Sunday, July 7, 2013

Workflow for a Blended Learning Medical Elective with BMJ

Here is our workflow ( i am sure you have seen a brief outline here:

Upon joining us you will be required to join our regular ward rounds.
The regular workflow in our unit in the department of Medicine, begins with our residents leading the team of medical students and Consultant professors toward collecting data from patients’ bedsides.

Certain immediate decisions are taken on the spot by the Consultants and a few non-urgent ones are kept for processing later. Once the Consultant professors and residents have finished data collection and hands on emergency management rounds of the patients in their bedsides, the data is brought to our office in the research lab for further collaborative processing.

Further processing involves trying to

a) Explore multiple facets of the complex issues around the 'case' in its real-life settings. (See details around this common-sense out-of the-box thinking approach here: and here:

b) Search for current best evidence for diagnosis and further management of the described condition in each patient. (We prefer Google though Pubmed skills are always welcome). :-)

c) Match the available individual patient data (particular evidence) to generalize-able patient data/current best evidence available online and

d) Help the team come up with a contextually matched patient management plan personalized for each patient.

As mentioned in the BMJ link you will learn on our rounds to:

a) Acquire clinical skills for efficient patient data capture (mostly from our staff accompanying you on the rounds but also from the professor if/when necessary)

b) Acquire efficient clinical data processing skills (as detailed above)
c) Acquire skills for individual patient centered clinical audit and feedback to all stakeholders involved in the patient’s care (this may have future entrepreneurial implications...more later below).

d) Acquire skills in writing your individual patient centered experience during the elective as a case report and submit it to BMJ Case Reports for peer review (no Fellowship fee required).

Most of your two weeks will be spent in thinking and writing about the cases that you see with us and would like to publish with us. You will not be allowed to write nurses orders or perform any procedures (as that requires a legal registration with the local medical council here and may also disrupt local functioning). The thinking and writing will continue at your endaround your chosen cases even after your departure. Authorship will be allocated as per these guidelines:

Authorship credit can be obtained for 1) contributions to conception and design, analysis and interpretation of narrative-data around the case 2) drafting the article or revising it critically for important intellectual content; and 3) final approval of the version to be published.

You will require to write the case right from day one in a blended learning approach even as it evolves (at least the patient's history if not the discussion) and post it right away on a blog (after ensuring that you obtain signed informed consent)  and share the link also with our online processing forum 'tabula-rasa' where you have been already added through your face-book portfolio.

The only important thing we offer you here is an experience in 'patient-centered-learning' and the only reward we expect from you is to contribute to our learning by helping us explore our patients further even as you proceed to write about them. Learning is to a large extent self-directed and dependent on reflective observations and abstract conceptualizations around the concrete events that we experience. Our concrete experiences in turn depend heavily on our curiosity and our ability to ask questions without worrying about giving away our ignorance.

DO’s and DON’T’s during your stay:

Don’t write any prescriptions on the hospital file.

Do write about the case in your own notepad and share it through the online forum after ensuring you have taken the appropriate authorization and informed consent from the patient.

Don’t quarrel with the nurses and other staff

Do interact with them in a positive manner to benefit your patient/s who you shall be researching, reporting and publishing at the end of your elective.

Worst Case Scenario: You may expect us to teach you and not find our case-based discovery-driven learning worthwhile and also find it to be largely a waste of time and money spent in accommodation and travel. Consequently you may not be able to write anything worthwhile around any of the cases you meet in these two weeks.

Best Case Scenario: You may enjoy the daily case-based learning experience, ask difficult questions from our team without fear and help us to find out the answers and learn together using a blended approach and publish y/our case in At the end of the elective you receive a certificate from us and BMJ other than your published case as a proof of your having completed this elective. Once you begin to publish cases in BMJ you may start getting reviewer assignments and eventually you can work your way into the BMJ editorial board. Following this experience you may even become a social entrepreneur (for example you may open a case-based clinical audit CA firm and much like a Chartered accountant get paid to inspect and set right patient-management patterns of other health professionals. 

Hope your stay with us generates the best case scenario that you can cherish throughout your life.

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