An Indian MD-Phd program vs a Translational clinician-scientist entrepreneur TCSE India program

This idea (below) not only emerged from the recent discussion on developing an MD-Phd program in India but also with a subsequent realization that there was a large population of MSc and MBBS graduates who were unable to join Phd or MD programs in India due to the standard entrance bottle-necks and they could benefit from an entrepreneurial career path. The idea is to develop an entrepreneur program for this large segment of students that enables them to stand on their own feet and helps India to stand on its own feet. Perhaps one can write a DBT/DST/ICMR project proposal to gain permission for beginning this? The focus of this program would lie in answering patient health-care requirements through innovative low cost solutions that the student entrepreneurs would develop and incubate through a start up that can be supported by the DBT/DST/ICMR funding (or bank loans obtained by the student entrepreneurs). This can by backed by an Institute providing the bench/laboratory with academic guide (such as Indian Institute of Science, PGIMER or IIT etc) as well as an Institute providing the bedside clinical platform with clinician-academic guide (my university in Bhopal where i practice?). Brief outline of Structure/Curriculum: At the very beginning of the TCSE program students can be coached through a clinical rotation to identify requirements (problems that require doable solutions) in specific patient-populations. Through a case study approach, these students could make attempts to find which of these patient-problems can be offered optimal innovative solutions by the MSc or MBBS students themselves. Here is a brief outline designed by us on the different clinical areas these students would need to touch on in order to get a good idea of the patient's requirements: http://journals.bmj.com/site/marketing/landing-pages/Indian_Caseelectives.xhtml Although the outline highlights what medical students may learn on a short elective, it very much covers what is essential clinical learning to approach any clinical problem. This is detailed further in a recent lecture to KMC Manipal here:http://www.pitt.edu/~super1/lecture/lec50421/001.htm We have already incubated an entrepreneurial solution to patient-problems using a web based information sharing platform http://care.udhc.co.in/ that engages a “Trained Community Health Entrepreneur”(TCHE) under an income generating, social-enterprise model for rural India (details here: http://www.missionarogya.org/p/arogyaudhc.html) and the TCSE model is in many ways an extension of this, only the TCHE may require just a high school background whereas a TCSE is a post graduate and potential Phd-MD who is willing to take the entrepreneurial route. This course may not have a fixed time bound curriculum and the TCSE can choose to take the necessary amount of time required to achieve his/her entrepreneurial aspirations that would depend on a) his/her identification of the problem for which s/he would like to develop a solution ( this would be during the clinical rotation phase in an Institute providing the bedside clinical platform and clinical academic guide) b) Developing the solution (the bench phase in an institute providing the bench/laboratory and academic guide) and c) marketing the solution to the identified patient population( a large fraction of who could be tapped from the patient population in the institute where the TCSE learned to identify the patient problem). If we can obtain the official permission formalities, I can guide the initial clinical phase of this program voluntarily and if you are willing to guide the bench phase in your institute (or suggest someone close to Bhopal) we could quickly pilot this? Do let me know your thoughts.

The Radiopathology of Medicine

In the near future, with further development of technology, radiology will be able to not only comment on macroscopic pathology but microscopic pathology as well. Pathology would need to become an integral part of Radiology at that time.
Carrying this futuristic speculation further...there will be a phase when radiopathology shall become a single discipline and due to technology it is possible that the computer will also be able to label each and every finding be it macro or microscopic radiology (Not necessarily pure AI but even current generation 'user driven Web 2.0 has the same potential),making it easier for everyone to learn radiopathology so much so that the current generation of physicians who are heavily dependent on radiologists and pathologists will become independent and radiopathologists will be forced to
become physicians again.

BMJ Case Reports approach to clinical problem solving in http://care.udhc.co.in/

Welcome to our UDHC network. Thanks for joining.

I am forwarding a potential case-report currently emailed by our social worker from Mathabhanga. Please help this patient (see details attached) to arrive at an innovative solution for his low back ache.

The steps toward this are:

a) Transcribe and translate the patient's handwritten letter/history and provide a summary of his problem inputs posted to the UDHC narrative page. (similar to what has been recently done by Deepanjan here: http://care.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=313

b) Search for current best evidence for diagnosis and further management of lumbar canal stenosis (something of the sort provided here:https://www.ecri.org/Documents/EPC/Diagnosis_and_Treatment_of_Degenerative_Lumbar_Spinal_Stenosis.pdf and as well as other evidence of 'innovative therapy discussed in social media sites on low-backache and lumbar stenosis (see this link to a recent BMJ Case Report from university of Sheffield detailing a process of social media data matching that the Sheffield team did along with their patient of chronic abdominal pain labeled IBS:http://www.ncbi.nlm.nih.gov/pubmed/23239770)

c) Match your available individual patient data to generalizable patient data/current best evidence available online

and

d) Come up with a contextually matched patient management plan. Send it as an output1 (back to the patient through the social worker and his local physician) after getting moderator clearance (the current moderator for 726 area PIN code is me) and follow up the response to treatment through a series of inputs and outputs (see the input and output page here:http://care.udhc.co.in/

e) Prepare a case report for BMJ Case Reports similar to http://www.ncbi.nlm.nih.gov/pubmed/23239770

For step 'a' you may require the help of someone who knows how to read and translate from Bengali (particularly from area pin code 726 or even starting from 700 and so on...this patient's botanical name attached by the social worker is LEUCAS CEPHALOTES and the website name will read as LEUCAS726CEPHALOTES).

Looking forward to working with you (and other interested UDHC co-authors copied here) around this patient.

best,

rb

What is desirable in any article being submitted to the International Journal of User Driven Healthcare?

For articles submitted to the International Journal of User Driven Healthcare http://www.igi-global.com/journal/international-journal-user-driven-healthcare/41022 we look forward to write ups that take the topic of the research as the backdrop, and provide summary overviews of the topic's background and the project's findings, but centre stage is given to unpacking the research project's narrative, from question formation, research design through to data gathering, fieldwork,analysis and research outputs. Particular attention may be paid to any methodological problems or points of interest generated in the carrying out of the study and how these were dealt with or raised questions of research practice.

POCET UDHC and the taste of blue mangoes( http://care.udhc.co.in as a point of care engagement toolkit POCET)?

‘Engagement’ is a generic, inclusive term to describe the broad range of interactions between people. It can include a variety of approaches, such as one-way communication or information delivery, consultation, involvement and collaboration in decision-making, and empowered action in informal groups or formal partnerships. http://www.dse.vic.gov.au/__data/assets/pdf_file/0019/105823/Book_1_-_An_Introduction_to_Engagement.pdf

The UDHC community of practice is a blended learning ecosystem that merges offline point of care engagements between health professional and patient stakeholders along with online user-driven point of care engagement through patient and health-professional/social worker 'user' inputs that are further processed online through research-evidence searching and matching to effect immediate patient outcomes posted back as outputs in http://care.udhc.co.in and 'tabula-rasa.' Unanswered questions generated in this activity remain as seeds for further primary research.

Slightly provocatively for the 'population based researchers' in our community UDHC is all about 'tasting the mangoes rather than counting the mango trees' (' ' is currently an un-google-able Indian proverb). UDHC learners/researchers are mostly secondary researchers who are uniquely privileged 'birds'  perched on the branches of these patient 'mango trees' and have easy access to tasting and sharing the mangoes and dropping its seeds here and there for 'population based researchers' to pick up, plant on the ground and keep count.

(More provocatively) Einstein too was one such bird who made a life out of creating mathematical models mostly from the fruits of the labors of primary researchers. He never did a single experiment himself (other than his thought experiments) but simply generated ideas good enough to drive more and more primary researchers (worker ants) who could give up their lives to be driven by this 'Albatross'(bird).

Would medical students of this day and age wish to be 'Einsteins' and share their 'problem solving abilities' for immediate patient benefits and taste and share the mangoes (outcomes) or like to remain worker ants? More likely they may prefer to do both? Would 'population based researchers' like to rethink their current positions and get nearer to patients?

Medical Student Caregiver workflow

As medical student caregivers (see this definition of a medical student: student.bmj.com/student/view-article.html?id=sbmj030241) we discuss and learn from patient cases and practice what is also labeled as 'patient centered learning' and along with this we try to get students (ourselves) to write case-study based qualitative research papers based on our 'patient-centered learning' experiences. We also communicate on emails as there are many emailing online users who may not have the time or inclination to be on all forums. As medical students you can contribute to nurturing  this learning ecosystem by starting to share your cases (patient experiences after obtaining and uploading their informed consent) to our website http://care.udhc.co.in and then discussing them on our online forum of 600+ users. Don't be intimidated by the fact that you may not have been trained to handle cases in college. All you need to evaluate cases is just common sense and if you have good knowledge of anatomy it becomes an added bonus. Everything else can be learned through further online mentoring. Will be looking forward to your inputs and don't hesitate to clarify your doubts either through messaging or preferably through crowd-sourcing them in our online forum. 

Two separate workflows for user interactions?

Two separate workflows to register/allow 'Independent-care-seekers' and 'Caregivers for dependents?'

Independent-Care-seekers would be mostly urban computer users posting their own cases who can register emulating the healthboard pattern of one click registration. http://www.healthboards.com/

Just take a look at how they get 'users' to register for their site:http://www.healthboards.com/boards/register.php

While many of their rules http://www.healthboards.com/boards/faq.php?faq=faq_hb do not apply to our workflow we can emulate their skeleton that works around the problem (of signed-patient-consent-form or one-click-disclaimer dilemma) we are facing now.

Caregivers for dependents (comprising of our Mathabhanga social workers or patient relatives or even medical students and health professionals reporting their cases) will need to go with the current workflow and will not be allowed to post without the uploaded consent form. This workflow is actually borrowed from and currently active in the BMJ Case Reports journal as all the case reports are made by similar caregivers (mostly health-professionals) who have to upload their signed patient consent forms for their case reports to be peer-reviewed.

As currently much of our activity on http://care.udhc.co.in/ is through 'Caregivers for dependents' i guess we would have to make do with the current-workflow (which is mostly based on the BMJ model) but one can think of creating a separate window in the website for the 'Independent urban care-seeker' (Healthboard model) who can get in without the consent form bottle neck with a one-click disclaimer?