Summary :
UDLCO project : User driven learning around retail vs research in education and practice
UDLCO conversational transcripts :
10/29, 7:44 AM] SS :
[10/29, 8:59 AM] Rakesh Biswas: Lip service for last 50 years since ROME!
[10/29, 9:03 AM] B : Catch them Early...
Include research in curriculum at school level..
Yes....
Long waited change......
[10/29, 9:24 AM] Prof Sarmishtha : Including research?? Or nurturing curiosity in students, develop the attitude of students ?
This is followed by a newspaper clip image about no takers for non clinical post graduate seats
[10/29, 9:34 AM] Rakesh Biswas: There is nothing non clinical in healthcare education!!
Change the game. Market them as genuine clinical experience driven learning and see the change!
[10/29, 9:38 AM] Rakesh Biswas: First step would be to open OPDs for all these clinical subjects such as
Clinical anatomy clinic :
Medical diagnosis begins with anatomical diagnosis
Clinical Physiology:
80% of our current patients suffer from illnesses caused by functional alterations of their physiology where there is no structural alteration (aka pathology)!
Clinical Biochemistry :
Majority of our patients are metabolic syndrome
[10/29, 9:39 AM] Path A : Absolutely sir! I totally agree…. Its only the mindset of us teachers….. NMC has only now come up with nullifying the concept of categorising these subjects as pre/para/clinical, but this should have been practised/or may even being practised by many….. in a recent visit of DGHS to our institution, the same idea was highlighted by him…… e.g physiologists should run all the neurophysiology labs, microbiologists should go for icu/infection control rounds, pathologists should come up with pathology explanation clinics (PEC is already an established concept in the west)
[10/29, 9:41 AM] Rakesh Biswas: Move beyond this!
Every department needs to have their own clinical opd and start seeing patients from Monday (tomorrow)
[10/29, 9:42 AM] S : ๐
[10/29, 9:43 AM] MS : This is really a feasible solution
[10/29, 9:43 AM] Rakesh Biswas: Initially there will be some expected friction with so called clinicians (gatekeepers to patient experience) but legally now they can't barricade the other MBBS departments from seeing patients! They belong as much to the department of physiology and pathology as much as they belong to general medicine
[10/29, 9:44 AM] S : You said it!
Many of my Physiology colleagues said this also
[10/29, 9:46 AM] S : Even as a nonmedical Physiologist, I had proposed for ANS stress lab
Obesity clinic.
Which was never entertained
[10/29, 9:46 AM] Rakesh Biswas: The next challenge for the neo clinicians will be to attract and retain patients in their department!
Family adoption and PaJR udhc CBBLE systems can ensure that they attract and retain the primary beneficiaries of medical education perhaps even more efficiently than the old clinicians who are currently into retail overdiagnosis and overtreatment!
[10/29, 9:48 AM] Rakesh Biswas: You need someone in the current hyped clinician role to offer you a place in his her opd and then everyone can witness the magical transformation of medical education and practice
[10/29, 9:55 AM] S : And that's the issue, people are so insecured of their position, they refuse to act collaboratively -
[10/29, 9:56 AM] Brj : Researcher and Critical Thinker.....
360 degree change of mindset......
Slavery mindset by Maculey education system Vs Nationalist independent mindset.....๐
[10/29, 9:57 AM] S : I will wait to see that transformation
May be that is happening in some places with your type of clinicians, but they are sporadic
Not nationally visible ๐
[10/29, 9:58 AM] Rakesh Biswas: Once people become acutely aware that the patient is the center of all learning and become oblivious to earning more and more (most difficult), they will realize they never had any position in the first place! It was just an illusion of position! They realize it only after retirement in their deathbed
[10/29, 9:59 AM] S : Once again
Change of mindset of whom??
I think we first need to do some introspection!
Quality of PG theses speaks something about that, dont they??
[10/29, 10:04 AM] Shivaswamy Comm Med: Waiting for a perfect system means many young will miss the bus! "Catch them young". Now even IISc & IISER, ISRO are encouraging UG students to do research to motivate future scientists (Early Research Exposure similar to Early Clinical Exposure).
[10/29, 10:07 AM] Rakesh Biswas: It needs to begin by changing primary school teacher's mindsets who are discouraging primary school students to ask questions, maintaining their status quo at blooms level 1-2 !
We need to promote blooms level 3 right from primary school and not wait for some students to get into some hands on professional courses by acing level 1-2!
Only then can we start the bloom game from even level 6, which is what ROME was all about.
More here :
[10/29, 10:11 AM] Rakesh Biswas: Yes but most of these named institutes are bench institutes and it's difficult for them to believe that early clinical exposure is early research exposure and they end up harming healthcare education by propagating the idea of research as a bench rather than bedside activity!
There are no bedside to bench translational research institutes in the country other than a few lip servers on tax payers money
[10/29, 10:13 AM] Bone : First thing to do is remove the mandatory pg thesis...then people who are genuinely interested in research will do quality work and quality work will get published.Now most are forced to do research and they end up published these half cooked data...which will actually bring down the research quality
[10/29, 10:19 AM] Rakesh Biswas: The other way would be to restrict non researchers (aka non learners) to enter medicine MBBS!!
Everything off course depends on how one defines research, learning, academics etc
One definition is :
Academics is nothing but a tool to solve real life problems
There is no difference between learning and research.
We need not call it constructivist learning to cater to measured quantitative experimentation that currently dominates what most people take to be research
[10/29, 10:23 AM] S : It all depends on the teachers to inculcate curiosity and research instinct in students during regular classes, lab sessions, avoiding cook book strategy of practicals
Then those who will be interested will come up and do short research projects or be part of bigger projects that the teachers are having
[10/29, 10:31 AM] AD : All that I gather from the above mentioned discussions can be summarised as follows. Correct me if I have not understood the discussion:
1. What is medicine after all? Anyone can practice medicine. There is no need of any postgraduation or training. Aren’t BAMS and BHMS already doing that?
2. Research is sacrosanct for MBBS. People who have done MBBS MD MS are brainless people who do not have a scientific mindset. Who needs them anyway? Google and chatgpt are there to do their work.
3. So MBBS should be made a research course.
[10/29, 10:37 AM] Rakesh Biswas: 1) Correct (sort of) ๐
2) No it's sacrosanct for everyone who need to learn to solve real problems. Not for those who are Macaulay's slaves.
3) It should be made into a course that promotes learning (at blooms levels 3-6) rather than the current slavery it eschews into creating retailers!
Research rather than retail can be a slogan to stem the tide of it's getting reduced to manufacturing robots working for the drug and device profiteers
[10/29, 10:42 AM] AD : We practice and teach evidence based medicine. However you are free to speak about your own method of teaching.
[10/29, 10:46 AM] Rakesh Biswas: What to do if I'm the physician and I fall ill?
Well I would at least know what's killing me (again not sure if that improves the quality of death if not life)? ๐
I agree that we often speak what we don't practice ourselves and while I can have my way on my own body, given my position as a Professor of Medicine but most humans can't afford that.
Most of us would likely succumb to the forces of medical retail marketed as meta-analysed EBM rather than true scientifically palpable EBM!
[10/29, 10:47 AM] Rakesh Biswas: You think you practice and teach EBM!!
Believe me we still don't know it well. I have spent majority of my academic and practicing career with EBM
[10/29, 10:54 AM] Rakesh Biswas: Most physicians in India are not able to go into the details of RCTs and the marginal efficacies they project because of nil training in reading research papers as well as too busy in pharma and device driven retail practice where the true conclusions of those RCTs would create cognitive dissonance to their practice!!
Most of them take the RCT author's conclusions lauding the intervention as the actual conclusion of the paper!!
[10/29, 10:56 AM] Rakesh Biswas: Unfortunately I'm afraid even LLM's may be doing the same unless they are specially trained to read RCTs in the pico format!! ๐ @Dr Avneesh Khare ๐ฎ๐ณ ?
[10/29, 10:56 AM] Dr Avneesh Khare ๐ฎ๐ณ: Medical community needs to take charge of LLMs being deployed in Medicine but unfortunately, can't do anything without education about the technology, will end up like EMRs being forced down the throat
[10/29, 11:01 AM] Rakesh Biswas: What most physicians in India practice is better termed GBM! Guideline based medicine!
Works wonders for their defensive medicine practice and allows them to remain where they need to.
However some delving deeper into EBM may show them that most type 1 recommendations in consensus guidelines are based on low level evidence!
Again it would be helpful to understand the above only if they care to practice EBM. To practice defensive medicine nothing more than GBM is useful and learning EBM can be a bit dangerous too and I'm a testimony to that
[10/29, 11:18 AM] SS : GBM may be sufficient for Primary health care & Solo practice secondary health care. EBM/Research based Medicine is better for teaching hospital/ tertiary care to frame new guidelines.
[10/29, 11:23 AM] AD: Really good observation of your work fellows
[10/29, 11:40 AM] SB : STG will soon be followed by AI-based health care delivery system, shoving doctors into เคฆเคฐिเคฏा
[10/29, 11:55 AM] Dr Avneesh Khare ๐ฎ๐ณ: I appreciate your humble demeanor ๐
[10/29, 12:21 PM] AD : Me and humble? ๐๐
[10/29, 12:24 PM] Dr Avneesh Khare ๐ฎ๐ณ: You are always right madam ๐๐ Happy Sunday ๐
[10/29, 12:31 PM] Bn : Good afternoon
Is anything being actually done to bridge the gap in thinking process between the policy makers and thinkers just like some of us in this group and the huge no of those working on the ground with limited access often or those with targets being given by the corporates/ private institutes or those with miniscule salaries whose livelihood depends on the practice they do ?
Just a different thought offered by me which could possibly initiate a discussion on what idealists think vs non idealists practice in a non ideal or real world
[10/30, 8:22 AM] Rakesh Biswas: Agree
[10/30, 8:33 AM] Rakesh Biswas: Don't worry. Everything is perfect as it is! ๐๐
Whatever we discuss is situational and contextual depending on our small areas of how we experience the real world.
Reality of work demands that we have 80% of us working like Macaulay's slaves and actually running the system using level 1-3 of blooms taxonomy and as Dr SS pointed out, let that level 3-6 leadership be the prerogative of tertiary care leaders!
[10/30, 9:57 AM] SS : Its like chess game, common soldiers only move forward as per standard instructions, its left to specialists/ medical educationists to reflect & plan ahead/ come back & defend/ change course. ๐ค๐ท
[10/30, 10:08 AM] SS : If an IMG/ FMG after taking modified Hippocratic Oath, follows STGs and treats the patient in primary/ secondary set up, it need not be considered as Macaulay's slave. ๐ค๐ท
[10/30, 10:41 AM] Rakesh Biswas: Agree soldier sounds better than slave
[10/30, 10:43 AM] S : Both soldiers and slaves can revolt very badly to change their situation if they are pushed too much- history is witness to that ๐
[10/30, 10:44 AM] Rakesh Biswas: They have nothing to lose but their chains
[10/30, 10:46 AM] S : So what have we got to lose? We are also chained by these regulations of accreditation bodies
[10/30, 10:47 AM] Rakesh Biswas:
Nothing!
Chains are our ontologic ties aka Maya
[10/30, 11:22 AM] S : We all know these, issue is how much is being transmitted to students??
What is being done if it is not followed?
Are we allowing enough opportunities for students- everyone of them, to imbibe, assimilate and imbibe qualities.
[10/30, 11:27 AM] AD : Cynicism about our own work and skepticism about our goal will make us all weak as a team.
Storming is an important aspect of group dynamics but the work should be towards norming and performing. Our goal is to make competent doctors
[10/30, 11:30 AM] S : It's not cynicism, it's reality check.
All storming, norming, forming- are fine and I agree, but unless the end result is visible and every other day regulatory bodies keep changing directives and guidelines, difficult to achieve what we intend to.
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