Monday, October 2, 2023

Ongoing medical cognition projects in medicine department

Ongoing projects in medicine other than the departmental post graduate thesis are all centred around "medical cognition" and optimizing clinical complexity using medical cognition tools. 


Other than routine medical cognition tools of  system 1 eyeballing pattern recognition, we use routine tools of system 2 asynchronous intelligence aka primordial AI aka academic learning to solve real patient problems.

Developing the Medical metacognition problem statement at the beginning of the introduction to all our ongoing projects is because, it's at the core of all our projects using both system 1 and 2 cognitive processing:

System 2 thinking began as an asynchronous academic tool to make communication and thinking slower to suit our individual workflows. 

However this essence of academics also makes our three dimensional existential reality two dimensional as that helps to somehow better analyze our three dimensional existence manifest in daily random events and even manipulate the randomness toward apparently improved outcome events.

Of all the routine system 2 tools, we have been largely enamoured by a few that we have written about  in the past and  continue to use them daily in our community patient follow up and family adoption through online PaJR groups which are the online components of our case based blended learning ecosystem CBBLE and the two have evolved from what has been often described in the past as "user driven healthcare" which has it's own big fat text book here :  https://www.amazon.in/User-Driven-Healthcare-Narrative-Medicine-Collaborative/dp/1609600975
as well as had a journal with the same name since 2011 here: https://www.igi-global.com/journal/international-journal-user-driven-healthcare/41022

More about our tryst with "using medical cognition tools to optimize clinical complexity" in this 2023 guest lecture at AIIMS, Bhopal archived here: https://medicinedepartment.blogspot.com/2023/10/medicine-department-presentations-2023.html?m=1

Ethical clearance obtained for this major project stem here : http://medicinedepartment.blogspot.com/2023/04/?m=0

Clinical professional development CPD organized on the theme of optimizing clinical complexity is 

Completed and published medical cognition projects :

Clinical complexity and PaJR tools 2023:  https://pubmed.ncbi.nlm.nih.gov/37335625/


Five ongoing old projects on the above theme :

1) Creating dynamic user driven ontologies : http://userdrivenhealthcare.blogspot.com/2022/?m=0





5) Collective, user driven conversational contextual peer review of real time open access research submissions and creation of dynamic user driven learning community ontologies UDLCO 



Current journal UDLCO :

Dr Tella Shruthi :



Ongoing projects previously shared in  2021 in the dsir template on request :


We can broadly divide our "medical cognition" into the right and left path. 

The right path projects are reasonably understandable from a modern perspective, while the left path projects are slightly post modern and may not be included in the offical departmental lists although they will still be linked appropriately in case someone visiting this site is curious. 



New projects using medical cognition tools :

1) Ongoing project : Sleep cycle longitudinal follow up study using frugal user driven sleep labs to determine the  impact of sleep patterns on development of NCDs. Elective student collaborator, Avinash Gupta from Bhairahva, Nepal and intern Dr Parvez Ansari from KIMS Narketpally, Prof Monika Pathania, AIIMS, Rishikesh 

Plant model collaborator TIFR CUBE lab Dr MC Arunan https://www.hbcse.tifr.res.in/research/past-projects/gnowledge-lab, Ms Swaha Saha, NJP and Dr Dinesh Datta, KMC, Warangal : 


Animal model TIFR CUBE lab collaborator Dr MC Arunan https://www.hbcse.tifr.res.in/research/past-projects/gnowledge-lab, Ms Swaha Saha, NJP
Dr Dinesh Datta, KMC, Warangal 


Pilot sleep studies done in our wards as part of the routine workflow:




A unique sleep pattern from personal tracker data and n of 1 intervention https://classworkdecjan.blogspot.com/2019/05/42-f-with-severe-regular-edema-with_17.html?m=1



Previous log of our ongoing sleep project in dsir template as requested from principal's office: http://medicinedepartment.blogspot.com/2021/02/per-dsir-template.html?m=0

2) Ongoing project : Gait analysis: normal and abnormal patterns in relation to illness outcomes  PG student collaborator Dr Himaja, Intern Dr Kshitij from KIMS Narketpally. 
From University of Hyderabad, collaborator, Prof Nagendra and Dr Irfan 

Past work on this project by UoH :




Recent data capture from our ward :



3) Life style medicine project: Effect of daily energy intake monitoring in the form of food plate images and energy output in the form of hourly activities in improving outcomes through regular PaJR continuity
External collaborators from Pune studying AI tools in food plate optimization toward better outcomes and Prof Pathania with her life style pdcc student: https://aiimsrishikesh.edu.in/a1_1/?page_id=1081

Resources from and for our PaJR patients : http://medicinedepartment.blogspot.com/2023/09/?m=0

4) Utilizing LLM tools to assess interns clinical competence depicted in their online learning portfolios. External collaborator Mr Rahul Kulkarni from Pune. https://www.linkedin.com/in/rahul10100/ and here's his video that shows his plan for how he can help mentor our health professional students and patients toward better life outcomes: https://youtu.be/wqZvp83cfbs?feature=shared

Internship assessment done by LLM showcased here as a single sample : http://medicinedepartment.blogspot.com/2023/09/submitted-internship-competence.html?m=1

5) Creating sample question paper through clinical vignettes taken from online learning portfolio case reports and reshaped into questions (MCQs, Long essay, short essay) using a large language model and human professor supervised learning
Project collaborators: Dr Tella Shruti, Dr Dinesh Datta, Mr Rahul Kulkarni


6) Creating persistent clinical encounters through first contact physician user driven EMRs followed by patient user driven PHRs (patient journey records PaJRs) collectively archived in dynamic case reports (EHRs):
Collaborators: Dr Manogyna intern and UGs from 3rd, 5th and 9th semester 

7) Early clinical exposure to patient vulnerability in social media and need to champion their privacy confidentiality through meticulous removal of patient and institutional identifiers along with valid informed consent during the conversion of three dimensional system 1 patient data to 2 dimensional system 2 patient data archived and continually evolving in dynamic online learning portfolios.







Medicine department presentations 2024-17

Past medicine department presentations:https://medicinedepartment.blogspot.com/2022/06/medicine-lectures-archived-over-years.html?m=1

2025 August :

https://medicinedepartment.blogspot.com/2025/08/lecture-module-current-role-of-ai-in.html?m=1

2025 November 7: https://userdrivenhealthcare.blogspot.com/2025/11/all-visuals-for-ai-in-decision-making.html?m=1


2024:

November 28 at University of Hyderabad:

Presentation details with video links:

https://medicinedepartment.blogspot.com/2024/11/technology-end-user-driven-ecosystem.html?m=1

Links to the lecture preceding the demo:

Post lecture demo discussion video:


CPD Jan 25, 2024 at Narketpally:

Presentation details:

https://medicinedepartment.blogspot.com/2024/01/medical-cognition-cpd-jan-25-2024theme.html?m=1

Videos of the presentation:

https://youtube.com/playlist?list=PL8jaOf7fby04Eq3Gabfj6yWNTOfCYy0cv&feature=shared

2023:


Faculty :

10 August 2023: AIIMS Bhopal: invited guest lecture 

Image of invitation :






YouTube link to lecture:


May 5, 

Y20 participants at AIIMS, Rishikesh
from our 3 Elective students, Vivek Podder,  post doctoral Miami cancer institute, Pranab Chatterjee, John Hopkins post doctoral  BhagyaJyoti Priyadarshini, Orissa and Dinesh Datta KIMS UG now KMC PG,  

Image :




Panelists, AI healthcare 


Above link can be scrolled to 6 hrs 27 minutes to find our students 


8 February 2023: Oman Medical college : invited guest lecture 

Image of invitation 




YouTube link to lecture :




25th January 2023 : CPD on optimizing clinical complexity 




YouTube link :



YouTube link :


Dr Raveen and Prof Murthy, Department of Surgery, KIMS, Narketpally 


Dr Saicharan and Prof Meltzer, Thomas Jefferson university, Philadelphia  


Faculty 

Key note address with Prof Joachim Sturmberg'sSchool of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle





2022:

PGs :




Dr Vaishnavi with Prof Meltzer, Thomas Jefferson university, Philadelphia  


Dr Aashita with Prof Akshay Anand, PGIMER, Chandigarh 


Overall write up on the Clinical problem solving CPD 2022: 






Sunday, October 1, 2023

End of posting osce and mini-CEX results announcement for 2018 batch posted in general medicine for August and September 2023

Summary : Pragmatic OSCEs and mini-CEX were conducted for each of the following interns listed below who were interned to the department of medicine for 45 days largely in August and September 2023, everyday in batches of four, while assessing them summatively on the days they were working face to face with the assessor both at OPD and IPD as well as following them up formatively everyday through their work logged in their online learning portfolios as well as PaJR groups in a user driven manner.  

And user driven submissions of online portfolio links on learning themes for 360 degree peer feedback and assessment submitted here :  https://medicinedepartment.blogspot.com/2023/09/submitted-internship-competence.html?m=1

Current batch list of interns and their quantitative and qualititative  assessments :

41 K  TEJASWINI 


Quantitative evaluation: 55/100
No extension (pass) 


Qualitative evaluation: Can do better 


42  K CHERISH 


Quantitative evaluation : 60/100
No extension (pass) 


Qualitative evaluation  : Takes initiative, trainable 
Can focus on asking more questions and sharing and communicating more 


43 K NIKHIL SAI 


Quantitative evaluation : 65/100
No extension (pass) 

Qualitative evaluation  : Takes initiative, trainable, Hardworking, sincere

Can focus on asking more questions and sharing and communicating more 

44 K VENGALA PRASANNA 


Quantitative evaluation : 50/100
No extension (pass) 

Qualitative evaluation  : Trainable, 

Can focus on asking more questions and sharing and communicating more 



45 K SAMPATH


Quantitative evaluation : 60/100
No extension (pass) 

Qualitative evaluation  : Trainable, Hardworking, sincere

Can focus on asking more questions and sharing and communicating more 


46 K PHANI KEERTHANA


Quantitative evaluation : 55/100
No extension (pass) 

Qualitative evaluation  : Trainable, sincere

Can focus on asking more questions and sharing and communicating more 


47 K  SHIREESHA 


Quantitative evaluation : 50/100
No extension (pass) 

Qualitative evaluation  : Trainable

Can focus on asking more questions and sharing and communicating more 


48 K CHETANA


Quantitative evaluation : 50/100
No extension (pass) 

Qualitative evaluation  : Trainable

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


49 K TULSYAN



Quantitative evaluation : 55/100
No extension (pass) 

Qualitative evaluation  : Trainable

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


50  K YAMINI ( went on USMLE leave midway )


Extension : 30 days 

51 KSHITIJ SHARMA



Quantitative evaluation : 55/100
No extension (pass) 

Qualitative evaluation  : Trainable, Takes initiative 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


52 K  NIKHILESHWAR


Quantitative evaluation : 45/100
Extension 20 days  

Qualitative evaluation  : Trainable, Late starter 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


53 LASYA REDDY PESARU



Quantitative evaluation : 50/100
No extension (pass) 

Qualitative evaluation  : Trainable, Takes initiative 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 

54  M  PARDHU ( did not report atall) 

Extension  60 days 


55 M  SRIBINDU


Quantitative evaluation : 50/100
No extension (pass) 

Qualitative evaluation  : Trainable

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


56 M  VINEETH


Quantitative evaluation : 30/100
Extension 30 days 

Qualitative evaluation  : Needs more extension to see if he's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


57 M  SANTHOSHINI



Quantitative evaluation : 40/100
Extension 20 days 

Qualitative evaluation  : Needs more extension to see if she's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


58 M AARTHI PRIYANKA


Quantitative evaluation : 50/100
No extension (pass) 

Qualitative evaluation  : Trainable

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


59 M BHARGAVI




Quantitative evaluation : 40/100
Extension 20 days 

Qualitative evaluation  : Needs more extension to see if she's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 

60 M HEMANTH

Quantitative evaluation : 40/100
Extension 20 days 

Qualitative evaluation  : Needs more extension to see if he's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 

FMG POSTED FROM 

1 st AUG TO 30 SEPT 

FMG 6 - Lakshmi Bhavya Popuri

Quantitative evaluation : 30/100
Extension 30 days 

Qualitative evaluation  : Needs more extension to see if she's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 



FMG 7 - Mahitha Pandurao Akireddy


Quantitative evaluation : 45/100
Extension 20 days 

Qualitative evaluation  : Needs more extension to see if she's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


FMG 8 - Mallavarapu Ramya Sri 

Quantitative evaluation : 40/100
Extension 30 days 

Qualitative evaluation  : Needs more extension to see if she's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


FMG 9 - Mohammad Ashraf 

Quantitative evaluation : 47/100
Extension 10 days 

Qualitative evaluation  : Needs more extension to see if he's better trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 


FMG 10 - Nischal Cyril Kumar 

Quantitative evaluation : 40/100
Extension 20 days 

Qualitative evaluation  : Needs more extension to see if he's trainable 

Can focus on asking more questions and sharing and communicating more as well as maintaining continuity and consistency of work done 



Analysis of anonymized student feedback regarding Medicine department

Summary : This is a single observer review and analysis of student feedback regarding teaching delivery and formative assessment of medicine department received from a batch of students finishing their degree and on their way to finish the final hurdle of the university. The validity of this anonymized feedback appeared high as students had fearlessly opened their heart outs and well addressed our negatives as we had ensured that we were properly blinded to their identity.

The entire feedback in images of their hand written notes can be accessed here:https://37swetha.blogspot.com/2022/11/2018.html?m=1
The feedback has been analyzed and problem statements identified as well as solutions planned. 


Single observer analysis :

Clearly there is a gross mismatch with the departmental vision for the students learning and the students own vision of what their learning should be like and this post is to try and bridge this colossal gap. 


The departmental vision is to create physicians who are competent to understand a patient's problem through a proper clinical data capture (history, examination and investigations) and draw an optimal management plan tailored to the patient's requirements and ensure adequate follow up to support the patient's illness journey. 


The students vision apparent from the feedback is to pass their exams safely and learn standard clinical  skills that may not require the apparently humongous effort that they are having to put in compared to other subjects in their career journey. 


Also they are unable to sink their teeth into the kind of clinical skills we demand from them as they believe they haven't been taught anything and so we shouldn't expect them to know anything. 


Our current reading of this batch and most prior batches is that there are 5-10 students who can cope with the efforts necessary and the large majority is getting bulldozered and stressed out. 


Bottom line is lack of time as against a tremendous demand for efforts that appears unrealistic to the majority. 


Students want medicine to be broken down into bite sized conceptual chunks that may have palpable black and white outcomes but if we try to do that we will end up showing them an unreal picture of Medicine. What they are witnessing now through their own efforts to log a case is real medicine which is unfortunately disturbing as the messy real world of Medicine often is. However if we discount this discomfort now we shall only be delaying it and cause irreparable damage to their psyche when they are forced to face real medicine at a later date.  


What are the changes that the department can make from their side given the limited amount of time ? 


We can start the rounds after their last theory class at 10:15 AM sharp and students will need to assemble by each patient's bedside while we show them clinical skills during the rounds and then unfortunately we will still need to waste a lot of time trying to understand our real patient requirements that may feel like a waste now to students but will feel more useful with passage of time as they gain more competency in understanding patient requirements listening to their non linear narratives. 


What we need from the students? 


We need them to become active learners and transform from the passive learner role most of them have been forced into due to various reasons largely related to schooling. We need them to do their case based assignments and ask us questions at every step (asynchronously online) so that we can help them to create an impact on us and our patients. 

Ultimately it's this ability of theirs to create an impact on our learning ecosystem is what is most valuable and essentially what we are trying to assess. 


The online learning portfolios containing the case logged work of each medical student, are largely a platform for the medical students to demonstrate the impact of their learning on our department and patients in a manner that makes them become a valuable member of our team. This can enable us to demonstrate a clear correlation between their learning outcomes and patient outcomes. 


The way forward will not be easy but overcoming difficult paths can lead to better and greener pastures. 

Did the students provide valid feedback? 


The feedback collected from the students appears very valid as they have fearlessly addressed our negatives as we ensured that we were properly blinded to their identity 👇