Understanding the complexity of clinical experience through

online ‘conversational learning’ networks

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

MEDICON, 2011, Mumbai, India

Understanding the complexity of clinical experience

I NEED A DEMO!!!!!!!!!

"A 23-year-old man presented to his physician 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.08.2009.2221

Conversational LearningA bit more details regarding the patient’s history

No significant medical history

Associated fever?Characteristics?

Temp- 37.9°C, Pulse -84/min, BP normal, Soft, non-tender lymph nodes palpable at cervical, axillary, inguinal..

Testicular examination Good thinking.

Was Normal

Normal Lab values provided

Race? Smoking Drug history? take out one node for H/P

node biopsy no lymphoma. Reactive hyperplasia only. Bone marrow biopsy appeared reactive only too.

connective tissue disease may be a possibility?

Patient’s CT scan uploaded showing B/L Pl effusion & consolidationhis condition

deteriorated with fever, fluid retention, hypoalbuminaemia . 2 wks. into hosp. stay pruritic maculopapular rash over upper limbs

Chronic Myeloproliferative Disorder ? The discussion continues….

Tiny.cc/bkdq3Tiny.cc/bkdq3

AIMS and OBJECTIVESAIMS and OBJECTIVES

Conversational learning toward clinical problem solving.

Web based Platform for communication between multiple levels of learners.

A 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 diseaseOver 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.

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:

Health-professionals Patients and their relativesAnyone who uses the web and has a user name

• Study platforms: Web forums, Peer-reviewed journals, Emailing lists, Rural Remote Online Health Care.

• Approaches :

Web based manual collection of data Accurately modeling patient experiences Discussions on relevant themes.

Analysing the data without stressing on numbers or statistics

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

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

Unravel Key Learning Points BY Both

Utilizing Background Knowledge

Learning to operate online search engines

Which adds to their foreground knowledge

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

Asynchronous, multi-user learning interface

Largely non-linear

Application of structured information to real life clinical cases

Presence of human bias

Large bulk of narrative data which was difficult to manage in print-age but is largely manageable in web space.

The internet is a rich source of 'patient narrative data' that can be mined effectively.Improve health-care through clinical problem solvingPromote transparency in health care and qualitatively study its processes

Mushrooming of destructive feedback platforms

Overly concerning the patient and caregiver about the health-care process.

Breaches of privacy 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