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Understanding the complexity of clinical experience through online

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					            Understanding the complexity of
              clinical experience through
            online ‘conversational learning’
                        networks



                               Bera Kaustav, 4th Semester MBBS, Medical College
                               Kolkata
                               Biswas Tamoghna, 8th Semester MBBS, Medical
                               College Kolkata
                               Biswas Rakesh, Professor, Department of Medicine,
                               People’s College of Medical Sciences, Bhopal


MEDICON, 2011, Mumbai, India
Understanding the complexity of 
      clinical experience

                           "A 23-year-old man
             I NEED A      presented to his physician
           DEMO!!!!!!!!!   with swellings behind his
                           ear. He gave a 3 week
                           history of night sweats, 4
                           kg weight loss over 3
                           months, multiple swollen
                           lymph glands, and mild
                           persistent headache. He
                           was referred urgently to
                           hospital."
                           (BMJ Case Reports)
                           BMJ Case Reports 2010;
                           doi:10.1136/bcr.08.2009.22
                           21
                  Conversational Learning
 A bit more details 
 regarding the                                                          No significant medical history
 patient’s history
                                                              Temp- 37.9°C, Pulse -84/min, BP normal, Soft, non-
                                                              tender lymph nodes palpable at cervical, axillary, 
                          Associated fever?                   inguinal..
                          Characteristics?
                                                            Normal Lab values provided
    Testicular 
    examinatio            Good thinking. 
    n                     Was Normal              node biopsy no lymphoma. Reactive hyperplasia only. Bone 
                                                  marrow biopsy appeared reactive only too.

Race? Smoking Drug 
history? take out one        connective tissue                                      Patient’s CT scan uploaded 
node for H/P                 disease may be a                                       showing B/L Pl effusion & 
                             possibility?             his condition                 consolidation
                                                      deteriorated with fever,
            Chronic                                   fluid retention,
        Myeloprolifera                                hypoalbuminaemia . 2
        tive Disorder ?                               wks. into hosp. stay           The discussion continues….
                                                      pruritic maculopapular
                                                      rash over upper limbs
                                                                                    Tiny.cc/bkdq3
  AIMS and OBJECTIVES
ØConversational learning toward clinical 
 problem solving.


ØWeb based Platform for communication 
 between multiple levels of learners.


ØA Focus on Patient narrative and Empathy.
“I had returned home to England, precipitously
from a trip to India, with high fevers, which rose
to 105 degrees; a terse ‘Take Paracetamol’ being
the only instruction from the GPs at our local
clinic.”
Days of fever later, my mother was finally
advised by a friend to ring emergency services,
and the doctor on call did not hesitate to call an
ambulance.

The rest, as they say, unfortunately, is history,
my history
Since my eighteenth birthday I have watched
this body undergo symptoms lifted off the pages
of any basic book on this disease
Over the years I have experienced fatigue,
mouth ulcers, joint pains, lymphedema,
lymphadenopathy, pleural and pericardial
effusions, Sjögren's, Raynaud’s, hair loss, brain
fog and depression.
Not to mention the most banal of all – pain.

I say banal, because it is an almost humiliating
experience to have to describe pain on a
numbered level of 0-10.
The flow of information..
The term 'User' is a label
that includes:

ØHealth-professionals
ØPatients and their relatives
ØAnyone who uses the web
and has a user name
• Study platforms: Web forums, Peer-reviewed 
  journals, Emailing lists, Rural Remote Online 
  Health Care.
• Approaches :

  v   Web based manual collection of data
  v   Accurately modeling patient experiences
  v   Discussions on relevant themes.
v Analysing the data without stressing on numbers or    
  statistics

v Learning through free flowing conversations without 
 any rules imposing a constant structure or narrative

v Learning to solve real life clinical problems through a 
 step by step approach
Rural online clinical problem Solving
as a Medical student we learn to


v unravel Key learning Points
   By Both
              Ø Utilizing Background Knowledge

              Ø Learning to operate online search engines
                    
                        q Which adds to their foreground knowledge

                        q Also prepares us for medical uncertainties beyond
• Resources for other health professionals
• Support and engagement for fellow doctors
• Promotes interdisciplinary interest for life-
  long problem-based-online-learning



These resources are essential for continuing
  health professional education. 
Strength             Weakness               Opportunities          Threats


üAsynchronous,       § Presence of          üThe internet is a     §Mushrooming of 
multi-user learning  human bias             rich source of         destructive 
interface                                   'patient narrative     feedback platforms
                     §Large bulk of         data' that can be 
üLargely non-        narrative data         mined effectively.     §Overly concerning 
linear               which was difficult    üImprove health-       the patient and 
                     to manage in print-    care through           caregiver about the 
üApplication of      age but is largely     clinical problem       health-care process.
structured           manageable in web      solving
information to real  space.                 üPromote               §Breaches of 
life clinical cases                         transparency in        privacy and 
                                            health care and        confidentiality 
                                            qualitatively study 
                                            its processes
No external funding received
•      Dr. Amy Price, University of Miami, USA
•      Dr. Carmel Martin, Northern Ontario School of Medicine, Canada
•      Dr. Ravi Ramakantan, Former HOD, King Edward Memorial Hospital, Mumbai, India.
•      Dr. Pranab Chatterjee, Medical College Kolkata, India

				
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