Best practices in Learning / mastering clinical subjects in MBBS course

1. Best practices in Learning / mastering clinical subjects in MBBS course Prof. M. Daud Khan Dec.17. 2013

2. Goal & Objective • 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. Partnership: Based on Trust Students Faculty Parents

3. Scope & Purpose • Focus on emerging concepts in medical education & clinical practice. • Focus on strategies on how to adopt best practices in PIMC

4. The dream, the ultimate goal

5. Mission statement

7. Introduction The Knowledge Triangle Attitude (Affective domain) Knowledge (Cognitive domain) Skills (Psychomotor domain)

8. Introduction

9. Stages of Maturation Dependence Dependence Inter dependence

10. Principles of Andragogy ( Adult Learning) Knowles six principles: • Adults are internally motivated and self directed • Adults bring life experiences and Knowledge to new learning environments. 3. Adults are goal oriented 4. Adults are relevancy oriented 5. Adults are practical 6. Adult learners like to be respected

11. Andragogy Types 0f adult learners • Active learners • Reflective learners • Theoretical learners • Pragmatic learners

12. Pedagogy vs Andragogy • Andragogy • Learner is experienced • Learner is • Independent • Curriculum is more flexible and learning is need based • Students are performance centered • Learning is logic and relevance oriented • Pedagogy • Learner is Raw • Learner is • Dependent • Curriculum is well structured and rather rigid • Students are • Subject centered • Learning is not logic or relevance oriented

13. Class room teaching( LMS) • 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 environment Active learning Feed back Evaluation ( formative And Summative)

14. “I never try to teach my students any thing. I only try to create an environment where they can learn” Albert Einstein

15. SPICES Model of Medical Education • Student-centred ---Teacher-centred • Problem-based---- Information-oriented • Integrated -----Discipline-based • Community-based ----Hospital-based • Elective ----Uniform • Systematic ---Apprenticeship

16. Learner centered - benefits • 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

17. Contents divided into three categories • Must learn • Useful to learn • Interesting / Nice to learn

18. 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.

19. 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.

20. 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.

21. 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

22. Education is Changing from Socratic Methods to Cyber Learning

23. 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.

24. Med NET ; Opportunities • Broadband network • Link medical schools, hospitals, public health centers • For Tele-education Telehealth Bio-informatics Research Grid

25. Bed side teaching, Learn from your Patient. • 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 Listen patiently & carefully Record Clarify Cross questions

26. Types of Diseases • According to Causes: • Infectious/ Communicative diseases • Non Infective Diseases( NCDs) • Life style Diseases • Deficiency Diseases • Hereditary Diseases • Genetic Diseases

27. History taking and examination: • 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

28. Systemic 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

29. Relevant investigations Basic data: • Urine • CBE • Other system based essential investigations ( Lab., Radiological, Ultrasonic, 3 Ds, etc.) • Data Synthesis • Data Analysis • Arriving at Final Dx.

30. Co relation between theory and practice • 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

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

32. Management In Partnership with Patient/ Family Consent form Invasive Non Invasive Urgency Safe Efficient Effective Affordable

33. Prognostication

34. Preventive strategy

35. Management • Discharge & Follow up • Home treatment • Domiciliary support • Letter to primary physician • Follow up • Transport support

36. Management • Record keeping • Statistical analysis • Research • Publication • Quality Assurance • Internal Audit • External audit • Cost Analysis Quantity Quality Customer’s satisfaction

37. Bereavement Empathy Kindness Compassion

38. Management • Monthly Mortality conference • Analytical review • Negligence • Errors of Judgment • Letigations • Lessons learnt • Quality management

40. 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

41. 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

42. 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

43. Old world: Doctors practice primarily as individuals New world: Doctors work predominantly in teams Role of Doctor is Changing Dr.T.V.Rao MD

44. Old world: Source of knowledge is expert opinion New world:Source of knowledge is systematic review of evidence Definition of Knowledge is Changing

45. The Learner Is the Center

46. CME Mission To providing medical education programs that are responsive to the needs of physicians and that offer opportunities for ongoing intellectual stimulation and professional renewal.

47. 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

48. 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.

49. Computer make the Diagnostic-Therapeutic Cycle,Simplified Data collection: -History -Physical examinations -Laboratory and other tests Information Data Decision making Patient Therapy plan Planning Diagnosis/assessment

50. 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.