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 below (and earlier as an illustration of evolving research around 'medical cognition') :
2002 Manipal, Pokhara : Contrary to what generalizeable randomized controlled trial data projected, every individual was unique and had unique life trajectories and it was found that medical students were best suited to unearthing these trajectories as documented here: https://www.eubios.info/
Some of these medical students who were now academic faculty, revisited this idea in the last CBBLE paper here: https://www.ncbi.nlm.
2007 Manipal, Melaka : It was gradually becoming clearer that current evidence based medicine needed a more meaningful methodology to answer individual patient requirements here: https://pubmed.ncbi.nlm.
2008: And soon the first conceptual model for current CBBLE was shared here: http://www.ncbi.nlm.nih.
It was called "user driven healthcare" UDHC and described a prevalent phenomenon evolving with the internet and the only difference with the later CBBLE appears to be that the term "blended learning" got added to the same process suggesting that the CBBLE had a strong component of offline connection and locality that was blended to requirements of online users.
The CBBLE idea as a subset of the UDHC phenomenon was to build a Case based reasoning database that could offer any individual, a platform for obtaining comparisons between other individual patients who had similar data patterns and then see if near matches of individual trajectories would offer similar outcome trajectories in those group of patients and this was inspired by a seminal paper on case based reasoning linked here: https://pubmed.ncbi.nlm.
The pursuit of clinical problem solving using online user driven learning was a polymathic pluralistic activity and we derived a lot of lessons from other fields as illustrated in chapters of the UDHC book here
2009 PCMS Bhopal : The model could be scaled to the last mile primary care and act as an efficient bridge between primary and tertiary, individual home, community collaborative center and academic institutions as proposed here: https://pubmed.ncbi.nlm.nih.
2010-2021 (Connecting multiple medical colleges with last mile patients)--
Many such cases started getting logged by last mile workers in various parts of India particularly West Bengal and they were processed by a CBBLE that fed case based problems to a global forum for conversational learning as shared here: https://www.ncbi.nlm.
2008-2014: PCMS, Bhopal
While one of the faculty coordinator for the CBBLE was in the above Medical College location, the actual forum was made by global medical and engineering students and there is more about them in the above article as well as in the UDHC book and journal issues here https://www.igi-
One of the organizers of the conference, Mr Shoubhik Bose created a website for UDHC that is currently archived here :
It displayed a pseudonymisation "Telemedicine" workflow with patient names replaced by botanical names and patients asked to plant their namesakes.
There were issues (weaknesses) in the form of questions such as :
Other than patients and caregivers what are the chances that others with malintent will be able to identify these patients?
These are still important issues that we are trying to grapple with and improve upon daily.
These health records were also multilingual with advice in Bengali (other than English as demonstrated here
The Online links to other currently surviving patient records can be found in the online learning portfolios of the last mile worker users here below:
(The number in the URL reflects the area pin code from where the last mile worker operates).
These last mile workers had begun a new genre of multilingual, deidentified online patient records that were partially structured and managed in most instances to convey individual patient requirements and their work was further shared globally in published case studies linked below:
The paper below is a collated depiction of cases emailed by some of our last mile workers and how their differently structured patient histories were still useful to develop a learning ecosystem between the offline patient and online healthcare learner and helper.
With the steady progress of our last mile workers abilities to create web based logs of patient records, the abilities of the medical students in our learning ecosystem remained at par by translating quite a few, perhaps 50-70 of these online patient records into journal publications accessible here https://pubmed.ncbi.nlm.
2013 one of the activities of a team member who looked after the editorship of BMJ Case reports was to spread the word about case based learning and how every individual patient was an independent research project and below are links to some of the lectures delivered in
Bhopal PCOR 2014: http://www.pitt.edu/~
Bangalore 2015 http://www.pitt.edu/~
Delhi Banga Bhavan 2015 http://www.pitt.edu/~
2014 year saw the inauguration of the BMJ Case reports Elective program (detailed here: https://casereports.bmj.com/
from PCMS Bhopal and hosted initial students from India and France (shared here: http://userdrivenhealthcare.
2015 was particularly important as LNMCH was the first medical college that started funding research assistants who were more conversant with Hindi to take this work forward and below are some of their work in their multilingual online learning portfolios along with their assessments by the faculty coordinator :
RA1: Hindi online patient record
RA2: Link to online patient logs:
RA2: Link to one time assessment:
RA3: Link to one time assessment:
RA4: Link to online patient logs:
RA4: Link to one time assessment:
RA5: Link to online patient logs:
RA5: Link to one time assessment:
2016 saw another shift in base this time to a medical college in West Bengal, Durgapur where a few ideas around patient centered scholarship of integration in Medical education and research were consolidated in the form of the lectures below and shared in various forums such as medical education conferences organized by JIPMER, Pondicherry and "International Society for Evidence-Based Health Care" Kisch island around the same time.
Medical Education Curriculum: How do we change the game? http://www.pitt.edu/~super1/
Generalism in Medical Education: What and Why? http://www.pitt.edu/~super1/
Assessment of Generalist Learning Competency: http://www.pitt.edu/~super1/
Current challenges in Evidence based Medical Education and the way forward :
One of the fall outs of the above consolidated ideas was to action it in the form of a curriculum that would blend seamlessly with existing curricula and this was illustrated at that time here in the form of a "Case-Based-Online-Learning-
The elective learning program was furthered here in this global health case study linked below, by two visiting medical students from UK and it highlights our workflow of sharing "open access patient records with de-identified patient documentation such as doctors’ notes, diagnostic test results and the patient’s perspective" toward improving their outcomes along with students learning outcomes.
The original online patient record blog prepared by our community health worker, that was foundational to the published case study is accessible here: https://ebpc-udhc-
The BMJ Elective student visits continued and some of their videos below depict our current workflow for scholarship of integration in a vivid manner here : https://youtu.be/xvE5b8Xk3vM (presented by our elective students in a medical education conference in AIIMS, Bhuvaneshwar, early 2020)
And here: https://youtu.be/csF8VQbOYRo(presented by our elective student to a medical college in California, early 2021)
Other than a few of our patient centered case studies as Global health case reports linked below :
Middle-aged man who could not afford an angioplasty. BMJ Case Reports CP. 2019 Mar 1;12(3):e227118.https://www.
Traumatic Subdural Hematoma: Integrating Case Based Clinical Judgement with Guidelines:
Other than the BMJ Elective program students who added immense inputs to this 'scholarship of integration' detailed in the institution project log linked above, the pandemic drove newer opportunities to explore online learning with our students that added considerable data to our work around scholarship of integration facilitated by the CBBLE tool as portrayed here :
The pandemic made us take our classes live globally and we regularly connect with our students live during our 10:00 AM to 12:00 PM morning rounds as videoed and archived in the link below where we are presenting our cases to a global audience:
And here's a sample of our regular class videos of case presentation lectures during our 2-4 PM sessions.
Here's a summary video of what we do
We can share recorded sessions in a more structured way rather than the impromptu manner in which it has been filmed but then we need a film maker who will do it for us.
Meanwhile till then our student user driven online learning portfolios that keep getting updated regularly in real time keeps reflecting their competencies that we have showcased in this link here : https://medicinedepartment.blogspot.com/2021/07/?m=0
Above is the background that sets the stage for the description of the current framework for scholarship of integration with a most recent example in the next module.
Please click on the link below to get back to the first layer of the chapter:
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