Thursday, April 23, 2015

Medical Electives in ‘Patient information communication management’




Methodology:

100% practical hands on learning which will be documented and stored in paper as well as archived online for formative assessment at the end of the course (also see section on 'assessment' and 'course-content' below and Telehealth center workflow plan)

Objectives of the Course:

Train course participants to effectively utilize Information and Communications Technologies ICT toward applying information driven clinical problem solving for improving patient health outcomes in the community.

Become efficient tele-health practitioners by collecting patient information through telephone and email and further processing of the data by gathering and adding evidence based solutions from medical consultants
using store and forward techniques with e-mail, phone as well as face to face meetings.

Become efficient health journalists by researching and writing up case studies around interesting clinical problems as well as write health reviews to spread health awareness in local languages.

Duration: Assessment driven

Assessment of Course participants:

A system of formative Assessment will evaluate student generated data/learning points arising from their experiences during the course of their online learning interactions with virtual patients and faculty.This means there will be multiple weekly assessments and validation/corrections of the candidate's learning through a dialogue between the facilitator and the student all of which will be recorded on the web site. At the end of the course all these formative assessment data shall be qualitatively
analyzed for an overall assessment. There will be no formal exam/summative assessment at any point of the course


Course Content and learning outcomes:


At the end of the course students will be able to obtain

1. An overview of clinical problem solving
(The student will learn to prepare a patient problem list, identify an anatomical and
etiological diagnosis and as one of the stakeholders in the patient’s care facilitate a
positive relationship between the patient and his/her primary-secondary-tertiary health
professionals through efficient and optimal knowledge sharing between all these
stakeholders)

2. Master Clinical history taking and examination

(The student will learn to assist and facilitate the process of examining the patient’s
narrative and other information obtained through physical examination with and
without the help of modern technological tools such as radiological imaging and
laboratory parameters reflecting the patient’s internal chemistry)

3. Master the Essentials of anatomy, radiology, physiology and biochemistry
(This is necessary to reach an anatomical, functional and molecular diagnosis for a
given clinical problem at hand. Students will be taught to discover these essentials
while practicing online clinical problem solving beginning with the case at hand and
traveling right down to basic anatomy, physiology and biochemistry in context of case-based
information collected from clinical, radiological and laboratory data.)

Students will learn an approach to solve problems around diseases of:

Ø Cardiovascular system (Cardiology)
Ø Respiratory system (Pulmonology)
Ø Renal and genitourinary system (Nephrology, Urology)
Ø Hematological system (Hematology, Immunology)
Ø Nervous system (Neurology)
Ø Gastrointestinal system (Gastroenterolgy)
Ø Reproductive system (Men’s and Women’s health)
Ø Skin and Integumentary system
Ø Cognitive system (Psychology, Psychiatry)
Ø
Musculoskeletal system (Rheumatology, Orthopedics)
4. Master Essentials of pathology and microbiology
(Necessary to reach an etiological diagnosis and students will be taught to discover these in
the context of solving their patient’s problems)
5. Master Essentials of Pharmacology, EBM and Net-searching
(Necessary to formulate a solution and treatment plan and students will be taught to discover these in the context of solving their patient’s problems)

Course Faculty: Will comprise of Medical Consultants and Professors

Onsite: 9-4 PM and virtual 24x7



 Project Goal: Finding the best way to train a Community health worker well equipped to handle a variety of patient requirements

Eligibility criteria for project participation: Dreams Big (beyond the Nobel), Good computer and language skills (lives online 24X7 and has own portable device and data card connection), Entrepreneurial mindset

WHY and WHAT?

The answer comes from a parable that's very common in the public health community. This is a parable of three friends. Imagine that you're one of these three friends who come to a river. It's a beautiful scene, but it's shattered by the cries of a child, and actually several children, in need of rescue in the water. So you do hopefully what everybody would do. You jump right in along with your friends. The first friend says, I'm going to rescue those who are about to drown, those at most risk of falling over the waterfall. The second friend says, I'm going to build a raft. I'm going to make sure that fewer people need to end up at the waterfall's edge. Let's usher more people to safety by building this raft, coordinating those branches together. Over time, they're successful, but not really, as much as they want to be. More people slip through, and they finally look up and they see that their third friend is nowhere to be seen. They finally spot her. She's in the water. She's swimming away from them upstream, rescuing children as she goes, and they shout to her, "Where are you going? There are children here to save." And she says back, "I'm going to find out who or what is throwing these children in the water." From Rishi Manchanda’s TED talk: http://www.ted.com/talks/rishi_manchanda_what_makes_us_get_sick_look_upstream/transcript?language=en#t-520480


An ideal community health worker may need all the three attributes described in the parable above?
Current day modern medicine and all our medical education is mostly Hospital Based and focused on Rescue and this is one of the characteristics we can expect in most of our community health workers but again training them to the desired levels can be challenging though not impossible especially with the help of technology one can see this being ushered in through 'home-healthcare?

Rescuer Attributes/Myer’s Brigg’s Typologies: Sensory reflexes, Feeling

Raft building in healthcare has been delegated to administrators, policy makers and politicians but raft building needs to begin in the community and the CHW is well positioned to initiate it again with the help of technology that has the power to connect him/her with decision makers?

Raft Builder Attributes/Myer’s Brigg’s Typologies: Extroverted, Sensory, Thinker, and Judgmental.

Upstream swimmers in Healthcare are very few and are generally thought to be taken up by people labelled health activists but this is a role often left to patient’s relatives or even patients themselves. The role of a CHW here is perhaps paramount?

Upstream swimmers Attributes/Myer’s Brigg’s Typologies: Intuition, Thinking, Feeling, Perception

I have used Myer Brigg's typologies and anyone wishing to figure out their own typology can just click on this link:http://www.humanmetrics.com/cgi-win/JTypes2.asp#questionnaire 

There are 72 yes/no questions but once you answer them it may be fun to diagnose your own typology and see what kind of community health work you are suited for?

Friday, April 10, 2015

Global Health Case Reports Template

We have begun developing the Global health case reports campaign on a war footing in collaboration with the BMJ Case Report Editorial board who have been gracious enough to peer review our pre-publication drafts and we are looking forward to more Global Medical Elective students joining  our program with us here http://promotions.bmj.com/jnl/bmj-case-reports-student-electives/
in Bhopal.

Pasted below is a Global Health Case Reports Template (also downloadable from the BMJ Case Reports web site if you google for it) to guide our prospective authors:






TITLE OF CASE Do not include “a case report”



150 WORD SUMMARY Focus the summary on the case or the Global Health problem that you want to discuss. You may wish to give an indication of the severity of the case or the scale of the problem







CASE PRESENTATION Explain the relevant features of the case in sufficient detail so that someone in another country would have a good understanding of who you are describing. Go back to the history of the problem, and forward to the outcomes that have resulted










GLOBAL HEALTH PROBLEM LIST Just list the problems raised in the case. These will be discussed more precisely in the section below







GLOBAL HEALTH PROBLEM ANALYSIS The problem analysis directly addresses each problem in your case that needs attention to achieve a better health outcome for the patient. This should be a well-researched and balanced account. Find and appraise all the relevant medical, epidemiological and socio-political literature. Explaining missing epidemiological data is important in the appraisal of the literature. Make sure you discuss all the relevant aspects of the case, including important anthropological, cultural and community issues









LEARNING POINTS/TAKE HOME MESSAGES 3 to 5 bullet points – this is a required field and should be directly relevant to the Global Health issues being discussed






REFERENCES Vancouver style





FIGURE/VIDEO CAPTIONS Figures should NOT be embedded in this document




PATIENT’S PERSPECTIVE Optional but strongly encouraged




Copyright Statement

I, [INSERT YOUR NAME IN FULL], The Corresponding Author, has the right to assign on behalf of all authors and does assign on behalf of all authors, a full assignment of all intellectual property rights for all content within the submitted case report (other than as agreed with the BMJ Publishing Group Ltd) (“BMJ”)) in any media known now or created in the future, and permits this case report  (if accepted) to be published on BMJ Case Reports and to be fully exploited within the remit of the assignment as set out in the assignment which has been read. http://casereports.bmj.com/site/misc/copyright.pdf.

Date:



PLEASE SAVE YOUR TEMPLATE WITH THE FOLLOWING FORMAT:

Corresponding author’s last name and date of submission, eg,

Smith_March_2014.doc


·         This template is for case reports with a focus on Global Health; you will need to submit your completed template online http://mc.manuscriptcentral.com/bmjcasereports
o    You will be asked for more detailed information on submission where you can also upload images, multimedia files, etc
o    Further details are available in the Instructions for Authors

PATIENT CONSENT
·         You must have signed informed consent from patients (or relatives/guardians) before submitting to BMJ Case Reports. Please anonymise the patient’s details as much as possible, eg, specific ages, ethnicity, occupations. For living patients this is a legal requirement under the UK’s Data Protection legislation; we will not send your article for review without explicit consent from the patient or guardian. If the patient is deceased the Data Protection Act does not apply but authors must seek permission from the next of kin. If you cannot get signed consent from the next of kin, the head of your medical team/hospital or legal team must take responsibility that exhaustive attempts have been made to contact the family and that the paper has been sufficiently anonymised not to cause harm to the family. You will need to upload a signed document to this effect.
o   Further information is available online
o   Consent forms are available in several languages

PUBLICATION ETHICS
·           BMJ takes publication ethics very seriously and abides by the best practice guidance of the Committee on Publication Ethics. BMJ is a member of CrossCheck by CrossRef and iThenticate which is a plagiarism screening service that verifies the originality of content submitted before publication. iThenticate checks submissions against millions of published articles, and billions of web content. Authors, researchers and freelancers can also use iThenticate to screen their work before submission by visiting www.ithenticate.com
    • Every article is screened on submission and any that is deemed to overlap more than trivially with other publications will be rejected automatically with no right of appeal

Monday, March 30, 2015

Frequently asked questions for the BMJ Medical Elective

Could I have more information as to how to go about applying for this opportunity? This doesn't appear to be mentioned in the information provided here: http://promotions.bmj.com/jnl/bmj-case-reports-student-electives-2/

As far as a formal application is concerned we do not require any formal application beyond an email from our side although we are ready to sign any official documents necessary for VISA processing etc. Medical Students and interns should make sure to share with us a permission letter granting them leave from their parent institution during their proposed time of elective visit to our institute where they shall engage with our patients.

What is the name, physical and postal address of the hospital we will be attending?

Department of Medicine,
Kamineni Institute of Medical Sciences,
Narketpally,  Near Hyderabad,Telangana
Email:rakesh7biswas@gmail.com


Can we get an idea about the cost of accommodation, meals and local travel? 


We shall be introducing you to our students here (on email) as they can answer some more specific queries about the cost of food, local travel and accommodation although our guess is that it will be less than the approximate 10-20$ per day mentioned in the website here: http://promotions.bmj.com/jnl/bmj-case-reports-student-electives-2/

Is this more of an online learning program? Can you share links to a workflow or curriculum? 

Ours is not just an online but a blended (offline-online) learning program and most of your day will be spent in the wards interacting with the patients collecting data for your case study and later evenings and nights would be spent in uploading and discussing them online. Here's http://userdrivenhealthcare.blogspot.in/2013/07/workflow-for-medical-learning-elective.html more detail about our workflow. 

The advantage that you will have over our medical students here is that you can focus solely on our medicine patients 24x7 and not get bogged down by the demands of other subjects in the curriculum. :-)

Here's some past lecture http://www.pitt.edu/~super1/lecture/lec50661/001.htm about the data collection and here's http://www.pitt.edu/~super1/lecture/lec53671/002.htm more about how to write your publishable case-report (which is the intended outcome of your entire learning experience and naturally as you would be working with many cases each day we would expect a sizable number of write ups around those cases from you). :-) 

We encourage our students to first record their cases in a raw format in a blog after taking their informed consent in a form downloadable herehttp://www.udhc.co.in/STATICS/docs/udhc-bengali.pdfhttp://www.udhc.co.in/STATICS/docs/udhc-hindi.pdfhttp://www.udhc.co.in/STATICS/docs/udhc-english.pdf  (links to the consent form in Bengali, Hindi, English) other than collecting their consent in the BMJ format here: http://authors.bmj.com/submitting-your-paper/patient-consent-and-confidentiality/

More here: http://userdrivenhealthcare.blogspot.in/2016/08/guidelines-for-online-health-record.html about how to prepare the case initially in the raw format and the steps to convert it into a published case-report. 

More links below showing the web based log books of our recent BMJ elective students :

http://classworkdecjan.blogspot.in/2016/12/about.html


http://bmjcaselogvivek.blogspot.in


Below are links to some of the BMJ case reports published by our elective students:


http://casereports.bmj.com/content/2018/bcr-2018-224166.full?keytype=ref&ijkey=JqzW1SExmrndyVO


https://casereports.bmj.com/content/12/3/e227118.full


https://casereports.bmj.com/content/2016/bcr-2015-211127.full?keytype=ref&ijkey=GrkuudGK4zzuAwk



-The specific things you will require me to be learning?

Principles of a systems approach to health-care through

a) clinical data capture (Bedside Clinical methods as well as Imaging and Labs) followed by sharing the de-identified raw data as a real time case report toward further clinical data processing (see "b" below)



b) clinical data processing through an online discussion with our web based network of health professionals in a "global elective learning" group.

and

c) clinical outputs to our primary beneficiaries of medical-education (also known as patients). 


The outputs (in terms of patient management) will be chiefly provided by the supervisor who often has to tailor them to match available resources (as the patients are often from disadvantaged communities) and the student is expected to observe, experience and reflect upon the consequences and/or causation of health disadvantage and share them with our team in the form of written text in our online forum.

We sincerely believe that "clinical Informatics" is all about shared decision making through a robust information communication framework between our health professional colleagues and patients and all other stakeholders in healthcare.

-Supervision arrangements, including how you will supervise me (observation, allocation to other supervisors, discussion etc), and how you will assess my performance.


Ours is a Blended learning program and other than the face to face interactions and observations in the hospital and community settings, the student will be formatively assessed as well as supervised through our online community where all our cases are discussed regularly (and an online learning-portfolio for the student can be generated from the student's learning interactions). The student will be encouraged to share his/her searches, reflections and thoughts around each case with a larger community so that his/her inputs can actually benefit the patient in terms of generating interest and quality care from all those involved with the patient (offline and online).

-Requirements of me (pre - placement preparation, documents and equipment you require me to bring etc)


As this is a blended learning program the student must have a laptop with an internet connection to enable him/her to communicate with our network. The student's own pre-placement research and thoughts will be discussed and answered in advance by the supervisor to ensure a better mental preparation for the course. The students institutional identity card and an official permission letter from the institute will be sufficient for any verification that may be necessary.

Wednesday, February 11, 2015

Medical Elective learning points from our recent student visitors February 2015

Bhavik Shah is a final year MBBS student from BJMC, Ahmedabad and Chase Yarbrough is a PGY2 resident in Harvard Medical School receiving dual training in Medicine and Pediatrics as part of a 5 year program. We had the pleasure to learn with them last week during their visit to our institute for the BMJ Cases Medical Elective and following are some of our learning insights around the differences between the US medical education system and Indian Medical education system shared so that we can discuss how to optimize the upsides and downsides of both.
1) According to Chase Yarbrough, the US medical graduate UMG finishes all their theory lecture classes by the end of second year and is expected to spend the rest of their 2 years in the wards and take 'ownership' of their patients, presenting and discussing their cases in the wards and altogether getting involved with the treating team. The Indian medical graduate IMG on the other hand is expected to attend lecture classes throughout the 4 years and taking 'ownership' of their patients is never encouraged for most part of their clinical attendance. The concept of 'Patient Ownership' (or perhaps a better label is 'developing a continuous and positive relationship with patients' ) is something that the Indian Medical graduate learns much later in his/her life as a clinician and many who are not fortunate enough to be part of a 'patient centered learning ecosystem' never feel the need to learn it?
2) The Indian Medical graduate IMG is encouraged to be a walking and talking encyclopedia of facts while the US medical graduate is taught to just 'look-up' what they may not know.
3) In their lecture-presentations the Indian Medical graduate, Bhavik highlighted terms such as radio-radial-femoral delay that are often supposed to be important exam questions here, but Chase felt that it may not be important to hammer every detail into the minds of students but rather encourage them to look-up things and keep learning.
4) Our senior resident Dr Nadiya who also joined us this week, (she has recently completed her MD residency from PGIMER, Chandigarh and MBBS from JIPMER) commented that a US medical graduate UMG is more mature to handle things in the above manner and the IMG may not be expected to know these. Medicine requires the ability to juggle both humanities and science and most of our IMGs are already specialized in science before they apply for medical school whereas the UMG doesn't specialize at a high school level. Chase had finished a degree in Computer science and was a high level coder before he became a medical student and one can argue that it need not have made him better able to handle medicine (other than the informatics component of medicine)? Also how do we explain why Bhavik appeared to be handling so well all the complex patient issues that we generally do not expect from an MBBS student in India?
5) Words that we take for granted here in India such as ragging, mugging, whatsapp etc were being heard by Chase for the first time. :-)

In spite of all these differences we were pleasantly surprised to find that both the IMG and UMG teamed up to deliver a splendid performance over their 1 week stay with us.

Other than their their involved participation with our patients from 9:00 AM to 4 PM, and the evening-lecture-classes they took for our students in LNMC (https://www.youtube.com/watch?v=v1m1hbxmdO8), they also made a great clinical presentation on one of our patients of severe mitral stenosis and aortic regurgitation (https://www.youtube.com/watch?v=NOn59DGoCSI, https://www.youtube.com/watch?v=NzNpJEWcrjw). Their demonstration (as a result of their internet searching) of other viable low cost options to tackle the social issues around the patient's problem went a long way toward helping the patient. I can't imagine any PG student in a premier institute in India going 'beyond' the discussion of 'disease related issues' and 'standard approaches to further management,' in their presentations. Chase and Bhavik's involvement with all their cases and their presentation went far beyond my expectations. :-)
So how do we create an ideal global physician with the best attributes from different learning cultures? Bhavik and Chase may have found their own way toward an answer. Bhavik hopes to do a residency in internal medicine in India and then travel the globe with the orgranization 'Doctors without borders' ( aka MSF) and Chase hopes to, after finishing his 5 year residency in internal Medicine and Pediatrics from Harvard, serve in rural India and become a rural doctor for the rest of his life.
Personally i have gained more from their visit than what they may have gained from us.