the importance of questioning in learning and the pursuit of knowledge. While science encourages questioning and seeking answers, religion often discourages questioning and emphasizes surrender and faith.

- *The Dangers of Dogmatism:* The conversation warns against dogmatic thinking and the dangers of claiming absolute knowledge. It highlights the importance of recognizing the complexity and mystery of existence.

- *Cultural and Philosophical Exchange:* The discussion also touches on the importance of exploring and learning from different philosophical traditions, both Eastern and Western.

*Insights:*

- The conversation highlights the importance of approaching knowledge with humility and recognizing the limits of human understanding.

- It emphasizes the need for ongoing questioning and inquiry in the pursuit of knowledge and wisdom.

- The discussion also suggests that spirituality and philosophy can be complementary, rather than mutually exclusive, and that exploring different traditions can lead to a deeper understanding of existence.


Copilot:

Here's a structured summary and thematic analysis of the conversation:

---

*🔑 Key Words*
- Socrates, Wisdom, Ignorance
- Kenopanishad, Brahman, Eastern Philosophy
- Western Philosophy, Secularism, Religion
- Questioning, Knowledge, Guru
- Science vs Religion, Authority, Comprehension
- Cultural Decline, Internet, Intellectual Humility

---

*🧭 Thematic Analysis*

*1. Wisdom Through Ignorance*
- Socrates' quote and the Kenopanishad shloka both emphasize the paradoxical nature of wisdom: true understanding begins with acknowledging one's ignorance.
- This theme bridges Eastern and Western thought, suggesting a universal philosophical insight.

*2. East vs West: Philosophical Traditions*
- Western philosophy is portrayed as question-driven and analytical, with Socrates as a pivotal figure.
- Indian philosophy is described as humble, anonymous, and spiritually vast, focusing on surrender rather than intellectual conquest.
- The contrast highlights differing epistemologies: logic and inquiry vs. transcendence and intuition.

*3. Cultural Self-Perception and Decline*
- There's a critique of India's philosophical complacency and cultural erosion due to colonial and religious influences.
- The conversation laments the loss of intellectual rigor and the misinterpretation of secularism as philosophical surrender.

*4. Science vs Religion: Epistemic Authority*
- Science is praised for its openness to questioning and revision.
- Religion is critiqued for discouraging inquiry and establishing authority through mystery and surrender.
- The Kenopanishad is used both to support and challenge this view, depending on interpretation.

*5. Role of the Internet and Modern Knowledge Sharing*
- The internet is seen as a tool for democratizing knowledge and potentially reversing cultural stagnation.
- There's hope that increased access to information can reignite philosophical curiosity and critical thinking.

---

*📚 Learning Points*

- *Intellectual humility* is foundational to both philosophical and spiritual growth.
- *Cross-cultural dialogue* enriches understanding and reveals shared human concerns.
- *Critical inquiry* is essential for progress, whether in science or philosophy.
- *Cultural introspection* is necessary to reclaim lost intellectual traditions.
- *Scriptural interpretation* can be both a source of insight and a tool of control—context and openness matter.

---


Saturday, November 15, 2025

UDLCO CRH: AI healthcare leadership through a PaJR data driven transparent and accountable workflow

Summary:


The conversation revolves around a proposed Healthcare Leadership Platform that utilizes real-world healthcare data to create realistic scenarios for leadership training. One conversationist aims to develop strategic and ethical leaders capable of governing AI adoption and driving digital transformation in clinical and administrative settings through a PaJR, participatory refined, data driven  platform. The discussion also touches on the Digital Personal Data Protection Rules, 2025, and its implications for healthcare data management.

*Key Words:*

- Healthcare Leadership Platform
- Artificial Intelligence (AI)
- Data-driven healthcare
- Digital Personal Data Protection Rules, 2025
- Patient Journey Record (PaJR)
- Data Protection Impact Assessment (DPIA)
- Significant Data Fiduciary (SDF)


Conversational learning Transcripts aka CDSS Conversational decision support and more recently participatory refinement (as in full text here: https://academic.oup.com/rssdat/article/1/1/udaf002/8317136)

[13/11, 13:15]hu1: Do they need faculty for this?😊

[13/11, 15:21]hu3: What is the definition of "expert"?

[13/11, 15:23]hu4: This may be ok for Lead with AI in operation. Definitely NOT for Lead with AI in science or technology. 😊

[13/11, 15:33]hu5: 

all in all alaguraja. 

Tamilians will understand 😀

all rounder in 1 subject

[13/11, 15:40]hu1: May be, an idea brewing for an AI healthcare edtech.


[13/11, 15:51]hu5: bolo


[13/11, 16:49]hu1: Here's a thesis for the esteemed members of the group to review and comment👇

Healthcare Leadership Simulator Platform (The
"MediLead" Platform)

This startup focuses on developing strategic and ethical leaders capable of governing AI adoption, managing complex data streams, and driving digital transformation in clinical and
administrative settings.

Core Concept

A sophisticated, cloud-based simulation platform that utilizes real-world (anonymized and
synthetic) healthcare data to create hyper-realistic scenarios for leadership training.

Target Audience
● 
Mid-to-senior level healthcare managers (Hospital VPs, Department Heads, Clinical Directors).

● Future healthcare executives (MBA/MHA students).

● AI/Data Science professionals transitioning into healthcare leadership.

Key Features and EdTech Value

● Dynamic, Data-Backed Scenarios: Leaders tackle challenges like managing a sudden surge in patient volume due to a pandemic (simulating real-time resource allocation), implementing a new diagnostic AI tool while navigating regulatory and ethical concerns,
or managing a system-wide cyber attack on patient data.

● "Digital Twin" Hospital: Participants manage a simulated hospital/clinic "twin" where their decisions (e.g., staffing, technology investment, process changes) have measurable, downstream effects on key performance indicators (KPIs) like patient outcomes, operational efficiency, and staff burnout rates.

● Ethical AI Governance Module: Specific training on establishing AI governance
frameworks, addressing bias in clinical algorithms, ensuring data privacy (HIPAA, GDPR compliance), and communicating AI decisions to clinical staff and patients.

● Personalized Feedback Loop: AI-powered grading and feedback that evaluates not just the outcome of a decision (did the KPI improve?) but the process (was the ethical concern addressed? was communication effective? was the data analysis sound?).

Why this is a good fit?

This moves beyond case studies to experiential learning. It develops the critical decision-making under pressure required for leaders to integrate AI safely and effectively, which is the single biggest technological challenge in healthcare today


[13/11, 16:49]hu1: My AI assistant made it for me😃😃


[13/11, 16:53]hu5: nice disclaimer


[14/11, 13:04]hu1: No takers, no investors?

[14/11, 13:10]hu2: Would love to take it up as hands on experiential learning electives in our campus. More about it here: 


Can we get a few potential healthcare leadership trainees to go through this publicly available data generated by our hospital and provide their inputs on how they may have averted this?👇




[14/11, 12:00]hu6: Digital Personal Data Protection Act & Rules published today: https://egazette.gov.in/(S(ht1vstbmp0ar3cpam2kdjj2q))/ViewPDF.aspx

[14/11, 13:12]hu7: Is this a new release sir?

[14/11, 13:13]hu7: Yes - today.

[14/11, 13:14]hu2ai: The **Digital Personal Data Protection Rules, 2025** (DPDP Rules) provide the crucial procedural and operational backbone to the **Digital Personal Data Protection Act, 2023** (DPDPA).

Here is a detailed analysis of the key rules and their direct implications for a **PaJR (Patient Journey Record) workflow**, along with actionable suggestions for compliance.

### Executive Summary

The DPDP Rules significantly formalize and add granularity to the obligations under the DPDPA. For a PaJR system, which handles highly sensitive personal data (health information), the rules around **consent, security, data breach notification, and data retention** are particularly critical. Your workflow must evolve from simply collecting data to actively managing it with demonstrable accountability and robust security.

---

### Key Rule Analysis & Impact on PaJR Workflow

#### 1. Rule 3: Notice by Data Fiduciary (PaJR Provider) to Data Principal (Patient)

*   **What it says:** The notice of consent must be clear, standalone, in simple language, and include an itemized description of the personal data and the specific purpose of processing. It must also provide easy means for the patient to withdraw consent, exercise rights, and file complaints.
*   **Impact on PaJR:** The generic consent forms you might use now will be insufficient.
*   **Suggestions:**
    *   **Redesign Consent UI:** Create a dedicated, pop-up or page for consent that is not buried within Terms of Service.
    *   **Granularity:** Instead of "I agree to share my data," specify: "I consent to the processing of my [medical history, medication logs, symptom descriptions] for the purpose of [personalized health tracking, clinician review, generating health insights]."
    *   **Easy Access:** Provide prominent, easy-to-find buttons/links labeled "Manage Your Consent" or "Withdraw Consent" within the PaJR app/portal.

#### 2. Rule 4: Consent Manager

*   **What it says:** Establishes a framework for registered "Consent Managers" – third-party platforms (like account aggregators in finance) that allow users to manage consent across multiple data fiduciaries from a single dashboard.
*   **Impact on PaJR:** In the future, patients might use a central health Consent Manager to control access to their PaJR data by hospitals, insurers, or researchers. You may need to integrate with such platforms.
*   **Suggestions:**
    *   **Monitor Ecosystem:** Keep an eye on the development of the Consent Manager ecosystem in India, especially for healthcare.
    *   **API Strategy:** Plan for a technical architecture that can securely interact with Consent Manager APIs to receive and act on patient consent instructions.

#### 3. Rule 6: Reasonable Security Safeguards

*   **What it says:** Mandates specific security measures, including:
    *   **Encryption, Masking, Tokenization** of personal data.
    *   Access controls and logging/monitoring of data access.
    *   Data backup and business continuity plans.
    *   Retention of logs and personal data for **a minimum of one year**.
    *   Contractual security obligations on Data Processors (e.g., cloud providers).
*   **Impact on PaJR:** This is a direct and non-negotiable requirement. A PaJR system is a high-value target.
*   **Suggestions:**
    *   **Technical Audit:** Conduct a security audit against these specific points. Ensure data is encrypted *at rest* and *in transit*.
    *   **Access Logs:** Implement detailed logging of *who* accessed *which* patient's record and *when*. This is crucial for breach investigation (Rule 7).
    *   **Review Contracts:** Ensure your contracts with cloud hosting providers (AWS, Azure, etc.) explicitly assign security responsibilities as required by this rule.

#### 4. Rule 7: Intimation of Personal Data Breach

*   **What it says:** In case of a breach, the Data Fiduciary (you) must:
    *   **Notify each affected patient** without delay, detailing the breach's nature, consequences, and mitigation measures.
    *   **Notify the Data Protection Board (DPB)** within **72 hours** with a detailed report.
*   **Impact on PaJR:** A data breach of health data is a catastrophic event. This rule mandates a swift and transparent response.
*   **Suggestions:**
    *   **Create an Incident Response Plan (IRP):** Have a clear, documented plan that designates a response team, defines communication templates for patients and the Board, and outlines technical containment steps.
    *   **Practice Drills:** Conduct table-top exercises to test your IRP.

#### 5. Rule 8 & Third Schedule: Data Erasure & Retention

*   **What it says:** Specifies that for certain entities (e-commerce, online gaming, social media), data must be erased if the user is inactive for 3 years, unless required by law. More importantly, it mandates that **all data fiduciaries must retain processing logs for at least one year**.

*   **Impact on PaJR:** While the 3-year rule may not directly apply to you, the one-year log retention is critical. Furthermore, you must have a clear data retention and deletion policy.

*   **Suggestions:**

    *   **Define a Retention Policy:** Establish a policy stating how long you retain a patient's core health data after account deactivation. This must balance the rule's principle of deletion with other laws (e.g., clinical record-keeping laws that may require longer retention).

    *   **Automate Deletion:** Build workflows to automatically flag data for anonymization or deletion as per your policy.

    *   **Log Management:** Implement a system to securely store access and processing logs for at least one year.

#### 6. Rule 10: Verifiable Consent for Children

*   **What it says:** Requires obtaining verifiable consent from a parent/guardian before processing a child's data. It specifies methods for verifying the parent's identity and adulthood (e.g., through reliable records or Digital Locker).

*   **Impact on PaJR:** If your PaJR is used for pediatric care, you need a robust age-gating and parental consent mechanism.

*   **Suggestions:**

    *   **Age Verification:** Implement an age-collection field during sign-up.

    *   **Parental Consent Flow:** For users identified as children, create a separate flow that pauses data processing until verifiable parental consent is obtained, using one of the methods outlined (e.g., integration with DigiLocker for verification).

#### 7. Rule 13: Additional Obligations of Significant Data Fiduciary (SDF)

*   **What it says:** SDFs have extra duties, including conducting a **Data Protection Impact Assessment (DPIA)** and annual audit, appointing a Data Protection Officer (DPO), and adhering to potential data localization requirements.

*   **Impact on PaJR:** Given the sensitive nature of health data, it is highly likely that a PaJR platform will be classified as an SDF.

*   **Suggestions:**

    *   **Proactive Compliance:** Act as if you are an SDF from day one.

    *   **Conduct a DPIA:** Proactively perform a DPIA for your PaJR system. Identify risks in your data processing and mitigate them.

    *   **Appoint a DPO:** Designate a Data Protection Officer (even if initially a senior team member) to be the point of contact and oversee compliance.

    *   **Prepare for Localization:** Be technically prepared to store and process a copy of critical personal data within India if the government mandates it for health data SDFs.

#### 8. Rule 14: Rights of Data Principals

*   **What it says:** Data Fiduciaries must publish the means for Data Principals to exercise their rights (access, correction, erasure, grievance redressal) and respond to grievances within a defined timeframe.

*   **Impact on PaJR:** Patients will have the right to ask for their data, correct it, or delete their account. You must have a system to handle these requests efficiently.

*   **Suggestions:**

    *   **Create a Rights Portal:** Build a dedicated section in the app/website where patients can easily submit requests to access, correct, or delete their data.

    *   **Grievance Redressal Mechanism:** Establish a clear process with a defined timeline (the rule suggests a "reasonable period not exceeding ninety days," but best practice is much faster) for responding to all user complaints and rights requests. Publish the contact details of your Grievance Officer.

### Overall Recommendations for Your PaJR Workflow

1.  **Gap Analysis:** Map your current data flows, consent mechanisms, security practices, and policies against each rule.

2.  **Document Everything:** The mantra of data protection is "Show, don't tell." Document your processes, risk assessments, and decision-making.

3.  **Privacy by Design:** Integrate these compliance requirements into the design of new features, rather than bolting them on later.

4.  **Team Training:** Ensure your technical, product, and support teams are trained on these rules and their importance.

5.  **Seek Legal Counsel:** This analysis is a starting point. Engage with a legal professional specializing in Indian data protection law to review your specific PaJR implementation and ensure full compliance.

By proactively adapting to these rules, you can not only achieve compliance but also build a more trustworthy and resilient PaJR platform, strengthening your relationship with patients and partners.


[15/11, 05:18]hu8: Dear hu2
Interested to see two separate links and a query on how _healthcare leadership trainees_ could help avert the latter.
By itself that term seems to be an oxymoron and also wondering if you want to avert the particular incident which caused a CPA ruling or the adverse ruling. Regrettably the latter has been an unfortunate and sad decision. The death has been caused by a mixture of bad Anaesthesia decision coupled with an emergency. Giving GA to a hypothyroid is fraught with risk. It is not clear but probably Spinal Anaesthesia failed and they had to give GA- The term double Anaesthesia is however a legal invention and making it the basis of the adverse award would means it would be thrown out as a clear evidence of not being commonsensical.
However how your PAJR would have helped prevent this is also not fathomable to me as the adverse circumstances and their interpretation is unlikely to be clear to a lay person and even less so to the so called legal brains.


[15/11, 05:20]hu8: Maybe metaAI could have answered??

[15/11, 08:19]hu2: Thanks for the interesting feedback 
🙂🙏

I'll also get the PaJR team to ask AI but for the time being for whatever it's worth here's my human input:

The PaJR workflow is largely about "data driven healthcare." 

Patient event outcomes data, drive patient interventions which becomes data to cyclically again influence patient event outcomes data toward creating a positive change in the health of the patient.


The newspaper article where the patient's case report has been shared well enough with some narrative data (not sure if they had a DPDP approved signed informed consent from the patient like PaJR does @⁨hu6 Cnmc⁩ or is further debate appropriate around how patient privacy appears to be a convenient trade-off especially when it works positively for either stakeholders in healthcare litigation, more about the misunderstandings around the word litigation forthcoming in another paper) but what a PaJR case report may have offered over and above the newspaper documented data is an hour by hour account of what actually happened during the hours from when this particular patient first felt the symptoms till her death with optimal transparency and accountability.

We have multiple examples that regularly get updated on our home page that could be currently far from the ideal we are striving towards in our daily quest toward using data driven healthcare to improve accountability and avert these misunderstandings because to a physician who has seen many peripartum cardiomyopathies and pulmonary embolisms and has patients regularly dying under his her care this is essentially a pure misunderstanding between those with professional expertise in the subject and between those who have been subjected to that professional expertise.

It's clearly a misunderstanding between those who can see the uncertainty in clinical complexity and those who are sold to the hype of healthcare market forces!

Further reading:


PaJR home page:



[15/11, 08:25]hu6: Privacy in ... is mostly selective.

[15/11, 08:28]hu2: I guess "selective privacy" is a global phenomenon as in"jiski lathi uski privacy!"


[15/11, 09:42]hu8: Agreed, but I quantify further - laws are made and enforced only to benefit the law makers- and here specifically are two examples -PCPNDT and Traffic rules 
- though some of the latter do help enforce traffic discipline but PCPNDT has only worsened healthcare
Regarding PAJR and the specific case- I don’t think any non professional saw the Pateint between being wheeled to OR and her death (she was not conscious when she came out)

[15/11, 10:02]hu2: Yes in this specific case all standard professional expertise was delivered and hence the PaJR pitch for making such data available in real time to multiple stakeholders at the point of care even as events unfold before it becomes too late and simply remains newspaper fodder with momentary shock value.

Question is will experts be able to handle a positive Orwellian (non dystopian) data driven healthcare system?

Or will they drown in cognitive overload?

Can @⁨hu1's AI healthcare leadership program make a difference in the current landscape?

As an aside from another parallel discussion around  recently viral AIIMS AI usage implications, there's this interesting debate in the comments section of Sumer's post linked here: 


Insightful comments from the founder of qure.ai overseeing this AIIMS Radiology triage:

"As a radiologist and a product manager at Qure (full disclosure, the above report appears to be generated by qXR algorithm developed by Qure.ai), my observation has been that sites that are truly successful in capturing the value of implementing AI in their clinical workflow have the following characteristics: 

1. They have a clear understanding of why they need automation and AI (Clear need) 

2. They have defined expectations from the AI algorithm which match their needs (Defined Expectations) 

3. They have clear understanding of the limitations and constraints of AI (Clear Boundaries)

 4. Good understanding where AI shines and where Radiologists shine (Collaborative vs Competitive Mindset)

An AI tool is only as successful as the clinical and radiological team that is behind it’s implementation and operation"

Thematic Analysis:*

- *Data-driven Healthcare:* The conversation highlights the importance of leveraging data to improve healthcare outcomes and create a more accountable and transparent healthcare system.

- *AI Governance:* The discussion emphasizes the need for strategic and ethical leadership in governing AI adoption in healthcare, ensuring that AI systems are designed and implemented with accountability, transparency, and patient privacy in mind.

- *Data Protection:* The Digital Personal Data Protection Rules, 2025, are discussed, highlighting the importance of protecting patient data and ensuring compliance with regulatory requirements.

- *Healthcare Leadership:* The conversation touches on the need for effective healthcare leadership, emphasizing the importance of developing leaders who can navigate the complexities of AI-driven healthcare and make informed decisions.

Some key points from the conversation include:

- The importance of creating a culture of transparency and accountability in healthcare, leveraging data to improve patient outcomes and reduce errors.
- The need for healthcare leaders to develop a deep understanding of AI and its applications in healthcare, ensuring that AI systems are designed and implemented to support patient-centered care.
- The importance of protecting patient data and ensuring compliance with regulatory requirements, such as the Digital Personal Data Protection Rules, 2025.
- The potential for AI to improve healthcare outcomes, but also the need for careful consideration of the limitations and constraints of AI in healthcare.



Sunday, November 9, 2025

UDLCO CRH: Narketpally ligamental imaginary pillow sign vs Tonic neck muscle spasm imaginary pillow sign

 Conversational learning transcripts:


[10/11, 07:25]hu1: Good morning 
I have seen a video that Pillow sign is seen  in Progressive supranuclear palsy(Parkinson plus syndrome)

[10/11, 07:25]hu1: Due to dystonia

[10/11, 07:57]hu2: Oh that's great. Please share that link


[10/11, 08:03]hu2: So we already know it's seen in catatonia and it's quite logical that it should be also seen in dystonia

We described here: https://pubmed.ncbi.nlm.nih.gov/40674544/, and here:https://medicinedepartment.blogspot.com/2025/03/project-7-years-in-narketpally.html?m=1, the Narketpally ligamental invisible pillow sign due to ossified posterior longitudinal ligamental fibrosis as opposed to the globally known catatonic psychological (and logically neck dystonic) invisible pillow sign  due to neck muscle spasm.

[10/11, 08:05]hu1: yes

[10/11, 08:06]hu1: But patient with parkinson also of same age group

[10/11, 08:07]hu1: Even though pt is having OPLL we cannot exclude Parkinson plus as both of them mostly are elderly

[10/11, 08:08]hu2: Parkinson's plus can be easily excluded on clinical examination

[10/11, 08:12]hu1: yes 
But can this sign be earliest one with no other signs present to exclude it or Dystonia itself is a progression of the disease?

[10/11, 08:16]hu2: Which disease? Parkinson's or fluorosis?

I agree that even with posterior longitudinal ligamental enthesitis in the early phase of fluorotic spondyloarthropathy, neck muscles can go into a state of dystonic spasm but then again it's easy to distinguish as eventually all tonic muscle spasms would recover and the pillow sign would disappear in them while ligamental ossification wouldn't disappear without surgery






India’s Medical education Revolution Under NMC 2025 authored by Dr Guriqbal Singh Jaiya, IAS (Retd.). along with Grok

 More about the author here: https://projectvikram.github.io/advisors/



The Making of a Healer: India’s Medical Revolution Under NMC 2025

(NMC = National Medical Commission – India’s apex regulator for medical education)





Imagine this:
19-year-old from a small town in Vidarbha steps off a dusty bus at her medical college. In her pocket: a white coat, still crisp. In her heart: a dream to save lives.

Five years later, she stands in a PHC (Primary Health Centre – India’s frontline rural clinic) at midnight, delivering a breech baby under a flickering bulb. The mother’s hand grips hers. The father weeps outside. She doesn’t panic. She doesn’t freeze.

She breathes, remembers the SPIKES protocol (a 6-step, evidence-based framework for delivering difficult news with empathy, developed by oncologist Dr. Robert Buckman) from Year 2, the narrative medicine journal from Year 3, the rural LIC (Longitudinal Integrated Clerkship – a 6-month continuous care model with the same patients) she followed.

This is not a fantasy.
This is the NMC 2025 CBME graduate (Competency-Based Medical Education – a curriculum focused on skills, not just knowledge).
This is the doctor India has waited for.


The Awakening: From Lecture Halls to Living Rooms

The old system trained technicians.
The new system forges healers.

The NMC, with 1.37 lakh MBBS seats (Bachelor of Medicine, Bachelor of Surgery – India’s undergraduate medical degree) and 816 colleges, is not just scaling—it is reimagining. The 2025 curriculum is a love letter to reality: early patient touch, mentored chaos, and empathy woven into the DNA of medicine.

No more mannequins as patients.
No more OSCE stations (Objective Structured Clinical Examination – standardized skill assessment with actors) as destiny.

Instead:

Simulation as rehearsal. Real patients as professors. Faculty as guides. Life as the exam.


Global Whispers, Indian Thunder

The world has shown the way.

  • In Australia, a first-year student sits with a GP (General Practitioner – family doctor), listening to a farmer describe chest pain.

  • In Germany, a final-year intern runs the ward at 3 a.m.—with a senior just a call away during the PJ (Praktisches Jahr – Practical Year).

  • In Cuba, medical students live in barrios, vaccinating, consoling, learning through the ELAM model (Escuela Latinoamericana de Medicina – Latin American School of Medicine).

India listens. India adapts. India amplifies.

NMC 2025 GoalGlobal LeaderIndian Thunder
Early Clinical ExposureAustralia (Flinders)1 real patient/week from Week 1
Continuity of CareNetherlands6-month LIC (Longitudinal Integrated Clerkship) in 100 colleges
Competency ProgressionUSA (AAMC EPAs – Association of American Medical Colleges’ Entrustable Professional Activities)50 EPAs with sign-off
ApprenticeshipGermany (PJ)Practical Year Internship
Social AccountabilityCuba (ELAM)50% rural-bonded seats

The Five-Year Odyssey: A Week-by-Week Epic

Year 1: The First Touch

Week 1. The White Coat Ceremony. Not pomp—promise.
Students watch Patch Adams. They cry. They write: “What does it mean to be a doctor?”

Week 2. First PHC visit. A diabetic grandmother teaches them how to hold a hand while taking blood pressure.

By Week 52, they’ve logged 50+ real patient stories. Not in a sim lab. In sweat, tears, and hope.

WeekThemeMagic Moment
1–2White Coat“I will listen.”
3–12AnatomyDissecting a cadaver and a patient’s fear
13–26ECE (Early Clinical Exposure)First stethoscope on a real heart
27–52Community MedicineFirst vaccine given, first smile earned

Year 2: The Integration

Pathology is no longer a slide. It’s Mrs. Sharma’s jaundice.
Students shadow autopsies, then sit with bereaved families. They learn SPIKES not from a script—but from a real father’s silence.


Year 3: The Crucible of Care

The LIC (Longitudinal Integrated Clerkship) begins.
In a tribal hamlet, Priya follows 10 patients for 6 months:

  • A pregnant mother with anemia

  • A child with malaria

  • A farmer with untreated hypertension

She is not a visitor. She is family.

RotationDurationSoul-Shaping EPA (Entrustable Professional Activity – a task a student can be trusted to perform)
Medicine8 wksEPA 10: “Explain diabetes in the patient’s language”
Surgery8 wksEPA 15: “Suture a wound with trembling hands—and steady the patient’s fear”
LIC6 monthsEPA 30: “Be the doctor a village remembers”

Year 4: The Forge of Leadership

Electives in AI diagnosticstelemedicine, and global health.
research capstone“How a PHC reduced maternal mortality by 40%”—published, not filed.


Internship: The German PJ – Where Fear Becomes Courage

The final year is apprenticeship.
Interns run OPDs (Outpatient Departments)deliver babiesmanage outbreaks.
A consultant is one call away—but the decision is theirs.

PostingDurationDefining Moment
Medicine4 monthsFirst solo admission at 2 a.m.
Community3 monthsFirst PHC outbreak contained

The Simulation-to-Reality Bridge: Hand-Holding as Sacred Duty

Simulation is rehearsal. Reality is performance.
The NMC’s zero-harm pathway:

StageSimulationReal-WorldHand-Holding
Pre-ClinicalMannequin CPR (Cardiopulmonary Resuscitation)PHC vitalsFaculty whispers: “Feel the pulse.”
ClinicalOSCE heartbreakReal griefDOPS (Direct Observation of Procedural Skills)“You did well. She felt seen.”
InternshipCrisis simReal crisisConsultant: “You’ve got this.”

Faculty: The Unsung Mentors

No revolution without teachers who bleed compassion.
The NMC trains 1 lakh faculty in bedside magic.

RoleRatioTraining
Preceptor1:5“How to teach a heart to listen”
LIC Mentor1:8“How to let a student fail—safely”

Rewards:

  • Rural service → 30% hike + legacy

  • EPA mastery → ₹50,000 + pride


Infrastructure: Temples of Healing

FacilityPurpose
Simulation LabRehearse
AETCOM Sanctuary (Attitude, Ethics, and Communication – NMC’s empathy curriculum)Reflect
PHC PortalLive

Assessment: Trust, Not Tests

50 EPAs—not marks.
EPA 25: “Break bad news so the patient still trusts you.”
Assessed by OSCEmini-CEX (Clinical Evaluation Exercise)portfolio, and the patient’s tears.


AETCOM 2.0: 100 Hours to Grow a Soul

This is where doctors become human.
(AETCOM = Attitude, Ethics, and Communication – the NMC’s mandatory humanities curriculum)

Module 1: The Healer’s Oath (15 hrs)

Film: Patch Adams. Task: Write a letter to your future patient.

“I will not just treat your disease. I will carry your story.”


Module 2: The Art of Bad News – Mastering the SPIKES Protocol (20 hrs)

SPIKES is not a checklist.
It is medicine’s most compassionate algorithm.

“Bad news is a wound. SPIKES is the suture.”

The 6 Steps – Explained, Lived, and Breathed

StepNameWhat It MeansHow It’s Taught (NMC 2025)Real-Life Example (PHC, Year 2)
1. SSettingCreate a private, distraction-free space. Silence phones. Sit at eye level.Role-play in AETCOM room: Dim lights, no chairs for hierarchy.Student turns off fan, closes door, sits on floor with a tribal mother.
2. PPerceptionAsk: “What do you already understand?” Never assume.SP script: Patient believes “pain = gas”. Student probes gently.“Uncle, aapko lagta hai yeh dard kyun ho raha hai?”
3. IInvitationAsk: “How much do you want to know today?” Respect autonomy.Branching video scenarios: Full truth vs. partial.“Aap poori baat jaanna chahte hain, ya thodi-thodi?”
4. KKnowledgeUse simple languagewarn before impact“I’m sorry, the report isn’t good…”Language lab: Translate “metastatic carcinoma” → “Cancer phail chuka hai”“Biopsy mein cancer nikla hai. Yeh serious hai, lekin hum saath ladenge.”
5. EEmotionsName the feeling: “I can see this is devastating.” Pause. Touch. Cry if needed.Actor training: Real tears allowed. Feedback on silence.Mother sobs. Student holds her hand for 45 seconds. No words.
6. SStrategy & SummaryOffer a plan: “We’ll start treatment tomorrow. I’ll be with you.” End with hope.Care map exercise: Draw next 3 steps on paper.“Kal se chemotherapy shuru. Main har hafte aunga.”

Teaching Methodology (20 hrs)

HourActivityOutcome
1–3SPIKES Lecture + Video (real oncology consultations)Understand theory
4–8SP Role-Play (10 stations) – Cancer, TB, infertility, child deathPractice in safe space
9–12Real Ward Shadowing – Observe seniors delivering newsSee mastery
13–16Student-Led SPIKES – With actual patients (supervised)First real wound
17–20Debrief + Reflective Journal – “What broke me? What healed them?”Grow a soul

EPA 25 Assessment: Deliver bad news to 3 real patients → 90% patient satisfaction + faculty sign-off


Module 3: Narrative Medicine – The Art of Listening to Stories (25 hrs)

“Medicine is a story-telling profession. If you cannot tell a story, you cannot heal.”
— Rita Charon, Founder of Narrative Medicine, Columbia University

Narrative Medicine is not poetry for leisure.
It is clinical rigor—using storytelling to diagnose sufferingbuild trust, and co-author care plans.

Core Principles (NMC 2025)

PrincipleDefinitionWhy It Matters in India
AttentionDeep, focused listening without interruptionCounters “3-minute OPD culture”
RepresentationTranslating the patient’s chaos into coherent narrativeTurns “pain in stomach” into “fear of dying alone”
AffiliationCo-creating meaning with the patientHeals doctor-patient divide

Narrative Medicine Techniques: A 25-Hour Deep Dive

TechniqueDescriptionNMC 2025 ImplementationExample Output
1. Parallel ChartingWrite two charts: Clinical (BP 140/90, Hb 9) + Narrative (Patient’s fear, family burden)Weekly during LIC – 300 wordsSee 10 Real Examples Below
2. Close ReadingAnalyze a patient’s 2-minute monologue like literature: metaphors, silences, toneAETCOM Lab – Audio record OPD, transcribe, annotatePatient says: “Yeh dard… jaise koi andar se kheench raha hai.” → Metaphor of loss of control
3. Reflective Writing Prompts10-minute free-write after every patientDigital Journal App (NMC-mandated)Prompt: “What did this patient teach me about courage?”
4. Patient-as-AuthorPatient writes/draws their illness journeyPHC Art Wall – Display in waiting areaA child draws cancer as a black cloud. Doctor adds: “We’ll bring the sun.”
5. Generative InterviewAsk open, story-eliciting questions: “Tell me about the day the pain began.”Year 3 LIC – 1 hour/patientFarmer: “Woh din barsaat thi… khet mein gir gaya…” → Reveals trauma, not just back pain
6. Narrative ReframingHelp patient re-write their illness story from victim → survivorSupport group facilitation training“I am not a TB patient. I am a father fighting to see my son graduate.”
7. Interprofessional StorytellingNurse, ASHA, doctor co-write a patient’s storyRural LIC Team HuddleASHA: “Woh ghar mein akela rehta hai.” → Social isolation flagged
8. Digital StorytellingRecord 3-minute patient video diariesTelemedicine electivePatient films daily blood sugar + emotional log

10 Real Parallel Charting Examples (NMC 2025 – Year 3 LIC, Rural PHC)

Format:
Patient ID | Date
CLINICAL CHART (SOAP format)
NARRATIVE CHART (300 words, first-person patient voice + student reflection)


Example 1: The Silent Farmer
Patient 001 | 12 Mar 2025
CLINICAL: 52/M, farmer, BP 160/100, BMI 28, FBS 180 → Newly diagnosed T2DM. Started Metformin 500 BD.
NARRATIVE:

“Doctor sahab said ‘sugar’. I thought of jaggery. My father died at 55—heart attack in the field. I have three daughters. No son. Who will plough if I fall? My wife cried when I told her. She said, ‘Ab khaana band karo.’ But how? Rice is life. The student doctor sat on the mud floor, drew a plate—half roti, half sabzi. He asked, ‘What scares you most?’ I said, ‘Leaving my girls.’ He wrote: ‘Goal = See eldest daughter’s wedding.’ I smiled for the first time in weeks.”
— Student reflection: I learned diabetes is not a number. It is a father’s fear of absence.


Example 2: The Anemic Mother
Patient 002 | 18 Mar 2025
CLINICAL: 28/F, G2P1, 32 wks, Hb 8.2, pallor++, started IV iron.
NARRATIVE:

“Baby kicks less now. I feel heavy, like carrying water uphill. My mother-in-law says, ‘Eat more ghee.’ But we have no money. My husband drinks. The student held my hand, asked, ‘What do you dream for this child?’ I said, ‘A daughter who goes to school.’ She drew a girl in uniform. Said, ‘We’ll get your blood strong first.’ I cried. No one asked my dreams before.”
— Student: Her anemia is not just iron. It is silenced ambition.


Example 3: The TB Fighter
Patient 003 | 25 Mar 2025
CLINICAL: 35/M, sputum AFB+, started CAT-1 DOTS. Weight 48 kg.
NARRATIVE:

“Cough started during Diwali. I hid it—didn’t want to miss wages. Now I’m ‘TB wala’. Neighbors cross the street. My son asks, ‘Papa, will you die?’ The student doctor said, ‘You’re a warrior. TB is the enemy. We’re your army.’ He gave me a badge: ‘TB Survivor in Training.’ I wear it inside my shirt.”
— Student: Stigma kills faster than bacilli.


Example 4: The Child with Fever
Patient 004 | 02 Apr 2025
CLINICAL: 6/F, fever 5 days, platelet 90k, NS1+, dengue IgM pending.
NARRATIVE:

“Ammi says I’m burning. I drew a dragon in my stomach. The doctor student asked, ‘What color is the dragon?’ I said red. She said, ‘We’ll give blue medicine to cool it.’ She let me keep the drawing. Now I’m not scared of the dragon.”
— Student: A 6-year-old taught me metaphor is medicine.


Example 5: The Widow’s Pain
Patient 005 | 10 Apr 2025
CLINICAL: 60/F, OA knees, VAS 8/10, started PCM + physiotherapy.
NARRATIVE:

“Pain started when my husband died. Knees remember the weight of his body when I carried him to cremation. The student asked, ‘Where does it hurt most?’ I said, ‘In my heart.’ She didn’t correct me. She massaged my knees and said, ‘We’ll carry the pain together.’ For the first time, I slept.”
— Student: Grief lives in joints.


Example 6: The Alcoholic Teacher
Patient 006 | 15 Apr 2025
CLINICAL: 45/M, teacher, LFT deranged, ALT 120, counseled de-addiction.
NARRATIVE:

“I drink to forget the child I failed. He hanged himself after failing Class 10. I was his teacher. The student doctor said, ‘Tell me his name.’ I said, ‘Rahul.’ She wrote it on my chart. Said, ‘Rahul would want you to live.’ I haven’t drunk in 3 days.”
— Student: Addiction is guilt wearing a bottle.


Example 7: The Pregnant Teen
Patient 007 | 20 Apr 2025
CLINICAL: 17/F, 20 wks, unmarried, USG normal, counseled nutrition.
NARRATIVE:

“Father will kill me. Boy left for city. The student doctor said, ‘This baby is yours now. What will you name her?’ I said, ‘Asha.’ She smiled. Said, ‘Hope is a good name.’ She gave me a secret phone number. I feel less alone.”
— Student: Shame is heavier than a fetus.


Example 8: The Stroke Survivor
Patient 008 | 28 Apr 2025
CLINICAL: 68/M, CVA left hemiparesis, started aspirin + physio.
NARRATIVE:

“I was a singer. Now my tongue is stone. The student played my old bhajan on phone. Asked, ‘What song lives in your heart?’ I hummed. Tears fell. She said, ‘Your voice is still there.’ She recorded it. Played it back. I heard myself.”
— Student: Stroke silences speech, not soul.


Example 9: The Cancer Warrior
Patient 009 | 05 May 2025
CLINICAL: 50/F, CA breast Stage III, referred to oncology.
NARRATIVE:

“Lump like a betrayal. Husband said, ‘Hide it.’ The student asked, ‘What do you want to fight for?’ I said, ‘My granddaughter’s first birthday.’ She drew a cake with 1 candle. Said, ‘We’ll get you there.’ I believed her.”
— Student: Hope is a calendar.


Example 10: The Orphaned Boy
Patient 010 | 12 May 2025
CLINICAL: 12/M, malnourished, Wt 25 kg, started RUTF.
NARRATIVE:

“Parents died in accident. Uncle beats me for food. The doctor student gave me a notebook. Said, ‘Write your dreams.’ I wrote: ‘Become a pilot.’ She said, ‘First, grow wings with milk.’ She comes every week. I’m gaining weight. And hope.”
— Student: Hunger is not just calories. It is crushed dreams.


25-Hour Module Breakdown

WeekFocusActivityEPA Link
1IntroductionRead The Hurt Song (patient poem)EPA 3: Active listening
2–3Parallel Charting10 real patients → 2 charts eachEPA 22: Holistic documentation
4–5Close Reading LabTranscribe + annotate 5 OPD dialoguesEPA 24: Interpret non-verbal cues
6Reflective Writing10 prompts → 500-word essayEPA 26: Self-awareness
7Patient-as-AuthorPHC mural projectEPA 28: Patient partnership
8Narrative ReframingRole-play survivor storiesEPA 30: Hope-building

Assessment:

  • Portfolio: 10 parallel charts + 1 reframed patient story

  • Patient Feedback: “Did the doctor understand your full story?” (>90%)

  • EPA 32 Sign-Off: “Use narrative to improve adherence”


Module 4: Arts-Based Empathy (20 hrs)

Paint a patient’s pain. Act out a consultation. Sing a lullaby to a mannequin baby.

A student’s painting of a child’s fever becomes the college’s AETCOM poster.

Module 5: Ethics in the Trenches (20 hrs)

Case: “The family can’t afford dialysis. What do you do?”

Debate. Cry. Decide. Reflect.

ModuleHoursTransformative Moment
115First tear in a journal
220First “thank you” after bad news
325First story that changes a policy
420First painting hung in a ward
520First ethical stand taken

Assessment: A reflective portfolio + patient gratitude notes


The Digital Pulse

  • AI App: “Is this rash dengue or measles?”

  • Telemedicine: Consult a tribal patient from a moving bus

  • VR Anatomy (Virtual Reality): Dissect a heart—then hold a real one


The NMC Dashboard: Watching 1.37 Lakh Dreams

MetricTargetRed Alert
EPA completion>90%<70% → Audit
Patient smile rate>85%<70% → AETCOM retraining

The 5-Year War Cry

YearBattle Won
202550 LICs launched
2026Every college has a mentor
2027First PJ interns save lives
2030India’s doctors heal the world

Epilogue: The Doctor India Deserves

In 2030, that girl from Vidarbha will not just deliver a baby.
She will name her after the mother she saved.
She will teach the next batch in the same PHC.
She will cry, laugh, and heal—because she was taught to be human first.

This is not a curriculum.
This is a calling.

“We do not train doctors. We awaken healers.”
— NMC 2025


Sources: All 13 original documents + AAMCGMC (General Medical Council, UK), CanMEDSGerman PJCuba ELAMDuke-NUSNetherlands LICsBuckman R. SPIKES (2000)Charon R. Narrative Medicine (2006)DasGupta S. Narrative Humility (2008)Parallel Charting Examples adapted from Columbia Narrative Medicine Program & AIIMS Rishikesh Pilot 2024.


On Tue, 4 Nov 2025 at 3:30 PM Guriqbal Singh Jaiya <gsjaiya@gmail.com> wrote:

The Making of a Healer: India’s Medical Revolution Under NMC 2025

(NMC = National Medical Commission – India’s apex regulator for medical education)

Imagine this:
19-year-old from a small town in Vidarbha steps off a dusty bus at her medical college. In her pocket: a white coat, still crisp. In her heart: a dream to save lives.

Five years later, she stands in a PHC (Primary Health Centre – India’s frontline rural clinic) at midnight, delivering a breech baby under a flickering bulb. The mother’s hand grips hers. The father weeps outside. She doesn’t panic. She doesn’t freeze.

She breathes, remembers the SPIKES protocol (a 6-step, evidence-based framework for delivering difficult news with empathy, developed by oncologist Dr. Robert Buckman) from Year 2, the narrative medicine journal from Year 3, the rural LIC (Longitudinal Integrated Clerkship – a 6-month continuous care model with the same patients) she followed.

This is not a fantasy.
This is the NMC 2025 CBME graduate (Competency-Based Medical Education – a curriculum focused on skills, not just knowledge).
This is the doctor India has waited for.


The Awakening: From Lecture Halls to Living Rooms

The old system trained technicians.
The new system forges healers.

The NMC, with 1.37 lakh MBBS seats (Bachelor of Medicine, Bachelor of Surgery – India’s undergraduate medical degree) and 816 colleges, is not just scaling—it is reimagining. The 2025 curriculum is a love letter to reality: early patient touch, mentored chaos, and empathy woven into the DNA of medicine.

No more mannequins as patients.
No more OSCE stations (Objective Structured Clinical Examination – standardized skill assessment with actors) as destiny.

Instead:

Simulation as rehearsal. Real patients as professors. Faculty as guides. Life as the exam.


Global Whispers, Indian Thunder

The world has shown the way.

  • In Australia, a first-year student sits with a GP (General Practitioner – family doctor), listening to a farmer describe chest pain.

  • In Germany, a final-year intern runs the ward at 3 a.m.—with a senior just a call away during the PJ (Praktisches Jahr – Practical Year).

  • In Cuba, medical students live in barrios, vaccinating, consoling, learning through the ELAM model (Escuela Latinoamericana de Medicina – Latin American School of Medicine).

India listens. India adapts. India amplifies.

NMC 2025 GoalGlobal LeaderIndian Thunder
Early Clinical ExposureAustralia (Flinders)1 real patient/week from Week 1
Continuity of CareNetherlands6-month LIC (Longitudinal Integrated Clerkship) in 100 colleges
Competency ProgressionUSA (AAMC EPAs – Association of American Medical Colleges’ Entrustable Professional Activities)50 EPAs with sign-off
ApprenticeshipGermany (PJ)Practical Year Internship
Social AccountabilityCuba (ELAM)50% rural-bonded seats

The Five-Year Odyssey: A Week-by-Week Epic

Year 1: The First Touch

Week 1. The White Coat Ceremony. Not pomp—promise.
Students watch Patch Adams. They cry. They write: “What does it mean to be a doctor?”

Week 2. First PHC visit. A diabetic grandmother teaches them how to hold a hand while taking blood pressure.

By Week 52, they’ve logged 50+ real patient stories. Not in a sim lab. In sweat, tears, and hope.

WeekThemeMagic Moment
1–2White Coat“I will listen.”
3–12AnatomyDissecting a cadaver and a patient’s fear
13–26ECE (Early Clinical Exposure)First stethoscope on a real heart
27–52Community MedicineFirst vaccine given, first smile earned

Year 2: The Integration

Pathology is no longer a slide. It’s Mrs. Sharma’s jaundice.
Students shadow autopsies, then sit with bereaved families. They learn SPIKES not from a script—but from a real father’s silence.


Year 3: The Crucible of Care

The LIC (Longitudinal Integrated Clerkship) begins.
In a tribal hamlet, Priya follows 10 patients for 6 months:

  • A pregnant mother with anemia

  • A child with malaria

  • A farmer with untreated hypertension

She is not a visitor. She is family.

RotationDurationSoul-Shaping EPA (Entrustable Professional Activity – a task a student can be trusted to perform)
Medicine8 wksEPA 10: “Explain diabetes in the patient’s language”
Surgery8 wksEPA 15: “Suture a wound with trembling hands—and steady the patient’s fear”
LIC6 monthsEPA 30: “Be the doctor a village remembers”

Year 4: The Forge of Leadership

Electives in AI diagnosticstelemedicine, and global health.
research capstone“How a PHC reduced maternal mortality by 40%”—published, not filed.


Internship: The German PJ – Where Fear Becomes Courage

The final year is apprenticeship.
Interns run OPDs (Outpatient Departments)deliver babiesmanage outbreaks.
A consultant is one call away—but the decision is theirs.

PostingDurationDefining Moment
Medicine4 monthsFirst solo admission at 2 a.m.
Community3 monthsFirst PHC outbreak contained

The Simulation-to-Reality Bridge: Hand-Holding as Sacred Duty

Simulation is rehearsal. Reality is performance.
The NMC’s zero-harm pathway:

StageSimulationReal-WorldHand-Holding
Pre-ClinicalMannequin CPR (Cardiopulmonary Resuscitation)PHC vitalsFaculty whispers: “Feel the pulse.”
ClinicalOSCE heartbreakReal griefDOPS (Direct Observation of Procedural Skills)“You did well. She felt seen.”
InternshipCrisis simReal crisisConsultant: “You’ve got this.”

Faculty: The Unsung Mentors

No revolution without teachers who bleed compassion.
The NMC trains 1 lakh faculty in bedside magic.

RoleRatioTraining
Preceptor1:5“How to teach a heart to listen”
LIC Mentor1:8“How to let a student fail—safely”

Rewards:

  • Rural service → 30% hike + legacy

  • EPA mastery → ₹50,000 + pride


Infrastructure: Temples of Healing

FacilityPurpose
Simulation LabRehearse
AETCOM Sanctuary (Attitude, Ethics, and Communication – NMC’s empathy curriculum)Reflect
PHC PortalLive

Assessment: Trust, Not Tests

50 EPAs—not marks.
EPA 25: “Break bad news so the patient still trusts you.”
Assessed by OSCEmini-CEX (Clinical Evaluation Exercise)portfolio, and the patient’s tears.


AETCOM 2.0: 100 Hours to Grow a Soul

This is where doctors become human.
(AETCOM = Attitude, Ethics, and Communication – the NMC’s mandatory humanities curriculum)

Module 1: The Healer’s Oath (15 hrs)

Film: Patch Adams. Task: Write a letter to your future patient.

“I will not just treat your disease. I will carry your story.”


Module 2: The Art of Bad News – Mastering the SPIKES Protocol (20 hrs)

SPIKES is not a checklist.
It is medicine’s most compassionate algorithm.

“Bad news is a wound. SPIKES is the suture.”

The 6 Steps – Explained, Lived, and Breathed

StepNameWhat It MeansHow It’s Taught (NMC 2025)Real-Life Example (PHC, Year 2)
1. SSettingCreate a private, distraction-free space. Silence phones. Sit at eye level.Role-play in AETCOM room: Dim lights, no chairs for hierarchy.Student turns off fan, closes door, sits on floor with a tribal mother.
2. PPerceptionAsk: “What do you already understand?” Never assume.SP script: Patient believes “pain = gas”. Student probes gently.“Uncle, aapko lagta hai yeh dard kyun ho raha hai?” (What do you think is causing this pain?)
3. IInvitationAsk: “How much do you want to know today?” Respect autonomy.Branching video scenarios: Full truth vs. partial.“Aap poori baat jaanna chahte hain, ya thodi-thodi?” (Do you want the full truth, or step by step?)
4. KKnowledgeUse simple languagewarn before impact“I’m sorry, the report isn’t good…”Language lab: Translate “metastatic carcinoma” → “Cancer phail chuka hai”“Biopsy mein cancer nikla hai. Yeh serious hai, lekin hum saath ladenge.” (The biopsy shows cancer. It’s serious, but we’ll fight together.)
5. EEmotionsName the feeling: “I can see this is devastating.” Pause. Touch. Cry if needed.Actor training: Real tears allowed. Feedback on silence.Mother sobs. Student holds her hand for 45 seconds. No words.
6. SStrategy & SummaryOffer a plan: “We’ll start treatment tomorrow. I’ll be with you.” End with hope.Care map exercise: Draw next 3 steps on paper.“Kal se chemotherapy shuru. Main har hafte aunga.” (Chemo starts tomorrow. I’ll visit weekly.)

Teaching Methodology (20 hrs)

HourActivityOutcome
1–3SPIKES Lecture + Video (real oncology consultations)Understand theory
4–8SP Role-Play (10 stations) – Cancer, TB, infertility, child deathPractice in safe space
9–12Real Ward Shadowing – Observe seniors delivering newsSee mastery
13–16Student-Led SPIKES – With actual patients (supervised)First real wound
17–20Debrief + Reflective Journal – “What broke me? What healed them?”Grow a soul

EPA 25 Assessment: Deliver bad news to 3 real patients → 90% patient satisfaction + faculty sign-off


Module 3: Narrative Medicine (25 hrs)

Write a 500-word story from a patient’s eyes.

“The doctor was young. She listened. For the first time, I wasn’t just a chart.”

Module 4: Arts-Based Empathy (20 hrs)

Paint a patient’s pain. Act out a consultation. Sing a lullaby to a mannequin baby.

A student’s painting of a child’s fever becomes the college’s AETCOM poster.

Module 5: Ethics in the Trenches (20 hrs)

Case: “The family can’t afford dialysis. What do you do?”

Debate. Cry. Decide. Reflect.

ModuleHoursTransformative Moment
115First tear in a journal
220First “thank you” after bad news
325First story that changes a policy
420First painting hung in a ward
520First ethical stand taken

Assessment: A reflective portfolio + patient gratitude notes


The Digital Pulse

  • AI App: “Is this rash dengue or measles?”

  • Telemedicine: Consult a tribal patient from a moving bus

  • VR Anatomy (Virtual Reality): Dissect a heart—then hold a real one


The NMC Dashboard: Watching 1.37 Lakh Dreams

MetricTargetRed Alert
EPA completion>90%<70% → Audit
Patient smile rate>85%<70% → AETCOM retraining

The 5-Year War Cry

YearBattle Won
202550 LICs launched
2026Every college has a mentor
2027First PJ interns save lives
2030India’s doctors heal the world

Epilogue: The Doctor India Deserves

In 2030, that girl from Vidarbha will not just deliver a baby.
She will name her after the mother she saved.
She will teach the next batch in the same PHC.
She will cry, laugh, and heal—because she was taught to be human first.

This is not a curriculum.
This is a calling.

“We do not train doctors. We awaken healers.”
— NMC 2025


Sources: All 13 original documents + AAMCGMC (General Medical Council, UK), CanMEDSGerman PJCuba ELAMDuke-NUSNetherlands LICsBuckman R. SPIKES Protocol (J Clin Oncol, 2000).


The Making of a Healer: India’s Medical Revolution Under NMC 2025

(NMC = National Medical Commission – India’s apex regulator for medical education)

Imagine this:
19-year-old from a small town in Vidarbha steps off a dusty bus at her medical college. In her pocket: a white coat, still crisp. In her heart: a dream to save lives.

Five years later, she stands in a PHC (Primary Health Centre – India’s frontline rural clinic) at midnight, delivering a breech baby under a flickering bulb. The mother’s hand grips hers. The father weeps outside. She doesn’t panic. She doesn’t freeze.

She breathes, remembers the SPIKES protocol (a 6-step, evidence-based framework for delivering difficult news with empathy, developed by oncologist Dr. Robert Buckman) from Year 2, the narrative medicine journal from Year 3, the rural LIC (Longitudinal Integrated Clerkship – a 6-month continuous care model with the same patients) she followed.

This is not a fantasy.
This is the NMC 2025 CBME graduate (Competency-Based Medical Education – a curriculum focused on skills, not just knowledge).
This is the doctor India has waited for.


The Awakening: From Lecture Halls to Living Rooms

The old system trained technicians.
The new system forges healers.

The NMC, with 1.37 lakh MBBS seats (Bachelor of Medicine, Bachelor of Surgery – India’s undergraduate medical degree) and 816 colleges, is not just scaling—it is reimagining. The 2025 curriculum is a love letter to reality: early patient touch, mentored chaos, and empathy woven into the DNA of medicine.

No more mannequins as patients.
No more OSCE stations (Objective Structured Clinical Examination – standardized skill assessment with actors) as destiny.

Instead:

Simulation as rehearsal. Real patients as professors. Faculty as guides. Life as the exam.


Global Whispers, Indian Thunder

The world has shown the way.

  • In Australia, a first-year student sits with a GP (General Practitioner – family doctor), listening to a farmer describe chest pain.

  • In Germany, a final-year intern runs the ward at 3 a.m.—with a senior just a call away during the PJ (Praktisches Jahr – Practical Year).

  • In Cuba, medical students live in barrios, vaccinating, consoling, learning through the ELAM model (Escuela Latinoamericana de Medicina – Latin American School of Medicine).

India listens. India adapts. India amplifies.

NMC 2025 GoalGlobal LeaderIndian Thunder
Early Clinical ExposureAustralia (Flinders)1 real patient/week from Week 1
Continuity of CareNetherlands6-month LIC (Longitudinal Integrated Clerkship) in 100 colleges
Competency ProgressionUSA (AAMC EPAs – Association of American Medical Colleges’ Entrustable Professional Activities)50 EPAs with sign-off
ApprenticeshipGermany (PJ)Practical Year Internship
Social AccountabilityCuba (ELAM)50% rural-bonded seats

The Five-Year Odyssey: A Week-by-Week Epic

Year 1: The First Touch

Week 1. The White Coat Ceremony. Not pomp—promise.
Students watch Patch Adams. They cry. They write: “What does it mean to be a doctor?”

Week 2. First PHC visit. A diabetic grandmother teaches them how to hold a hand while taking blood pressure.

By Week 52, they’ve logged 50+ real patient stories. Not in a sim lab. In sweat, tears, and hope.

WeekThemeMagic Moment
1–2White Coat“I will listen.”
3–12AnatomyDissecting a cadaver and a patient’s fear
13–26ECE (Early Clinical Exposure)First stethoscope on a real heart
27–52Community MedicineFirst vaccine given, first smile earned

Year 2: The Integration

Pathology is no longer a slide. It’s Mrs. Sharma’s jaundice.
Students shadow autopsies, then sit with bereaved families. They learn SPIKES not from a script—but from a real father’s silence.


Year 3: The Crucible of Care

The LIC (Longitudinal Integrated Clerkship) begins.
In a tribal hamlet, Priya follows 10 patients for 6 months:

  • A pregnant mother with anemia

  • A child with malaria

  • A farmer with untreated hypertension

She is not a visitor. She is family.

RotationDurationSoul-Shaping EPA (Entrustable Professional Activity – a task a student can be trusted to perform)
Medicine8 wksEPA 10: “Explain diabetes in the patient’s language”
Surgery8 wksEPA 15: “Suture a wound with trembling hands—and steady the patient’s fear”
LIC6 monthsEPA 30: “Be the doctor a village remembers”

Year 4: The Forge of Leadership

Electives in AI diagnosticstelemedicine, and global health.
research capstone“How a PHC reduced maternal mortality by 40%”—published, not filed.


Internship: The German PJ – Where Fear Becomes Courage

The final year is apprenticeship.
Interns run OPDs (Outpatient Departments)deliver babiesmanage outbreaks.
A consultant is one call away—but the decision is theirs.

PostingDurationDefining Moment
Medicine4 monthsFirst solo admission at 2 a.m.
Community3 monthsFirst PHC outbreak contained

The Simulation-to-Reality Bridge: Hand-Holding as Sacred Duty

Simulation is rehearsal. Reality is performance.
The NMC’s zero-harm pathway:

StageSimulationReal-WorldHand-Holding
Pre-ClinicalMannequin CPR (Cardiopulmonary Resuscitation)PHC vitalsFaculty whispers: “Feel the pulse.”
ClinicalOSCE heartbreakReal griefDOPS (Direct Observation of Procedural Skills)“You did well. She felt seen.”
InternshipCrisis simReal crisisConsultant: “You’ve got this.”

Faculty: The Unsung Mentors

No revolution without teachers who bleed compassion.
The NMC trains 1 lakh faculty in bedside magic.

RoleRatioTraining
Preceptor1:5“How to teach a heart to listen”
LIC Mentor1:8“How to let a student fail—safely”

Rewards:

  • Rural service → 30% hike + legacy

  • EPA mastery → ₹50,000 + pride


Infrastructure: Temples of Healing

FacilityPurpose
Simulation LabRehearse
AETCOM Sanctuary (Attitude, Ethics, and Communication – NMC’s empathy curriculum)Reflect
PHC PortalLive

Assessment: Trust, Not Tests

50 EPAs—not marks.
EPA 25: “Break bad news so the patient still trusts you.”
Assessed by OSCEmini-CEX (Clinical Evaluation Exercise)portfolio, and the patient’s tears.


AETCOM 2.0: 100 Hours to Grow a Soul

This is where doctors become human.
(AETCOM = Attitude, Ethics, and Communication – the NMC’s mandatory humanities curriculum)

Module 1: The Healer’s Oath (15 hrs)

Film: Patch Adams. Task: Write a letter to your future patient.

“I will not just treat your disease. I will carry your story.”


Module 2: The Art of Bad News – Mastering the SPIKES Protocol (20 hrs)

SPIKES is not a checklist.
It is medicine’s most compassionate algorithm.

“Bad news is a wound. SPIKES is the suture.”

The 6 Steps – Explained, Lived, and Breathed

StepNameWhat It MeansHow It’s Taught (NMC 2025)Real-Life Example (PHC, Year 2)
1. SSettingCreate a private, distraction-free space. Silence phones. Sit at eye level.Role-play in AETCOM room: Dim lights, no chairs for hierarchy.Student turns off fan, closes door, sits on floor with a tribal mother.
2. PPerceptionAsk: “What do you already understand?” Never assume.SP script: Patient believes “pain = gas”. Student probes gently.“Uncle, aapko lagta hai yeh dard kyun ho raha hai?”
3. IInvitationAsk: “How much do you want to know today?” Respect autonomy.Branching video scenarios: Full truth vs. partial.“Aap poori baat jaanna chahte hain, ya thodi-thodi?”
4. KKnowledgeUse simple languagewarn before impact“I’m sorry, the report isn’t good…”Language lab: Translate “metastatic carcinoma” → “Cancer phail chuka hai”“Biopsy mein cancer nikla hai. Yeh serious hai, lekin hum saath ladenge.”
5. EEmotionsName the feeling: “I can see this is devastating.” Pause. Touch. Cry if needed.Actor training: Real tears allowed. Feedback on silence.Mother sobs. Student holds her hand for 45 seconds. No words.
6. SStrategy & SummaryOffer a plan: “We’ll start treatment tomorrow. I’ll be with you.” End with hope.Care map exercise: Draw next 3 steps on paper.“Kal se chemotherapy shuru. Main har hafte aunga.”

Teaching Methodology (20 hrs)

HourActivityOutcome
1–3SPIKES Lecture + Video (real oncology consultations)Understand theory
4–8SP Role-Play (10 stations) – Cancer, TB, infertility, child deathPractice in safe space
9–12Real Ward Shadowing – Observe seniors delivering newsSee mastery
13–16Student-Led SPIKES – With actual patients (supervised)First real wound
17–20Debrief + Reflective Journal – “What broke me? What healed them?”Grow a soul

EPA 25 Assessment: Deliver bad news to 3 real patients → 90% patient satisfaction + faculty sign-off


Module 3: Narrative Medicine – The Art of Listening to Stories (25 hrs)

“Medicine is a story-telling profession. If you cannot tell a story, you cannot heal.”
— Rita Charon, Founder of Narrative Medicine, Columbia University

Narrative Medicine is not poetry for leisure.
It is clinical rigor—using storytelling to diagnose sufferingbuild trust, and co-author care plans.

Core Principles (NMC 2025)

PrincipleDefinitionWhy It Matters in India
AttentionDeep, focused listening without interruptionCounters “3-minute OPD culture”
RepresentationTranslating the patient’s chaos into coherent narrativeTurns “pain in stomach” into “fear of dying alone”
AffiliationCo-creating meaning with the patientHeals doctor-patient divide

Narrative Medicine Techniques: A 25-Hour Deep Dive

TechniqueDescriptionNMC 2025 ImplementationExample Output
1. Parallel ChartingWrite two charts: Clinical (BP 140/90, Hb 9) + Narrative (Patient’s fear, family burden)Weekly during LIC – 300 words“Patient 7: Ramu, 52. Clinical: DM Type 2. Narrative: ‘Doctor sahab, agar main mar gaya toh beti ki shaadi kaun karega?’”
2. Close ReadingAnalyze a patient’s 2-minute monologue like literature: metaphors, silences, toneAETCOM Lab – Audio record OPD, transcribe, annotatePatient says: “Yeh dard… jaise koi andar se kheench raha hai.” → Metaphor of loss of control
3. Reflective Writing Prompts10-minute free-write after every patientDigital Journal App (NMC-mandated)Prompt: “What did this patient teach me about courage?”
4. Patient-as-AuthorPatient writes/draws their illness journeyPHC Art Wall – Display in waiting areaA child draws cancer as a black cloud. Doctor adds: “We’ll bring the sun.”
5. Generative InterviewAsk open, story-eliciting questions: “Tell me about the day the pain began.”Year 3 LIC – 1 hour/patientFarmer: “Woh din barsaat thi… khet mein gir gaya…” → Reveals trauma, not just back pain
6. Narrative ReframingHelp patient re-write their illness story from victim → survivorSupport group facilitation training“I am not a TB patient. I am a father fighting to see my son graduate.”
7. Interprofessional StorytellingNurse, ASHA, doctor co-write a patient’s storyRural LIC Team HuddleASHA: “Woh ghar mein akela rehta hai.” → Social isolation flagged
8. Digital StorytellingRecord 3-minute patient video diariesTelemedicine electivePatient films daily blood sugar + emotional log

25-Hour Module Breakdown

WeekFocusActivityEPA Link
1IntroductionRead The Hurt Song (patient poem)EPA 3: Active listening
2–3Parallel Charting10 real patients → 2 charts eachEPA 22: Holistic documentation
4–5Close Reading LabTranscribe + annotate 5 OPD dialoguesEPA 24: Interpret non-verbal cues
6Reflective Writing10 prompts → 500-word essayEPA 26: Self-awareness
7Patient-as-AuthorPHC mural projectEPA 28: Patient partnership
8Narrative ReframingRole-play survivor storiesEPA 30: Hope-building

Assessment:

  • Portfolio: 10 parallel charts + 1 reframed patient story

  • Patient Feedback: “Did the doctor understand your full story?” (>90%)

  • EPA 32 Sign-Off: “Use narrative to improve adherence”


Module 4: Arts-Based Empathy (20 hrs)

Paint a patient’s pain. Act out a consultation. Sing a lullaby to a mannequin baby.

A student’s painting of a child’s fever becomes the college’s AETCOM poster.

Module 5: Ethics in the Trenches (20 hrs)

Case: “The family can’t afford dialysis. What do you do?”

Debate. Cry. Decide. Reflect.

ModuleHoursTransformative Moment
115First tear in a journal
220First “thank you” after bad news
325First story that changes a policy
420First painting hung in a ward
520First ethical stand taken

Assessment: A reflective portfolio + patient gratitude notes


The Digital Pulse

  • AI App: “Is this rash dengue or measles?”

  • Telemedicine: Consult a tribal patient from a moving bus

  • VR Anatomy (Virtual Reality): Dissect a heart—then hold a real one


The NMC Dashboard: Watching 1.37 Lakh Dreams

MetricTargetRed Alert
EPA completion>90%<70% → Audit
Patient smile rate>85%<70% → AETCOM retraining

The 5-Year War Cry

YearBattle Won
202550 LICs launched
2026Every college has a mentor
2027First PJ interns save lives
2030India’s doctors heal the world

Epilogue: The Doctor India Deserves

In 2030, that girl from Vidarbha will not just deliver a baby.
She will name her after the mother she saved.
She will teach the next batch in the same PHC.
She will cry, laugh, and heal—because she was taught to be human first.

This is not a curriculum.
This is a calling.

“We do not train doctors. We awaken healers.”
— NMC 2025


Sources: All 13 original documents + AAMCGMC (General Medical Council, UK), CanMEDSGerman PJCuba ELAMDuke-NUSNetherlands LICsBuckman R. SPIKES (2000)Charon R. Narrative Medicine (2006)DasGupta S. Narrative Humility (2008).