Sunday, September 26, 2021

September 2021 weekly log and outcomes of regular patient centered learning sessions

This is a regular academic session log for the post graduate residency training program comprising currently of residents of 2019 and 2020 batch. The training program comprises of a regular hands on learning of clinical decision making during the bedside rounds from 10 AM to 1:00 PM as well as 2-4 sessions officially divided daily into:


Theory on Monday, 

Seminar on Tuesday, 

Journal club on Wednesday, 

Tutorial on Thursday 

Group discussion on Friday 

Log Book audit on Saturday 

These are blended learning sessions with both online and offline components and while the offline learning timings are as mentioned above, the online component of the learning continues 24x7.

These have been instituted by the department of Medicine as part of a minimum standard paper based requirement carried out in our other accredited medical colleges as per a standard paper based format below :




2nd SEPTEMBER 2021
Thursday

                                                          

TUTORIALS :



TOPIC: DRUG INDUCED LIVER FAILURE

 

CONTEXT : A PATIENT OF LIVER FAILURE AFTER CONSUMPTION OF TINOSPORA CRISPA MISTAKEN FOR TINOSPORA CORDIFOLIA


TOPIC: POLYGLANDULAR AUTOIMMUNE SYNDROMES PGA


CONTEXT: A PATIENT OF DOWNS SYNDROME WITH PGA TYPE 2

Elogged case report link : http://mahithguduri63.blogspot.com/2021/09/downs-syndrome-with-autoimmune.html



BY:

 DR.A VAISHNAVI PGY3

DR.SWETHA UG 9TH SEM




ATTENDED BY: 

DR.PRADEEP PGY2

DR.VAMSHI PGY2

DR.MANASA PGY2

DR.SHASHI KALA PGY2

DR.ZAIN PGY3

DR.AJITH PGY3

DR.AASHITHA PGY3

DR.SUSHMITHA PGY3

DR.USHA SREE PGY3

DR.RASHMITHA PGY3





3RD SEPTEMBER 2021

Friday

                                   

GROUP DISCUSSION


TOPIC: CEREBRAL METASTASIS

CONTEXT: 

A) 45 YEAR OLD woman WITH ALTERED SENSORIUM AND past cervical cancer and MRI STUDY showing cerebral metastasis.


Elogged case report link : https://madamsneha74.blogspot.com/2021/09/gen-medicine-case-study.html?m=1



BY: 

DR.SHASHI KALA PGY2

DR. NEHA 9TH SEM

DR.MANOGYNA 9TH SEM 




ATTENDED BY: 

DR.PRADEEP PGY2

DR.VAMSHI PGY2

DR.MANASA PGY2

DR.SHASHI KALA PGY2

DR.ZAIN PGY3

DR.AJITH PGY3

SHI KALA PGY2

DR.ZAIN PGY3

DR



4TH SEPTEMBER 2021    

Saturday        


LOG BOOK AUDIT :


As mentioned and demonstrated in the links below each student's online portfolio is divided into non verbal procedural and verbal competency logs:


https://generalmedicinedepartment.blogspot.com/2021/07/department-of-general-medicine_5.html?m=1


https://generalmedicinedepartment.blogspot.com/2021/07/department-of-general-medicine_5.html?m=1

Number of PG students 20 Number of logbooks evaluated 2


Student 1: Dr Raveen PGY1:


https://raveen07.blogspot.com/?m=1


Logbook update : last in June 16, 2021 as an answer to the May 2021 online assignment for the monthly summative test. 


Learning Competency assessment from the summative test : 


the answers to the questions in the online question paper assesses the examinee's competencies in empathically dealing with:

Clinical problem solving 

Medical terminologies familiarity including areas of anatomy, physiology, pathology 

Current EBM strategies for managing diagnostic and therapeutic uncertainty. More here : https://medicinedepartment.blogspot.com/2021/05/online-blended-bimonthly-assignment.html?m=0



Other competencies undocumented by the PG. No assessible link to current workflow showing procedural or case presentation videos as well as verbal report of daily case based workflow. 


Impact : Negligible and below expectations in terms of logged workflow. 

However, the PG has unlogged competencies demonstrated during work in the form of working longer hours with discipline but tends to avoid academics. 


Student 2: Dr Zain PGY2


https://zainalammohammed59.blogspot.com/?m=1


Logbook update : last in September 8 2020

as an answer to the Sept 2020 online assignment for the monthly summative test. 


Learning competency assessment areas:

Clinical problem solving 

Medical terminologies familiarity including areas of anatomy, physiology, pathology 

Current EBM strategies for managing diagnostic and therapeutic uncertainty


Other competencies undocumented by the PG. No assessible link to current workflow showing procedural or case presentation videos as well as verbal report of daily case based workflow. 


Impact : Negligible and below expectations in terms of logged workflow. 

However, the PG has unlogged competencies demonstrated during work in the form of patient empathy, resource generation and utilization to meet patient requirements and this has had palpable impact on our learning ecosystem. 


Log Book audit summary:

Logbooks completed : nil Last update months back.


Logged learning points : nil


Logged learning impact: nil Reasons : Disinterest, apathy, lack of scholarship of integration?


These have been instituted by the department of Medicine as part of a minimum standard paper based requirement carried out in our other accredited medical colleges as per a standard paper based format below 






5TH SEPTEMBER 2021             

SUNDAY

Online emergency patient discussions




6TH SEPTEMBER 2021


MONDAY    

                                     

THEORY CLASS   


TOPIC: APPROACH TO DYSPNOEA


PULMONARY EMBOLISM DIAGNOSIS AND MANAGEMENT


CONTEXT : ELOG LINKS,


https://gtejaswini61.blogspot.com/2021/09/a-53-yrs-old-male-patient-with-sob.html


http://nehareddygaddam.blogspot.com/2021/09/65yr-old-male-with-sweating-and.html


Presented by :


Dr Karnati Vaishnavi

Dr Rashmita

Dr Raghav

Dr Soumya


Attended by :


PGs and 2017 UGs




7TH SEPTEMBER 2021


TUESDAY                                                    SEMINAR


Hypertensive intracranial hemorrhage 

Intensive monitoring and therapeutic outcomes

CONTEXT: https://mounikakethavath.blogspot.com/2021/09/case-of-60m-cva-with-right-sided.html?m=1



8TH SEPTEMBER 2021     

Wednesday                      

Journal club



CONTEXT:  DIAGNOSTIC UNCERTAINITY IN ADDISON'S DISEASE


ELOGGED case report LINK: Down's with Addison's :http://mahithguduri63.blogspot.com/2021/09/downs-syndrome-with-autoimmune.html


REVIEW OF LITERATURE around:


Accuracy of the Low-Dose ACTH Stimulation Test for Adrenal Insufficiency Diagnosis:

ONLY 4 OUT OF 36 PATIENTS WERE CLINICALLY TRUE POSITIVE FOR ADDISONS ALTHOUGH 36 TESTED POSITIVE WITH ACTH THAT IS SHOWED IN LOW CORTISOL RESPONSE 


LINK : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616948/



ATTENDED BY:  

DR.A.VAISHNAVI PGY3

DR.USHA SREE PGY3

DR.RASHMITHA PGY3

DR.MANASA PGY2

DR.SHASHI KALA PGY2


9th September 

Thursday 

Tutorial 


Approach to diagnostic uncertainty around non cardiogenic and cardiogenic pulmonary edema 


Context: Patient of cardiogenic pulmonary edema who was possibly treated as a non cardiogenic pulmonary edema as covid pneumonia with remdesivir based  only on radiology assessments. 

More here in the student logged case report: https://jahnavichatla.blogspot.com/2021/09/post-covid-respiratory-failure-dka.html


10th September 
Friday 
Group discussion online 
Holiday for Vinayak Chavithi

Topic : Non convulsive status 


Review of literature :

Which EEG patterns in coma are nonconvulsive status epilepticus?



11TH SEPTEMBER 2021

SATURDAY                                               


LOG BOOK Audit


Number of PG students 20 Number of logbooks evaluated 2


Student 1: Dr Shailesh PGY2


Logbook update : last in March 30, 2021


Logged learning Competency assessment : Incomplete case data capture analysis and follow up. No discussion 


Learning Impact : Negligible 




Student 2: Dr Karnati Vaishnavi


Logbook update : last in September 11, 2021


Logged learning Competency assessment :


Good case data capture, presentation and analysis skills although follow up notes absent. 


Learning Impact: Good impact on the local learning ecosystem. Has potential for scholarship of integration. 




12TH SEPTEMBER 2021    

SUNDAY 


13TH SEPTEMBER 2021

2:00-4:00                               

THEORY CLASS


TOPIC: APPROACH TO COMA


Context:

https://karnativaishnavi.blogspot.com/2021/08/altered-sensorium.html?m=1


PRESENTED BY :

DR.AASHITHA PGY3

DR.SHASHIKALA PGY2

Dr Karnati Vaishnavi


ATTENDED BY: 

DR.USHA SREE PGY3

DR.MANASA PGY2

DR.SHASHI KALA PGY2

DR.ZAIN PGY3

DR.AASHITHA PGY3

DR.SUSHMITHA PGY3



14TH SEPTEMBER 2021 

TUESDAY                                                      SEMINAR


TOPIC: 

ADVANCED THYROID CANCER 

DIAGNOSTIC AND therapeutic UNCERTAINITIES


CONTEXT : https://decodemed.blogspot.com/2021/09/this-is-online-e-logbook-to-discuss-our_12.html


PRESENTED BY: DR A.VAISHNAVI PGY3


ATTENDED BY:

DR.PRADEEP PGY2

DR.MANASA PGY2

DR.SHASHI KALA PGY2

DR.AASHITHA PGY3

DR.K VAISHNAVI PGY3

DR.USHA SREE PGY3



15TH SEPTEMBER 2021

WEDNESDAY                                          JOURNAL CLUB


TOPIC:

CRITICAL ILLNESS POLYNEUROPATHY AND MYOPATHY: A SYSTEMIC REVIEW

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146320/



PRESENTED BY : DR. AASHITHA PGY3


ATTENDED BY :

DR.PRADEEP PGY2

DR.SHASHI KALA PGY2

DR.ZAIN PGY3

DR.AJITH PGY3

DR.AASHITHA PGY3

DR.SUSHMITHA PGY3

DR.USHA SREE PGY3

DR.RASHMITHA PGY3



16TH SEPTEMBER 2021

THURSDAY                                  

TUTORIALS


TOPICs:


Stroke:


Context : POST STROKE ALTERED SENSORIUM



Pancytopenia


Context:


ACUTE DRUG INDUCED PANCYTOPENIA AND HYPONATREMIA (PANTOPRAZOLE)


PRESENTED BY : 

DR.RASHMITHA PGY3

DR.SUSMITHA PGY3


ATTENDED BY:

DR.MANASA PGY2

DR.SHASHI KALA PGY2

DR.AJITH PGY3

DR.SUSHMITHA PGY3

DR.USHA SREE PGY3

DR.RASHMITHA PGY3


17TH SEPTEMBER

FRIDAY                                 

GROUP DISCUSSION


TOPIC: CEREBRAL LOBAR FUNCTION TESTING IN STROKE WITH HIGHER MENTAL FUNCTION ABNORMALITIES


TOXIC ADENOMA DIAGNOSIS AND MANAGEMENT


APPROACH TO EVALUATION OF HEART FAILURE 


PRESENTED BY:

DR.SHASHI KALA PGY2

DR.USHA SREE PGY3

DR.AASHITHA PGY3


ATTENDED BY:

DR.MANASA PGY2

DR.SHASHI KALA PGY2

DR.ZAIN PGY3

DR.AJITH PGY3

DR.AASHITHA PGY3

DR.SUSHMITHA PGY3

DR.USHA SREE PGY3

DR.RASHMITHA PGY3 



18TH SEPTEMBER 2021

SATURDAY                        

LOG BOOK


19TH SEPTEMBER 2021

SUNDAY


20TH SEPTEMBER 2021

MONDAY                          

THEORY CLASSES


Approach to quadriparesis and myelopathy 

Context: 


http://prakashgowtham65.blogspot.com/2021/09/a-65-year-old-male-with-compressive.html

21ST SEPTEMBER 2021

TUESDAY                            

CLINICAL SEMINAR


TOPIC: NECROSITING PANCREATITIS : DIAGNOSTIC AND THERAPEUTIC OUTCOMES


BY:

DR.DURGA KRISHNA PGY2

DR.AJITH PGY3


ATTENDED BY:  

DR.SHASHI KALA PGY2

DR.ZAIN PGY3

DR.SUSHMITHA PGY3

DR.A VAISHNAVI PGY3

DR.USHA SREE PGY3


22ND SEPTEMBER 2021

WEDNESDAY :                  

JOURNAL CLUB

 

TOPIC :

OCTREOTIDE EFFICACY IN PANCREATITIS

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1727562/pdf/v045p00097.pdf


PICO format :


(P) Total patients (n=302) 


Treatment groups:


(I)ntervention: Octreotide


O1 (n=98);  O2 (n=101) ;


Comparator:


Placebo (n=103) ;


(O)utcomes:


Death (Total) 43 (14%) ;


Death outcomes compared in the three groups :


(P)16 (16%); (O1)15 (15%) ;(O2) 12 (12%)


BY: 

DR.AJITH PGY3

DR.DURGA KRISHNA PGY2


ATTENDED BY:

DR.SHASHI KALA PGY2

DR.AJITH PGY3

DR.SUSHMITHA PGY3

DR.USHA SREE PGY3

DR.RASHMITHA PGY3


23rd Thursday

Tutorial :


Approach to lowbackache and polyarthritis


Context : link?


Learning outcomes were translated to patient outcomes as a clinical decision to obtain brucella serology was made based on the tutorial discussion


Approach to refractory hypertension


Context:


Current:

http://keerthykasa80.blogspot.com/2021/09/a-35-year-old-female-with-hypertensive.html


Past: http://globaludhc07.blogspot.com/2015/12/a-50-years-old-woman-with.html?m=1


Review:

Diagnosis and treatment outcome in primary aldosteronism based on a retrospective analysis of 187 cases



Presenter :

A Vaishnavi PGY2


Learning outcomes were translated to patient outcomes as a clinical decision to add spironolactone was made based on the tutorial discussion


24th Friday

Group discussion


Topic : Myxedema coma with hypotension, pericardial tamponade, thyroxine and adrenergic pathways.


Context : http://mahithguduri63.blogspot.com/2021/09/myxedema-coma.html


Presenter : Ajit PGY2


Outcome:


Learning outcomes were translated to patient outcomes as a clinical decision to do emergency pericardiocentesis was made based on the group discussion

25th Saturday


Log Book audit



26th Sunday 


27th Monday


Theory class


Topic:  Pancreatitis 

E Log link to patient context :

http://prakashgowtham65.blogspot.com/2021/09/50-year-old-male-with-chronic.html



28th Tuesday


BDS UG university exams and Flood holiday


29th Wednesday

Journal club


Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778526/


Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial:


Conventional anticoagulant treatment for acute deep vein thrombosis (DVT) effectively prevents thrombus extension and recurrence, but does not dissolve the clot, and many patients develop post-thrombotic syndrome (PTS). We aimed to examine whether additional treatment with catheter-directed thrombolysis (CDT) using alteplase reduced development of PTS.


P - 209 patients were randomly assigned to treatment groups (108 control, 101 CDT). Patients aged 18–75 years with a first-time iliofemoral DVT were included within 21 days from symptom onset.


I - CDT vs Conventional anticoagulantion.


O- At 24 months, 37 (41·1%, 95% CI 31·5–51·4) patients allocated additional CDT presented with PTS compared with 55 (55·6%, 95% CI 45·7–65·0) in the control group (p=0·047). The difference in PTS corresponds to an absolute risk reduction of 14·4% (95% CI 0·2–27·9), and the number needed to treat was 7 (95% CI 4–502). Iliofemoral patency after 6 months was reported in 58 patients (65·9%, 95% CI 55·5–75·0) on CDT versus 45 (47·4%, 37·6–57·3) on control (p=0·012). 20 bleeding complications related to CDT included three major and five clinically relevant bleeds.


https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61753-4/fulltext.



Context: 13 Year old girl with extensive iliofemoral thrombosis and suspected pulmonary infarction referred to KHL for catheter directed thrombolysis


30th Thursday :


Tutorial


Transfusion associated graft versus host disease


Context:


A young man with dengue thrombocytopenia refused platelet transfusion by the blood bank as his sister (first degree relative) was the only available donor.


Readings:


Malladi SV, Paul R, Chandra N, Rao NM, Raju SY. TA-GVHD, a Fatal Complication Following Blood Transfusion from a First-Degree Relative. J Obstet Gynaecol India. 2013 Oct;63(5):344-6. doi: 10.1007/s13224-012-0189-x. Epub 2012 Oct 3. PMID: 24431673; PMCID: PMC3798441.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3798441/


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