Wednesday, June 23, 2021

Book chapter : Scholarship of Integration and the future of Medical education and research

Cite as : Scholarship of Integration and the future of Medical Education and Research (MER): Student user driven, patient centered assessments with learning outcomes driving health care outcomes, Ch. In, Adkoli BV and Ray A, Eds, Medical Education Research: Theory, Practice, Publication and Scholarship, Notion Press, Chennai, India, 2021 



This is a personal pre publication draft of a book chapter with the above title by a medical education faculty coordinator with a special interest in making connections between the primary beneficiaries of medical education (patients and medical students).


Dedication :


To our patients and students 


(As this chapter is mostly about them and our efforts to boost and integrate their scholarship). 


Specifically I would like to dedicate it to our current udhc core four students who have performed scholarship of integration with near perfection and would be a shining example of it in the near future. Also specifically our patients in the udhc CBBLE group from rural remote and even urban locales of India and elsewhere globally without whom there wouldn't have been any scholarship of integration in healthcare.



Beginning :


WHAT (is this chapter about)? 


Abstract :


Scholarship of integration in medical education and research makes connections within and between disciplines, locating knowledge in a broader context giving meaning to specific discoveries. More here : https://medicinedepartment.blogspot.com/2021/06/abstract-for-book-chapter-on.html?m=1
Other than WHAT it is and WHY it is an important tool this chapter describes HOW scholarship of integration in medical education and research practice has been operational in some medical colleges in India through patient centered, student driven connections that address their individual learning requirements toward better health care outcomes. 

Key Words (3-7)

Scholarship; integration ; patient centered learning; medical education, medical practice, research, connections


Promotional event for "Scholarship of Integration in Medical education and research organized in April 2021:


medicinedepartment.blogspot.com/2021/07/scholarship-of-integration-in-medical.html?m=0



Introduction 

Assess need :

WHO are the intended audience for this chapter? 

All beneficiaries of Medical education including the primary beneficiary aka patients or careseekers as well as caregivers ranging from medical students, their teachers and practicing physicians as well as medical education and practice researchers and administrators. More here on an expanded definition of medical students (that connects all beings) here : http://consciousnotebooksequel.blogspot.com/2014/?m=0 and in a past lecture here :http://www.pitt.edu/~super1/lecture/lec50421/002.htm

(WHAT issues does this chapter address)? 

Medical education research is a tool to eventually improve patient outcomes as patient is the ultimate beneficiary of Medical education and this chapter will again not only address this vital 'scholarship of integration' information gap but become instrumental in driving positive change in this direction. More here :

Brief :

Scholarship of integration in Medical education and research : what it is and what it isnt:

Before we describe scholarship of integration we need to address what is scholarship and highlight it's primordial evolution to what appears unique to the human species as a mode of asynchronous learning and sharing. More here :

https://medicinedepartment.blogspot.com/2021/06/introduction-to-evolution-of-human.html?m=1

Scholarship of integration makes the vital connections necessary to grow scholarship from it's roots to its terminal branches trying to touch the sky. 

More here: medicinedepartment.blogspot.com/2021/06/brief-scholarship-of-integration-in.html?m=1



CONTEXTUALIZE


WHY (the need to connect different ways of knowing and doing in healthcare)? 

To put the current disintegration of Medical education and practice into context, we need to first understand individual patient requirements and societal requirements to gain further insights into medical practice and how it can be integrated with medical education. 


We share below an illustrative example from one of our online expert patients that we have published before here: https://pubmed.ncbi.nlm.nih.gov/19018905/


(Medical Practice) Connecting to individual patient requirements through empathic narrative : 

More here: https://medicinedepartment.blogspot.com/2021/06/part-1-contextualizing-need-for.html?m=1


Individual integration of different roads to healing :

The above expert patient has subsequently published another paper with our team members where she elaborated on her cure and the integration of multidisciplinary interventions that was brought about to effect it. She subsequently utilized the power of online integration to provide a voice to similar stories from many patients around the world. 

More here: 

https://medicinedepartment.blogspot.com/2021/06/individual-integration-of-different.html?m=1

Failed political integration attempts at different roads to healing in US :

More here :

https://medicinedepartment.blogspot.com/2021/06/failed-political-integration-attempts.html?m=1

Pandemic driven acceleration of scholarship of integration between different ways of knowing and doing in healthcare:


The current chaos in modern medical healthcare reflects a failure of evidence based medical education and research directed at the end beneficiary of Medical education, that is the patient and the time is ripe for scholarship of integration to develop the optimal adaptive systems framework for it. 

Quoting verbatim from a recent essay in Lancet global health particularly focused on India although very relevant globally,


"Academic institutions and professional medical societies should reflect on their roles. A range of recommendations and treatment algorithms from norm-defining medical institutions and societies are circulating on social media. These institutions are notable by their failure to share the evidence that informs these recommendations, discuss nuances of implementation, or present conflicts of interests of those involved in developing these recommendations."



National Medical Integration and the role of scholarship of integration in Medical education and research:

Hundred years ago, independent research in Ayurveda on scientific lines was planned with the establishment of the "Jatiya Ayurbigyan Vidyalaya" in 1921, (also known as Calcutta National Medical College) founded as a product of the Non-cooperation movement and was inaugurated by Subhas Chandra Bose. Calcutta National Medical College was nationalized in 1967 and was perhaps the first private medical college in India to be nationalized.

Hundred years later there is a pandemic driven resurgence toward another attempt at integration and scholarship of integration in medical education and research can go a long way to connect these different ways of knowing and doing healthcare through a patient centered framework that is described below.

DESCRIBE 

HOW (is scholarship of integration, a framework for transparent and accountable healthcare and education)? 


The problem statement for this chapter as also mentioned above in the introduction is the current "disintegration of Medical education with practice" and the tool that it aims to resolve the problem with is scholarship of integration in Medical education and research. 

The chapter will now proceed to describe how this can be done  through a current working prototype of student user driven, patient centered assessments of learning outcomes driving health care outcomes and also provide a historical overview of how this developed in different Indian Medical colleges through a faculty coordinator and his students and patients. 

Evolution of a model for patient centered, scholarship of integration in Medical education and research 


The participatory case based blended learning ecosystem CBBLE framework that is a model for a patient centered, scholarship of integration in Medical education, has been actively evolving since a few decades in different medical colleges in India and has been described in detailed timeline in the link below :

Working prototype of a scholarly integration of medical education and research framework


The working prototype shared here is a minimalistic, user driven learning framework that enriches pre existing curricular and assessment infrastructures instead of dramatically attempting to change it but aims at effecting a slow transformation.


Student user driven, patient centred assessment prototype

In this module our readers can see how the patient data captured in the previous module was utilized in a monthly summative assessment test for the same batch of students to test their competencies in patient care related to clinical problem solving through empathic patient data capture and continuity of communication. 

More here: https://medicinedepartment.blogspot.com/2021/06/student-user-driven-patient-centred.html?m=1

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



The definition of competency for a medical student health professional is: “habitual, consistent and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflections in daily practice for the benefit of the individual being served” More here : https://medicinedepartment.blogspot.com/2021/06/gradual-integration-of-traditional-with.html?m=1

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


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

Peer to peer review/assessment of Online assignments in E logged learning portfolios


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

Evidence based medical assessments drive student learning outcomes


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

Making connections between different ways of knowing and doing :

In the above framework of what is just one stream of healthcare delivery among other delivery frameworks, we cite below a patient centered example of another closely related healthcare delivery framework that the British subjugated 200 years back. More here : medicinedepartment.blogspot.com/2021/06/making-connections-between-different.html?m=1

Above was a description of HOW scholarship of integration in medical education and research practice has been operational in some medical colleges in India through patient and student centred connections between their individual learning requirements toward better health care outcomes. 

Now we shall proceed to engage our readers to EVALUATE the above described process, again through a patient centered medical education lens and describe the ROAD ahead. 


EVALUATE



So WHAT? 

(S)trengths: Promising solution to current felt need that can bridge gaps in healthcare learning competencies as well as address patient outcome complexities.


(W)eaknesses: Quasi-experimental and complex study design and consequent potential of study sample selection bias. (Workarounds: ensure transparent and accountable online documentation of entire process that is naturally subject to external peer review in real time)


(O)pportunities: Potential to scale into a sustainable model of practice based learning toward improving patient outcomes.


(T)hreats: Participant motivation leading to study attrition, patient privacy and confidentiality (Workarounds: regular motivational meets with participants of both groups with real-time transparent documentation of the interaction that transpires between all the stakeholders)


This section is meant to encourage the readers to reflect and self-evaluate their learning at the end of the chapter. The following assignments may help in this process:


The essential premise behind scholarship of integration in Medical education and research as portrayed in this chapter has been around making connections between patients, medical students (who in the expanded definition of life long learners are aka practicing doctors as well as faculty) More here : http://consciousnotebooksequel.blogspot.com/2014/?m=0

.

What is the first step toward developing competency in making connections? In the medical student driven real example of connecting to patients what were the necessary competencies that came from medical  training than from upbringing? 

The next driver toward making connections in scaling  scholarship of integration is an often neglected tool aka peer review/assessment. Traditionally assessments have always been between a higher authority aka teacher assessing a lower powered student while in the real world humans assess each other all the time and all humans thrive on feedback.  

Here:

https://medicinedepartment.blogspot.com/2021/06/medicine-department-paper-for-june-2021.html?m=1

is the Medicine assessment  online assignment for June 2021 that aims to evaluate the examinees aptitude for 


a) scholarship, which is reflected in their ability to read comprehend, analyze, reflect upon and discuss captured patient centered data as in their 'original' answers to the assignment for May 2021. 

b) scholarship of integration, which is reflected in 

1) their ability to connect with and capture patient centered data (as already demonstrated by many of the 2019, 2017, 2016 batch students who have captured it in their E logs as a part of their formative assessment) 

2) their ability to connect with and engage in shared learning with their peers through peer review feedback. 

Here is a link to an answer by one of the 2019 batch students : 


Can regular student driven peer review/assessment of patient centered learning in medical students create the much needed change in not just  improving scholarship in individual students and faculty but improve overall collective learning outcomes as well as health care outcomes? 

Roadmap :

Scholarship of integration is a movement that will grow organically and is also as old as civilization only it has been currently augmented by technology that facilitates human connections and scholarship through improved asynchronous communication. More here : https://medicinedepartment.blogspot.com/2021/06/introduction-to-evolution-of-human.html?m=1 and here : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1891293/#!po=75.3968


One of the amazing transformations that we can look forward to in the near future is tremendous improvement in "individual patient data" based reasoning systems that will give new meaning to precision medicine, which shall make the process of healthcare cognition accessible, transparent and accountable to larger populations. Considerable headway is happening in this direction detailed in this paper where  in addition to the "traditional differentiation between implicit and explicit knowledge, it outlines the concepts of general and individual knowledge and connects general knowledge with the "frame problem," a fundamental issue of artificial intelligence, as well as  individual knowledge with another important paradigm of *artificial intelligence*, case-based reasoning, a method of individual knowledge processing that aims at solving new problems based on the solutions to similar past problems." More here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC544898/

This will all begin with the simple step as described in the chapter, of making the first connection between a life long medical student and patient, toward empathic data capture and representation in a shared database and as soon as an individual patient data is shared, the data is matched with similar past patients illness trajectories and triangulated toward an optimal diagnostic and therapeutic plan for the current patient data shared.

This plan for every individual patient may not remain restricted to a single stream of medicine but will be able to effortlessly integrate different ways of knowing and doing medicine. 








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