Understanding the complexity of
clinical experience through
online ‘conversational learning’
Bera Kaustav, 4th Semester MBBS, Medical College
Biswas Tamoghna, 8th Semester MBBS, Medical
Biswas Rakesh, Professor, Department of Medicine,
People’s College of Medical Sciences, Bhopal
MEDICON, 2011, Mumbai, India
Understanding the complexity of
"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
(BMJ Case Reports)
BMJ Case Reports 2010;
A bit more details
regarding the No significant medical history
Temp- 37.9°C, Pulse -84/min, BP normal, Soft, non-
tender lymph nodes palpable at cervical, axillary,
Associated fever? inguinal..
Normal Lab values provided
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….
rash over upper limbs
AIMS and OBJECTIVES
ØConversational learning toward clinical
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
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
The rest, as they say, unfortunately, is 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
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
• 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
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
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-
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
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