User driven health care: Computer-aided, patient-centered, discovery-based learning through early clinical exposure with a multidisciplinary collaborative team

Introduction: There is a striking deficiency in medical learning competencies attained by medical faculty and students that are hardly ever reflected on or brought to notice in the course of caring for their patients. A biochemist may not know how the HbA1c values that s/he regularly facilitates in his lab is actually utilized by the clinician and patient and the clinician may not realize how the HbA1c values are actually generated in the lab. The undergraduate students need to be trained to become a primary basic doctor who can take care of a rapidly growing patient population but in our current curriculum they end up being taught specialized subjects like biochemistry, pharmacology even before they get to see a patient and get to realize why they need to learn what they are learning, how this knowledge may be applied by them to meet their patient requirements and if their training can allow them to answer queries that arise naturally and not as a result of an outdated curriculum that compels them toward non-contextual rote memorization.This affects current day healthcare practice where a large proportion of health professionals are in danger of becoming apathetic to patient requirements. To resolve the above mentioned problems in current medical education and healthcare, Medical council of India MCI has recently proposed 'early clinical exposure (see this recent debate here:https://groups.google.com/forum/?hl=en#!topic/meu_india/p41ahzTVMvo) and building on it further, we propose a patient-centered computer aided learning project with a ‘learning team’ comprising of first years receiving ‘early clinical exposure’ ECE as well as experienced faculty engaged in blended collaborative learning around ‘individual patients.’

Methods: We shall utilize a mixed methods quasi-experimental study design. In the course of a learning session for 1 year,a team of faculty and students (n=25) will be exposed to regular 'patient encounters' in the inpatient and outpatient wards of LNMC &RC. The group shall also comprise of students from the 1st year MBBS toward effecting early clinical exposure.This team shall capture patient-data at the 'point of care' (in the form of images of clinical findings as well as radiology data) and then subsequently bring them to our 'computer aided learning' CAL lab for further processing.The patients selected will have a sufficient level of clinical complexity likely to generate maximum learning outcomes in terms of patient centered learning questions (detailed here:http://www.pcori.org/research-we-support/pcor/). In the CAL lab the collected 'patient data' shall be uploaded on to a 'patient centered online health record' PCOHR website currently active here:http://www.udhc.co.in/ and currently housing a regularly growing database of patient records here:http://www.udhc.co.in/INPUT/input_directory.jsp
Subsequently the prepared 'patient centered online health record' PCOHR link is shared on to our online social-media based processing forum that has a current global membership of 1000+ members, many of who actively participate in solving patient problems posted to the forum. All this patient centered 'data collection and processing' activity shall be subsequently documented in 'patient centered online health records' PCOHRs such as these http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=304 and research publications generated from them such as these http://casereports.bmj.com/content/2014/bcr-2013-202916.full The learning and patient-health outcomes of the CAL group of 'patients, students and faculty' shall be compared with a 'control group' of patients,students and faculty who receive a 'placebo' CAL intervention (after pragmatic randomization and blinding) and the results documented.

Results/Expected Outcomes: This mixed methods study design will document results through qualitative thematic analysis of student-faculty learning insights, qualitative insights on patient-health-outcomes and quantitative estimates in terms of the number of validated participatory learning inputs contributed by each student and faculty and quantitative estimates of patient health in terms of QoL. The results of the impact evaluation of our PCOHR educational intervention strategy will be validated as per currently known paradigms(http://en.wikipedia.org/wiki/Impact_evaluation). An additional feature of note in our project is the utilization of online learning portfolios of students and faculty, which are generated partly automatically online from their documented participatory learning conversations in our currently active online CAL forum. These portfolios will be thematically analyzed to assess the results/learning-outcomes of each faculty and student's CAL activity. The portfolio based quantitative learning points generated around each patient will be compared with the results/outcomes obtained in terms of their respective patient improvement using quantitative QoL estimates (SF36 etc).

Discussion and Implications for Practice: The 'patient-centered learning' process will further involve learning feedback provided to the patient's primary caregiver by our 'computer aided learning' CAL team and then noting the results in comparison to a 'control group' of patients whose providers receive no CAL feedback. Our hypothesis toward the expected outcome of this project is that the CAL team as well as their patients will have respectively better learning as well as QoL outcomes than the control group-team. CAL performed and scaled in an appropriate patient centered manner can go a long way toward improving health professional learning as well as improving patient outcomes and the combination of the two will be instrumental in augmenting national capacity building and transforming healthcare.

SWOT Analysis:

Strengths: Promising solution to current felt need that can bridge gaps in healthcare learning competencies as well as address patient outcome complexities.

Weaknesses: Quasi-experimental and complex study design and consequent potential of study sample selection bias. (Workarounds:ensure transparent and accountable online documentation of entire process that is naturally subject to external peer review in real time)

Opportunities:Potential to scale into a sustainable model of practice based learning toward
improving patient outcomes

Threats: Participant motivation leading to study attrition, patient privacy and confidentiality (Workarounds: regular motivational meets with participants of both groups with real-time transparent documentation of the interaction that transpires between all the stakeholders)