Tuesday, January 14, 2025

UDLCO CRH Project: Medical educational drivers to over-testing and overtreatment captured in peer to peer online learning groups

Summary


The conversation revolves around a medical case scenario discussing a 53-year-old female patient with hypertension, diabetes, and rheumatoid arthritis. Peer learners share their approaches to diagnosing and treating the patient, and the group moderator critiques the answers, highlighting the importance of addressing the underlying pathology and the limitations of current medical practices.

Key Words
1. Medical education
2. Over-testing
3. Overtreatment
4. Hypertension
5. Diabetes
6. Rheumatoid arthritis
7. Medical cognition
8. Evidence-based medicine
9. Artificial intelligence




Conversational learning Transcripts (non Socratic dialogue around a probable non real patient simulation scenario:

 [06/01, 19:44] group moderator : A 53 year old female, with medically controlled diabetes, under metformin 500 bd, is suffering from morbid hypertension. The average diurnal PBP being 180/100

The patient is on telmisartan/metoprolol 40/50 in combination. 
The patient is a patient of clinically diagnosed RA under methotrexate 7.5 bi weekly.

Renal profile is normal with no dyselectrolemia, creatinine 0.8
Hb 10
TLC WNL
Thyroid profile WNL.
Lipid profile WNL

How to approach the case to diagnose the underlying pathology and how to escalate the anti hypertensives? 

Please opine and oblige...


[07/01, 03:04] peer learner 1: How I might have approached the case-
Firstly if her bp still averages 180/100 after telmi/metopr, then I wld firstly admit her & start on injectable diuretics (Lasix 10mg TDS later tapering to BD & so on) in conjunction with Nicardia 20 mg SOS if BP still persists above 140/90 mm Hg after her lasix & Telmi/Metoprolol.. 
In RA, body is under oxidative stress too which probably also plays a role in HTN, so I'll provide her with some antioxidant combination & MVI too..

Then if her bp starts returning to baseline I'll discharge her by switching her bp med to a readily available standard combination of Chlorthalidone-Telma-Am tablet🤔 also since due to oxidative stress & inflammation assoc with RA & Morbid Htn on top of that, she is at severe risk of any Cerebrovascular or Cardiovascular adversity, I'll advice her to switch from metformin to glifozins which are known to be protective in cardiac related scenarios..."

Clinical problem question scenario over.

Question to:

Medical cognition (integrating medical education and practice) learners and enthusiasts:

Can you identify the medical cognition drivers to over-testing and overtreatment captured in this real (but deidentified) peer to peer online learning scenario.

Can you as a first step begin by pointing out the non evidence based interpretations of medical data that arises out of too much focus on hypothetical pathophysiologies and too less on RCT data?

On Wed, 8 Jan 2025, 09:18 ap wrote:

Happy New Year! This is a great concept! Might you frame it like NEJM  and personalize it for co-productive community medicine? This way you could broaden your impact as you  are making a puzzle (medical mystery)  to solve by all. This appeals to all and can bring in cultural relevance, local barriers etc…


Date: Wed, 8 Jan 2025, 09:52 rb

Reminded of the prolific framings of such similars I used to engage in around 2000 at one column called "images in clinical medicine"! 

Unfortunately while they have pubmed traces the full text may have disappeared from everywhere else: https://pubmed.ncbi.nlm.nih.gov/15055875/

I guess I moved to framing them rather loosely in blogspot as there's no rigorous peer review to get there but it may still thrive asynchronously through human life long post publication peer review if not AI bot user driven processing!


On Sun, 12 Jan 2025, 17:24 rk> wrote:

This is very fascinating. It will take some time but I'm trying to model all these decisions in a causal reasoning graph. Lets see if that representation is able to quickly point out where the mistakes were.

Quick question -



On Tue, 14 Jan 2025, 19:43 rb > wrote:
My answer is also a critique of the answer given by peer learner 1.

The question by the original poster OP was:

How to approach the case to diagnose the underlying pathology and how to escalate the anti hypertensives? 

Peer learner 1 in his answer chooses to ignore the first half of the question and simply jumps to fix the hypertension!

One answer to the first component of the question, "How to approach the case to diagnose the underlying pathology"


 is: It's easy if one can spot the phenotype!

Here's how the phenotype of a metabolic syn patient may look like (as in the opening clinical image in the link): https://medicinedepartment.blogspot.com/2024/10/clinical-complexity-project-individual.html?m=1

Essentially it's about accumulating a lot of adipocytes around the trunk!

There are some western repositories offering a loose eye ball estimated visual representation of body fat such as here: 

We have much more visual images in our departmental patient centered metabolic syn data base that needs an AI to cluster them in the above format hopefully in the near future and we are even currently wondering how to register all our images in Wikimedia commons (if anyone could help to work out the logistics)!

Coming back to the pathophysiology:

These adipocytes are very metabolically active and a key driver to the underlying pathophysiology of hypertension through endothelial inflammation and fibrosis causing vessel stiffness.

The second component of the answer is the trickiest and also would be the most impactful area we can work on with the help of AI driven PICO format evidence generators for each therapeutic choice!

But again more importantly one is likely to realise that there's not much evidence for any of the BP lowering pharmacological interventions in improving long term organ failure outcomes and it's logical that eliminating the risk factors for development of trunkal obesity is more likely to be a scientific cure than simply producing a cosmetic effect on the BP using vasodilators or diuretics!

Thematic Analysis
_Codes_
1. Medical education
2. Case scenario discussion
3. Diagnostic approach
4. Treatment options
5. Critique of medical practices
6. Evidence-based medicine
7. Artificial intelligence

_Themes_

1. _Medical Education and Cognition_: The conversation highlights the importance of medical education and cognition in shaping medical practices.

2. _Diagnostic Approach_: The discussants share their approaches to diagnosing the patient, emphasizing the need to address the underlying pathology.

3. _Treatment Options and Limitations_: The conversation critiques the treatment options presented, highlighting the limitations of current medical practices and the need for evidence-based medicine.

4. _Role of Artificial Intelligence_: The discussants mention the potential role of artificial intelligence in improving medical practices and generating evidence-based guidelines.

Learning Points

1. _Importance of Addressing Underlying Pathology_: Medical practitioners should focus on addressing the underlying pathology rather than just treating symptoms.

2. _Limitations of Current Medical Practices_: Current medical practices may not always be evidence-based, and practitioners should be aware of these limitations.

3. _Need for Evidence-Based Medicine_: Evidence-based medicine is crucial in ensuring that medical practices are effective and efficient.

4. _Potential Role of Artificial Intelligence_: Artificial intelligence can play a significant role in improving medical practices and generating evidence-based guidelines.

 



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



Posted by at No comments:

Saturday, January 4, 2025

UDLCO : Journal club with author on capacity building mental well being and medical professionalism in medical students

Summary


The conversation revolves around a study on medical students' experiences with professionalism, mental well-being, and coping strategies. The study used qualitative phenomenological methods and focus group discussions to gather insights. The discussants praise the study, ask questions about methodology, and highlight the importance of addressing mental well-being issues in medical education.

Key Words
1. Medical students
2. Mental well-being
3. Professionalism
4. Coping strategies
5. Qualitative research
6. Focus group discussions
7. Medical education


Conversational Transcripts:

03/01, 14:49] +97 Congratulations 🎉🎈 very nice study

[03/01, 15:10] +96: Really insightful dear colleague!



[03/01, 20:34] rb: The sampling diversity is intriguing!

To quote:

"Sampling represented diverse backgrounds (with 27 females, 18 fifth-year students, and 30 Malays)."


[03/01, 20:41] rb: Liked this diagram very much 👇



[03/01, 20:53] +96: Thank you. This statement from Abstract is well elaborated in the subsequent section. e.g Characteristics of participants in the FGD:
Purposeful sampling was used to select the 40 partici-
pants, who were medical students from various years,
comprising both males and females from diverse racial
backgrounds (see Table 5). Most participants were female
(67.5%), fifth-year students (45%), and Malay (75%). The
homogeneity of the participants, who were all undergrad-
uate medical students, was relevant to the study’s focus.


[03/01, 22:16]rb: Thanks

Reading further I came across these two apparently disparate paragraphs that needs your help to bring together:

"The FGDs were conducted synchronously online using Zoom©. Participants were required to keep their web cameras on during the sessions, allowing the moderator (principal author) to observe nonverbal cues such as facial expressions, eye contact, and body language."

"Text Interpretation (Step 1): The authors read and re-read the texts."

Query:

How was the synchronous zoom session data converted to text?

How were the non verbal cues factored into the interpretation?


[03/01, 23:02] +96: Thank you. Although in the wake of responding to and or satisfying reviewers’  queries we ought to omit a few details (pertinent for readers), but i still believe and affirm that reading in full the paper in general and the section of  ‘Data analysis and robustness’ in particular will clear it. As an inductive coding approach was adopted for data
analysis, allowing codes to emerge directly from the
data without a predefined framework.  Best wishes.


[03/01, 23:30] +96: Voice to text transcripts conversion manual- non verbal.   Cues were looked for (if any) nothing there/ insignificant.


[04/01, 10:15]rb: Nice having a journal club with the author. 
👏👏

Look forward to do this more often. Wishing you more such papers 👍

Perplexity inputs:

The study "Unveiling the interplay of medical professionalism, mental well-being and coping in medical students" explores how medical students' experiences with professionalism, coping strategies, and mental well-being interact. Using qualitative phenomenological methods, the researchers conducted focus group discussions with 40 students to gather insights into their challenges and coping mechanisms.Critical Appraisal:
  • Study Design: The qualitative approach is appropriate for capturing nuanced experiences but may lack generalizability due to the small sample size and purposive sampling.
  • Results: The findings highlight significant themes around mental well-being issues and coping strategies, indicating a complex relationship between these factors and professionalism. However, the reliance on self-reported data may introduce bias.
  • Conclusion: The study effectively underscores the need for targeted interventions in medical education to enhance student support systems. Future research should address limitations by including larger, more diverse samples to validate findings
The study identified two main themes regarding mental well-being (MWB) among medical students:
  1. Mental Well-Being Issues: This theme highlights persistent mental health challenges faced by students, including stress and anxiety related to their educational environment.
  2. Happiness: This theme illustrates factors that contribute to sustaining well-being, such as social support and positive experiences within their training.
These findings emphasize the complex interplay between coping strategies, professionalism, and MWB, suggesting a need for targeted interventions to support students effectively

The study recommends several interventions to support medical students, focusing on enhancing mental well-being and professionalism. Key recommendations include:
  1. Targeted Support Programs: Develop programs that address mental health challenges and provide coping strategy training, emphasizing resilience and stress management.
  2. Peer Support Systems: Establish peer mentoring initiatives to foster social support, encouraging students to share experiences and coping mechanisms.
  3. Mindfulness and Well-Being Workshops: Implement workshops that teach mindfulness practices and self-care strategies to promote positive coping.
  4. Curriculum Integration: Integrate discussions on mental well-being and professionalism into the medical curriculum to raise awareness and normalize seeking help.
These interventions aim to create a supportive educational environment that nurtures both the mental health and professional development of medical students.


Thematic Analysis
*Codes*
1. Study methodology
2. Mental well-being issues
3. Professionalism
4. Coping strategies
5. Medical education
6. Research limitations
7. Interventions for support

*Themes*
1. _Study Methodology_: The conversation touches on the study's methodology, including the use of qualitative phenomenological methods and focus group discussions.
2. _Mental Well-being Issues_: The discussants highlight the importance of addressing mental well-being issues in medical education.
3. _Professionalism and Coping Strategies_: The conversation explores the complex interplay between professionalism, coping strategies, and mental well-being.
4. _Medical Education_: The discussants emphasize the need for targeted interventions to support medical students' mental well-being and professional development.
5. _Research Limitations_: The conversation notes the study's limitations, including the small sample size and reliance on self-reported data.

Learning Points
1. _Importance of Addressing Mental Well-being_: Medical education should prioritize addressing mental well-being issues to support students' professional development.
2. _Need for Targeted Interventions_: Targeted interventions, such as peer support systems and mindfulness workshops, can help support medical students' mental well-being.
3. _Complex Interplay between Professionalism and Mental Well-being_: The relationship between professionalism, coping strategies, and mental well-being is complex and requires further research.
4. _Limitations of Qualitative Research_: Qualitative research, while providing rich insights, may have limitations, such as small sample sizes and reliance on self-reported data.




Posted by at No comments:

Wednesday, December 25, 2024

Diabetes dependent variable (glucose) and independent variable (insulin dose) graph in type 1 Diabetes 30F MP PaJR



Last mile, multilingual EHR-PHR, PaJR transcripts driven by patient advocate user around a 30 year old's navigation of her diabetes journey 👇

Posted by at No comments:

Diabetes dependent variable (glucose) and independent variable (insulin dose) graph in type 1 Diabetes, 3F WB PaJR



Last mile, multilingual EHR-PHR, PaJR transcripts driven by patient advocate user around a 3 year old's navigation of her diabetes journey 👇

Posted by at No comments:

Sunday, December 15, 2024

Current issues with MD residency thesis projects and potential solutions

Summary:


The MD thesis project system in tier 2 medical colleges in India is increasingly challenged, with students and faculty struggling to navigate the process. A proposed solution involves optimizing study design, prospective data capture, and thematic analysis using collective medical cognition tools and AI-driven qualitative thematic analysis.

Key words:

1. MD thesis projects
2. India
3. Study design optimization
4. Prospective data capture
5. Collective cognition tools
6. AI-driven qualitative thematic analysis
7. Medical education
8. Research methodology



Problem statement:

MD thesis projects submitted in India has become a quagmire and often hated by faculty and students both as a sore point that continues to be enforced by policy makers as a mandatory requirement to obtain the MD degree and most tier 2 medical colleges in India just pay superficial lip services to these thesis projects as also shared earlier in the UDLCO linked here: https://userdrivenhealthcare.blogspot.com/2024/02/udlco-indian-medical-faculty-and.html?m=1
One of the biggest reasons for the problem is that faculty and students are largely left to their own survival strategies to execute their thesis workflow and learn to fend for themselves, anecdotally often believed to learn to utilise short cuts that do more harm than good to their overall learning experience.

Solutions:

1) Optimizing Study Design:

Real patient centered qualitative study design with quantitative descriptions (mixed methods) that enables easier integration with existing patient care workflows.


2) Optimizing prospective data capture utilising collective cognition tools:

This tackles one of the biggest issues of the system's current inability to offer the lonely post graduate resident learner a  collective cognitive support that is also transparent and accountable.

Each patient data is begun to be captured as soon as the first encounter happens in the outpatient or inpatient setting and the patient is followed up through a system of PaJR and CBBLE where a team of patient centered advocates, faculty, students, interns and post graduate resident learners make the data grow with time through team based learning as illustrated here: 

Sample PaJR data of individual thesis patients in NMC dynamic E logged case report links:


The above single patient's data with clinical complexity and comorbidities can fit into multiple ongoing thesis projects as illustrated here:

1) Factors influencing sepsis outcomes: 

2) Trunkal obesity and biopsychosocial factors influencing outcomes:

3) Diagnostic and therapeutic factors influencing outcomes of patients with anemia in chronic renal failure

4) Spectrum of clinical presentations in diabetes with multimorbidities and factors influencing their outcomes 


The above single patient's data with clinical complexity and comorbidities can fit into multiple additional ongoing thesis projects as illustrated here:

4) Factors influencing the  development of heart failure and other outcomes in patients with suspected chronic CAD

6) Factors influencing  recovery outcomes in patients with respiratory failure 




3) Thematic analysis sample drafts of thesis projects analysed and submitted to university:





Inspite of the above simple strategy that involves regular participation through a  collectively supported ecosystem it's still cumbersome for post graduate residents to warm up to the above collectively supported transparent and accountable workflow and many of them simply resort to collecting very sketchy data alone in limited paper based 
case report forms and then retrospectively analysing those limited data where large part of the patient's could be missing. Last year we managed to upgrade this paper based limited thesis data collection by utilising EMR summaries prepared by the interns during each patient's discharge and while these were still far from the quality of data desired it was very useful in faster thematic data analysis using current AI LLM tools.


Sample final assessment and certification of the thesis:


Submitted template:
This is to certify that this dissertation titled ‘‘... outcomes in patients with ... disease in chronic ... disease" is a bonafide research work done from Mid 20xy - Mid 20xz under my guidance by Dr. ABC  ( Reg No: abcefgD )

The quality and validity of the data captured from each case, including patient outcomes in the study, may have been enhanced if it had been shared with our team regularly from the first and subsequent clinical encounters and not just before final submission deadline. This work was done in partial fulfilment of regulations laid down by xyz University of Health Sciences for MD General Medicine Degree Examination to be held in mm/DD/yy


Date:  
Place: 

                                                                                                        Professor
Department of General Medicine


Thematic Analysis of the entire above write up:

The conversation can be grouped into several themes:

1. _Problem Statement_: The MD thesis project system in India is flawed, with students and faculty struggling to navigate the process.

2. _Solutions_: Optimizing study design, prospective data capture, and thematic analysis using collective cognition tools and AI-driven qualitative thematic analysis.

3. _Collective Cognition Tools_: Utilizing tools like PaJR and CBBLE to facilitate collective cognition and support students in their thesis projects.

4. _AI-Driven Qualitative Thematic Analysis_: Leveraging AI tools to support thematic analysis and improve the quality of thesis projects.

5. _Medical Education and Research Methodology_: The need for improved medical education and research methodology in India, particularly in the context of MD thesis projects.

Codes:

1. MD thesis projects
2. Study design optimization
3. Prospective data capture
4. Collective cognition tools
5. AI-driven qualitative thematic analysis
6. Medical education
7. Research methodology
8. Problem statement
9. Solutions

Insights:

1. The MD thesis project system in India is in need of reform.
2. Optimizing study design, prospective data capture, and thematic analysis can improve the quality of thesis projects.
3. Collective cognition tools and AI-driven qualitative thematic analysis can support students in their thesis projects.
4. Improved medical education and research methodology are essential for producing high-quality thesis projects.

Learning Points:

1. The importance of optimizing study design, prospective data capture, and thematic analysis in MD thesis projects.
2. The potential benefits of using collective cognition tools and AI-driven qualitative thematic analysis in supporting students in their thesis projects.
3. The need for improved medical education and research methodology in tier 2 medical colleges in India, particularly in the context of MD thesis projects.
4. The importance of addressing the problem statement and finding solutions to improve the MD thesis project system in India.

Posted by at No comments:

Friday, December 6, 2024

UG final year University exams practicals video archives

 2018-2023 batch:

https://finalmbbspart2gmpracticals.blogspot.com/2023/03/2k18-batch-university-practical-exams_29.html?m=1



Posted by at No comments:

PG final year University exams practicals video archives

 Links: 

2020-23: https://gmpgpracticals.blogspot.com/2023/06/gm-pg-final-year-2k20-23-batch.html?m=1



Posted by at No comments:
Subscribe to: Posts (Atom)