Sharing our current regular blended learning workflow locally centred around our rural medical college and globally part of an online learning ecosystem of multiple medical college students and faculty.
Precovid it was difficult to get an online learning audience formally of our UG students but post covid the tables have turned and we have formally started engaging the 200 UG student batches currently stranded in their homes, semester wise and my description of our current workflow will be centered around our patients as well as our UGs in 8th semester Medicine as well as interns and three batches of PG students.
Our regular patient centered learning workday begins with our post graduate residents meeting our patients in the wards and ICUs from 8:00 AM to 9:00 AM while one unit batch of post graduates look after the outpatient that opens at 9:00 AM. A tabular summary of our daily workflow is linked in the bottom of this piece and one can skip the long rant with even longer rants intertwined in weblinks below and jump straight to it and then return to the rant for clarifications if necessary.
In non covid times there was a central academic session supposed to be held daily for all departments to showcase their own workflow based learning experiences over the week or month following which the consultant rounds begin by 10:00 AM to review the system 1 plan generated by the 8:00 to 9:00 AM post graduate resident rounds through system 2 Socratic questioning.
Here's some detailed discussion quoted below between the two systems of cognition aka dual process theory of cognition and decision making.
"System 1: intuition or pattern-recognition
System 2: Analytical critical appraisal
Reference: Systems 1 and 2 thinking processes and cognitive reflection testing in medical students
Can Med Educ J. 2016 Oct; 7(2): e97–e103. https://www.ncbi.nlm.nih.gov/
UG teaching learning workflow in medicine begins at 11:00 -1:00 PM post 8-10 AM- PG rounds and 10-11AM- UG case taking followed by 11:00-1:00 AM unit wise UG case presentation and discussion, which is currently not happening as the UGs are locked down.
However we have the 2-4 pm-intern PG sessions daily where our interns and PGs present cases and there is an offline active learning discussion that is recorded on video and shared globally online through YouTube and all our active learning videos can be accessed here: https://www.youtube.com/
The interns also record the same patients in their online log book portfolios and these online patient logs are fed to the UGs along with the links to online videos of the active offline learning sessions around the same case. Will share the illustrative links below along with the questions posed to the UGs for their solving and discussion and represention in their own UG online learning portfolios or E log books. Again can share all those samples 200 of which are currently available online.
Some of it has been detailed and made public here: https://www.quora.com/How-
The learning strategy also engages peer to peer and higher up by asking the UGs to share their logged thoughts and queries with the interns, pgs and faculty of the treating unit of the patient under discussion. The assessment is completely formative again done by the treating unit who can actually utilize the inputs of the UGs on their own patients.
The assessment includes following broad competencies
a) The student's approach to the clinical problem which needs competency in all MBBS subjects beginning with anatomy to first make an anatomical diagnosis followed by competency in pathophysiology and microbiology for the etiologic diagnosis and finally EBM for weighing in on the diagnostic sensitivity specificity as well as competency in handling pharmacological and non pharmacological interventions along with an ability to guage their efficacy using RCT data.
b) Originality of thought and ability to generate useful questions around the patient especially for the patient treating team
c) Ability to engage in active learning discussion with the treating team through asynchronous non intrusive text messages that are also logged and shared for evaluation (illustrative samples available).
Summative assessment would involve testing their ability to do the above in a smaller time frame and it will simulate a single post in their current online learning portfolio. And real formative assessment would also document their regular competencies in individual patient data collection (currently being done by the interns) and not just their competencies in individual patient data analysis.
Our current university PG theory exams have been postponed indefinitely but I don't see any reason why we can't implement the same strategy of summative assessments as mentioned above, which will be a better marker of their competencies and we can include the procedural videos they have themselves performed routinely during their training (as formative assessment).
We have published the earlier version of our case based blended learning ecosystem before and reshare the link here https://www.ncbi.nlm.nih.
We currently also include the discussion of one PG thesis research project in our regular 2-4 PM active learning sessions that are video uploaded and can be found in the link to all our videos shared above.
Here is a tabular summary link of the above rant https://docs.google.com/
Here's the detailed MCI guideline based rationale for the same roster
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