This is a regular academic session impact assessment 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.
The overall impact of each learning session is assessed under two main headings as impact on the student and impact on patient.
The detailed headings are :
Impact :
On learning ecosystem :
Cognitive competency levels touched in different levels of Blooms taxonomy BT (more here : https://sites.pitt.edu/~
Approach to disease localization (BT level 1 -3)
Resolving initial diagnostic uncertainty (BT level 1-4)
Therapeutic decision making toward evaluating patient requirements and outcome (BT level 1-5)
Developing and testing innovative diagnostic and therapeutic solutions ( BT level 1-6)
On patient care outcomes :
Was empathic trust built with patient and relatives?
Were the patient requirements identified adequately and a proper problem list made toward assessment?
Was standard of care provided with provision for care continuity ?
1st November
Monday
Theory
Cerebral venous thrombosis
Polycystic ovarian syndrome
Presentation video:
Presenter Dr Chandana
Dr Sai Govind
Attendees Other PGs and UGs
Impact :
On learning ecosystem :
Cognitive competency levels touched (BT level 1-4) :
Approach to CNS localization
Resolving initial diagnostic uncertainty
Therapeutic decision making
On patient care outcomes (achieved with BT level 1-4) :
Empathic trust built with patient and relatives
Standard of care provided with provision for care continuity
Window of opportunity (needs BT level 1-6): Needs better innovative solutions for her current problems.
2nd November 2021
Tuesday
clinical seminar 2-4 PM
Presenter Dr Zain
Dr Pavan
Vibha
Coronary artery disease, heart failure and unstable angina, sudden death
Presentation video
Attended by Other PGs and UGs
Impact :
On learning ecosystem :
Cognitive competency levels touched :
Approach to cardiac failure in terms of understanding symptomatology, clinical and investigational findings
(BT level 1-4)
On patient care outcomes (through BT level 1-4) :
Standard of care provided but condition worsened and mortality was the patient outcome
Window to future: better innovative solutions in terms of diagnostic monitoring and prediction tools as well as better therapeutic effectiveness of newer interventions.
3rd November 2021
Wednesday
Journal club 2-4 PM
Obstructive sleep apnoea non CPAP therapeutic options :
Presenter Dr Chandana
Attended by Other PGs and UGs
Impact :
On learning ecosystem (achieved BT level 1-4)
:
Enhanced knowledge of clinical diagnosis and available therapeutic interventions for obstructive sleep apnoea
On patient care outcomes (through BT 1-4) :
Empathic trust built with patient and relatives
Standard of care provided with provision for care continuity
4th November 2021
Thursday
Tutorial 2-4 PM
Deepavali
5th November 2021
Friday
Group discussion 2-4 PM
Periodic fever, seizures and glomerular injury
Review of literature :
Attended by Other PGs and UGs
Impact :
On learning ecosystem ( achieved BT level 1-4) :
Enhanced knowledge of clinical diagnosis and available therapeutic interventions for "periodic fever"
On patient care outcomes (using BT level 1-4) :
Offered the above learning points to the patient and his relatives and made them aware that their rare disease has been described before (initially globally in 1987) and available solutions identified although in terms of therapeutic outcomes not much was achieved except reducing overinvestigations and overtreatment of an hitherto unknown PUO.
6th November 2021
Saturday
Log Book evaluation :
All UG and PG log books are available here : https://medicinedepartment.
Dr Ajit PGY1 :
Logbook accessible here : https://ajithkumar9600.
Impact :
On learning ecosystem :
Cognitive competency levels touched in different levels of Blooms taxonomy BT (more here : https://sites.pitt.edu/~
Approach to disease localization (BT level 1 -3)
Resolving initial diagnostic uncertainty (BT level 1-4)
Therapeutic decision making toward evaluating patient requirements and outcome (BT level 1-5)
Developing and testing innovative diagnostic and therapeutic solutions ( BT level 1-6)
On patient care outcomes :
Was empathic trust built with patient and relatives?
Were the patient requirements identified adequately and a proper problem list made toward assessment?
Was standard of care provided with provision for care continuity ?
Short summary of competencies attained till now :
BT level 1-4
Specific comments :
Selective in workflow situations and chooses to limit his talents to procedures. Needs to improve on his fast reading, comprehension and writing skills to create better impact on the UGs and co PGs
Dr Zain :
Logbook accessible here : https://youtube.com/channel/
Impact :
On learning ecosystem :
Cognitive competency levels touched in different levels of Blooms taxonomy BT (more here : https://sites.pitt.edu/~
Approach to disease localization (BT level 1 -3)
Resolving initial diagnostic uncertainty (BT level 1-4)
Therapeutic decision making toward evaluating patient requirements and outcome (BT level 1-5)
Developing and testing innovative diagnostic and therapeutic solutions ( BT level 1-6)
On patient care outcomes :
Was empathic trust built with patient and relatives?
Were the patient requirements identified adequately and a proper problem list made toward assessment?
Was standard of care provided with provision for care continuity ?
Short summary of competencies attained till now :
BT level 1-4
Specific comments :
Able to establish good rapport with patients and obtain follow up although chooses to limit it to few occasions.
Needs to improve on his fast reading, comprehension and writing skills to create better impact on the UGs and co PGs
8th November
Monday
Theory :
Rheumatoid arthritis
Weils disease
Cardiac tamponade
Chronic Peritonitis
Context : http://gm-elogbook-anudeep-
Presentation video:
Presenters
Dr Zain
Ramya Tulsi Tejasree
Sharanya
Prashant
Attendees Other PGs and UGs
Impact :
On learning ecosystem :
Cognitive competency levels touched :
Approach to clinical localization of disease pathology
On patient care outcomes :
Empathic trust built with patient and relatives
Standard of care provided with provision for care continuity
One patient of hypotension with Weils disease died while the other with hypotension due to cardiac tamponade survived after pericardiocentesis.
Window of opportunity : Need blooms taxonomy level 6 discussion to develop better innovative solutions among the students but it's not happening anytime soon.
9th November 2021
Tuesday
clinical seminar 2-4 PM
Differentiating spondyloarthropathy with peripheral arthritis from Rheumatoid arthritis
Presenter
Dr Rashmita
Context :
27F
28F
Presentation video
Attended by Other PGs and UGs
Impact :
On learning ecosystem :
Cognitive competency levels touched :
Approach to polyarthritis in terms of understanding symptomatology, clinical and investigational findings
On patient care outcomes :
Standard of care provided but difficult to meet patient requirements
Window to future: better innovative solutions in terms of better therapeutic effectiveness
10th November 2021
Wednesday
Journal club 2-4 PM
Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction .
RCT - placebo control trial .
P- Total 4744 patients with HFref .
2373- Dapagliflozin 10mg od .
2371 - placebo
I- Dapagliflozin vs placebo
C- Placebo
O - The primary outcome was a composite of worsening heart failure (hospitalization or an urgent visit resulting in intravenous therapy for heart failure) or cardiovascular death.
1) 237 - In dapaglifozin grp had worsening heart failure and 227- Died.
2) 326- placebo had worsening HF
273- DIED .
CONCLUSION :
Among patients with heart failure and a reduced ejection fraction, the risk of worsening heart failure or death from cardiovascular causes was lower among those who received dapagliflozin than among those who received placebo, regardless of the presence or absence of diabetes.
But pts who were included , dapagliflozon had more patients with NYHA class 2 and placebo had more pts with NYHA class 3,4 HF . Which can explain frequent hospital admissions in them .
Presenter Dr KV
Context : A patient without diabetes started on dapagliflozin --- Link : http://pawanbhasin.blogspot.
Attended by Other PGs and UGs
Impact :
On learning ecosystem :
Newer therapeutic trials awareness
On patient care outcomes :
Was more confident of stopping the intervention after ascertaining it's non clinical significance after critical appraisal of the journal article.
11th November 2021
Friday
Group discussion 2-4 PM
Rheumatic fever diagnostic uncertainty and overinvestigations after referral
Headache and migraine
Context: Long distance referrals for diagnostic and therapeutic uncertainty
Attended by Other PGs and UGs
Impact :
On learning ecosystem :
History taking and patient education demo in action
On patient care outcomes :
Patient education and continuation of beneficial care
12th November 2021
Saturday
Log Book evaluation :
Interns 2015 residual batch of thirty on trial to finalize their internship completion on the basis of their apparent learning competencies attained at the end of their internship.
Their logs are accessible here :
13th November 2021
Sunday
14th November 2021
Sunday
15th November 2021
Monday
Theory
Potts spine
Presented by
Dr Nikita
Context :
39 M
30 M
Tuesday
Clinical seminar
November 16, 2021
Clinical seminar
Management of seizures
Presenter
Dr Raveen
Dr Kalyan
Wednesday
November 17 2021
Journal club
In this context: http://elogformedicalcase.
And a typical journal club RCT article with ridiculous efficacy such as this one
Second Article and context :
50 patients presenting to the hospital with peritonitis.
39 of them had typical infectious peritonitis, and their mean peritoneal fluid amylase level was 11.1 (range, 0 to 90).
6 patients had pancreatitis and a mean peritoneal fluid amylase level of 550 U/L (range, 100 to 1,140 U/L).
5 patients were found to have other intra-abdominal pathology, and their mean peritoneal fluid amylase level was 816 U/L (range, 142 to 1,746 U/L).
Context :
November 18, 2021
Thursday :
Tutorial : CNS localization
Presenter : Dr A Vaishnavi, Dr Zain, Dr Raveen and
Dr Bhavani
November 19, 2021
Friday
Group discussion:
Context : PUO in a male diabetic with loin pain and lower urinary tract symptoms of urgency and burning
Presenters : Dr Vaishnavi, Dr Nikita, Dr Pooja (intern) and Dr (Soujanya 2017)
Impact :
On learning ecosystem :
Cognitive competency levels touched :
Approach to clinical localization of disease pathology was done reasonably well and differential diagnostic hypothesis formulated in the face of high diagnostic and therapeutic uncertainty
On patient care outcomes :
Empathic trust built with patient and relatives
Standard of care provided with provision for care continuity
Challenges met/not met :
Fever monitoring and post admission illness timeline was well supervised.
Imaging and labs for further clinical localization of the PUO was driven by the discussion
Multiple therapeutic interventions were made for the differentials in the face of diagnostic uncertainty further driven by ongoing patient suffering and an attempt to gather the "medical cognition" learning points made here :
November 20, 2021
Saturday
Log Book assessment: Dr AV, Dr Nikita
Context : An elderly patient with severe anemia, hypotension, severe metabolic acidosis, encephalopathy and recent fracture femur
Case report link :
Impact :
On learning ecosystem :
Cognitive competency levels touched :
Approach to clinical localization of disease pathology was done reasonably well and differential diagnostic hypothesis formulated
On patient care outcomes :
Empathic trust built with patient and relatives
Standard of care provided with provision for care continuity
Challenges met/not met : managing diagnostic arranging of repeating hemoglobin levels, repeat imaging to assess hematoma, continuing dialysis, reviewing the literature around giving bicarbonate in high anion gap metabolic acidosis and an attempt to gather the "medical cognition" learning points made here :
Theory on Monday, 22nd -
Alcoholic DCMP with HFrEF
Ataxic gait
Video link
Seminar on Tuesday, 23rd
Topic- Infective endocarditis
Video link
Journal club on Wednesday, 24th
Liu H, Qiao L, He Z. Wernekink commissure syndrome: a rare midbrain syndrome. Neurol Sci. 2012 Dec;33(6):1419-21. doi: 10.1007/s10072-012-0966-4. Epub 2012 Feb 4. PMID: 22307446.
A clinically rare midbrain syndrome- Wernekink syndrome discussed in the context of following patient
Tutorial on Thursday 25th
Importance of direct visualisation of 2D ECHO rather than mere measures values with emphasis on different planar views.
Video link
Group discussion on Friday 26th
Detection of Rifampicin resistance by gene probe assay(CBNAAT)
95% of mutations associated with rifampin resistance occur in an 81-bp core region of the bacterial RNA polymerase gene, rpoB. (enzyme involved in synthesis of target site of Rifampicin)
All mutations that occur within this region result in rifampin resistance.
The assay uses novel nucleic acid hybridization probes called molecular beacons.
Five different probes are used in the same reaction, each perfectly complementary to a different target sequence within the rpoB gene of rifampin-susceptible bacilli and each labeled with a differently colored fluorophore.
Together, their target sequences encompass the entire core region.
The generation of all five fluorescent colors during PCR amplification indicates that rifampin-susceptible M. tuberculosis is present.
The presence of any mutation in the core region prevents the binding of one of the molecular beacons, resulting in the absence of one of the five fluorescent colors
Context- http://
Log Book audit on Saturday 27th
Theory on Monday- 29th-
Panhypopituitarism
Video link
Seminar on Tuesday- 30th
SEPTIC SHOCK AND AUTONOMIC DYSFUNCTION
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