Best practices in Learning / mastering clinical subjects

in MBBS course Prof. M. Daud Khan

Dec.17. 2013

Aim at creating the best possible learning and teaching / mentoring environment for medical students/graduates to enable & empower them to translate their dreams into realities.

Goal & Objective

Partnership:Based on TrustStudentsFacultyParents

Focus on emerging concepts in medical education & clinical practice.

Focus on strategies on how to adopt best practices in PIMC

Scope & Purpose

A highly motivated and responsible doctor,

equipped with necessary knowledge, skills and attitudes , committed to life long

learning and application of knowledge;

to meet the current and emerging global needs of patients and populations in a Kind ,

Caring and Compassionate

manner

The dream, the ultimate goal

We will try to educate students to become outstanding clinicians

who have the skills and passion to improve the health of the world’s

people through research, innovation, and leadership.

Mission statement

A set of basic competencies expected from a competent medical graduate ; Physician of

21st Century”Effective Communication.

Basic clinical skills.Using science to guide Diagnosis, Management,

Therapeutics & prevention.Lifelong Learning.

Self-Awareness, Self –Care & Personal Growth.The social & Community Contexts of Health Care.

Moral reasoning& Ethical judgment.Problem Solving.Professionalism

Leadership & Role Recognition.

The Knowledge TriangleIntroduction

Knowledge(Cognitive domain) Skills

(Psychomotor domain)

Attitude(Affective domain)

Acquisition of Knowledge, skill and attitude

Methods and processes of adult learning EvaluationLMS

Introduction

Stages of Maturation

Dependence

Dependence

Interdependence

Knowles six principles:1. Adults are internally motivated and

self directed2. Adults bring life experiences and Knowledge to new learning environments.3. Adults are goal oriented4. Adults are relevancy oriented5. Adults are practical6. Adult learners like to be respected

Principles of Andragogy ( Adult Learning)

Types 0f adult learners Active learners Reflective learners Theoretical learners Pragmatic learners

Andragogy

Pedagogy vs Andragogy

Pedagogy• Learner is Raw

• Learner isDependent

• Curriculum is well structured and

rather rigid• Students are Subject centered• Learning is not logic or relevance

oriented

Andragogy• Learner is experienced

• Learner isIndependent

• Curriculum is more flexible and

learning is need based

• Students are performance

centered• Learning is logic

and relevance oriented

Learning objective. Lecture plan and instructional

strategies. Expected outcomes Tutorial and small group discussions Seminars Symposia's Self directed learning Library E- learning

Class room teaching( LMS)

Class room environmentActive learningFeed backEvaluation ( formative AndSummative)

“I never try to teach my students any thing.

I only try to create an environment where they can learn”

Albert Einstein

Student-centred ---Teacher-centred Problem-based---- Information-oriented Integrated -----Discipline-based Community-based ----Hospital-based Elective ----Uniform Systematic ---Apprenticeship

SPICES Model of Medical Education

Anytime learning Any where learning Any number of times learning Customized to level of assimilation Individual or group learning Interactivity based learning – active

learning Enables group discussion across

geographical barriers. Adaptability and flexibility of the system

Learner centered - benefits

Contents divided into three categories

1. Must learn2. Useful to learn3. Interesting / Nice to

learn

Education Education in the largest

sense is any act or experience that has a formative effect on the mind, character or physical ability of an individual. In its technical sense, education is the process by which society deliberately transmits its accumulated knowledge, skills and values from one generation to another.

Act On Right to Education A right to education has been created

and recognized by some jurisdictions: since 1952, Article 2 of the first Protocol to the European Convention on Human Rights obliges all signatory parties to guarantee the right to education. At world level, the United Nations' International Covenant on Economic, Social and Cultural Rights of 1966 guarantees this right under its Article 13.

Traditional Methods of Teaching Teachers need to understand a subject

enough to convey its essence to students. While traditionally this has involved lecturing on the part of the teacher, new instructional strategies such as team-based learning put the teacher more into the role of course designer, discussion facilitator, and coach and the student more into the role of active learner, discovering the subject of the course.

What is Learning Is a relatively

permanent change in behaviour that comes about as a result of a planned experience Results from the interaction between what we already know, new information we encounter, and what we do as we learn

Education is Changing from Socratic Methods to Cyber Learning

Technology a boon to Education Technology offers

powerful learning tools that demand new skills and understandings of students, including Multimedia, and provides new ways to engage students, such as Virtual learning environments.

Med NET ; OpportunitiesBroadband networkLink medical schools, hospitals, public health centersFor

Tele-educationTelehealthBio-informaticsResearch Grid

Approach to patient. Greetings and introduction Permission for Hx taking and

examination History taking and examination: Present illness Past illness F.H Personal Hx Socio economic history

Bed side teaching, Learn from your Patient.

Listen patiently & carefullyRecordClarifyCross questions

According to Causes: Infectious/ Communicative diseases

Non Infective Diseases( NCDs) Life style Diseases Deficiency Diseases Hereditary Diseases Genetic Diseases

Types of Diseases

General physical Examination: Level of consciousness, level of

Orientation, Any sign of Pain and agony.

Pulse, BP, Skin color, cyanosis, anemia, jaundice, facial appearance, swellings, neck veins, pitting edema.

Lymph nodes Data collection, synthesis and

analysis arriving at History based DX

History taking and examination:

Exam. Of GIS Exam. Of RS Exam. Of CVS Exam. Of NS Exam. Of GUS Sensory organs Data Synthesis, Analysis and arriving

at Provisional DX

Systemic examination

Basic data: Urine CBE Other system based essential

investigations ( Lab., Radiological, Ultrasonic, 3 Ds, etc.) Data Synthesis Data Analysis Arriving at Final Dx.

Relevant investigations

Create a strong habit f co relating your patient S/S , and clinical findings with the typical book picture of the disease.

Note the steps of medical intervention. Note the steps of emergency treatment Note the indications and steps taken for

surgical intervention Explanation to patients /family and The

consent form Carefully read the details of surgical

intervention and co relate it with details in the book

Co relation between theory and practice

Emergency Non Emergency Indoor Out door Ambulatory/ non Ambulatory Criteria for admission Criteria for special care, ICU, Isolation

Management

Management Treatment plan

PrognosisMo

nitoring

progress

Discharge &

Follow up

In Partnership withPatient/ FamilyConsent formInvasiveNon InvasiveUrgencySafe Efficient EffectiveAffordable

Prognostication

Preventive strategy

Discharge & Follow up Home treatment Domiciliary support Letter to primary physician Follow up Transport support

Management

Record keeping Statistical analysis Research Publication Quality Assurance Internal Audit External audit Cost Analysis

Management

QuantityQuality Customer’s satisfaction

Bereavement

EmpathyKindnessCompassion

Monthly Mortality conference Analytical review Negligence Errors of Judgment Letigations Lessons learnt Quality management

Management

Why bother with the future?

The point is not to predict the future but to prepare for it and to shape it

Dr.T.V.Rao MD

Looking to the future: common mistakes

People consistently overestimate the effect of short term change and underestimate the effect of long term change.Ian Morrison, former president of the Institute for the Future

Dr.T.V.Rao MD

Bring in Change or You are Lost ?

If you think that you can run an organisation in the next 10 years as you've run it in the past 10 years you're out of your mind."CEO, Coca Cola

Dr.T.V.Rao MD

Role of Doctor is Changing

Old world: Doctors practice primarily as individuals

New world: Doctors work predominantly in teams

Dr.T.V.Rao MD

Definition of Knowledge is Changing

Old world: Source of knowledge is expert opinion

New world: Source of knowledge is systematic review of evidence

The Learner Is the Center

CME MissionTo providing medical education programs that

are responsive to the needs of physicians and that offer opportunities for ongoing intellectual stimulation and professional renewal.

Medical Informatics Medical informatics has

been also defined as the field that "concerns itself with the cognitive, information processing, and communication tasks of medical practice, education, and research, including information science and the technology to support these tasks

Health (Medical) Informatics a Rapidly developing science

Medical informatics is the rapidly developing scientific field that deals with resources, devices and formalized methods for optimizing the storage, retrieval and management of biomedical information for problem solving and decision making.Edward Shortliffe, M.D., Ph.D. What is medical informatics? Stanford University, 1995.

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Computer make the Diagnostic-Therapeutic Cycle,

Simplified

Patient

Data collection:-History-Physical examinations-Laboratory and other tests

Decisionmaking

Planning

Information

Diagnosis/assessment

Therapyplan

Data

About.comwww.about.com

The site contains the greatest collections of information on diseases and conditions on the Net. It spans the globe and provides interactive chats and forums for experts and patients to come together. This site not only directs you to outside sources, but also takes each topic and gives you the rundown from top to bottom.

Best Doctors    www.bestdoctors.com

Find the best doctors and provide the best content on a site that others can access free of charge. Founded by a man who was diagnosed with an inoperable tumor and wanted the best doctors to treat him, he set out to empower other patients through information.

Healthcommunities.com   www.healthcommunities.com

his site is specifically designed to give you disease-related information through what it calls channels. It's one of the most interactive medical portals on the Net, offering chats, discussion forums, and clinical trials. This site enables you to access the world of medicine in seconds.

  Health finder    www.healthfinder.gov

This government portal opens the world of Internet medicine. Whether it's through tools such as libraries, online journals, or medical dictionaries or hot topics that might interest you, this site delivers quickly and with reliability. A big bonus of the site is that it also provides content in Spanish.

InteliHealth    www.intelihealth.com

t's important for a portal to "have it all." This one is a good example. Whether it's drug information, a medical dictionary, or a rundown on a long list of diseases and conditions, Intelihealth is your gateway to top-notch information. It doesn't hurt to have Harvard Medical School's consumer health information tied to the site.

National Institutes of Health    www.nih.gov

Contain the leading collection of health research institutes in the world. Whether the topic is allergy and infectious disease or cancer, this is your gateway to health information. You'll find the latest in research and well-written fact sheets and brochures that reach out to inform all.

WebMD    www.webmd.com

One of the most heavily marketed portals on the Net, this site stands up to most of the hype. It's nicely divided for different audiences, ranging from patients and doctors to physician assistants to health teachers. It has a robust television service that allows you to watch broadcasts on different health topics.

Thank You