Conversational learning among medical students: harnessing the power of web 2.0 through user driven healthcare.

The prevalent system of Undergraduate Medical Education in India by and large thrives on a system of didactic lectures or antiquated textbooks based teaching-learning rather than dynamic patient based interaction. Couple that with minimal motivation and future incentives for students pursuing undergraduate research as well as the lack of formal training, a graduate medical doctor is not equipped with the basic mandatory skill set of appraising available evidence for treating patients in his practise.[1]

While lack of time and incentives are not an insurmountable roadblock, what further complicates the situation is the failure to find like minded academic peer groups and the absence of mentors which really dent the interest of even students ready to break through the barriers.

The model of User Driven Healthcare (UDHC)[2] has been developed harnessing the power of Web 2.0, where social media, dynamic interaction and academic learning all join forces to not only better patient care but improve medical student learning. User narratives report heightened learning experiences, stronger confidence in decision making, growth monitoring and also the ability to inculcate learning based on real world scenarios with a tangible consequence.

This not only forces the student to think on his feet but also allows him to develop confidence in his decision making process especially with the gratification of knowing that his management strategy can be used effectively in an actual setting.

The UDHC model is an asynchronous care giving, collaborative and conversational learning network[3] between ‘users’ who are medical students, health care professionals as well as students across a web based eHealth system. The ‘users’ generate the flow of information that ‘drives’ the network. This model of learning transcends geographical and cultural limits by taking advantage of social networking and collaboration sites like Facebook, Twitter and Wikipedia as well as integrating it with a fully functional personalised patient portal.[4]

The backbone of the system is formed by the ‘virtual volunteer physician’ network who cater to the cases, consisting of experienced physicians along with medical students. The system links them to patients in the vast underrepresented rural areas[5] through data inclusive of the patients’ narrative of their problems, workups by local practitioners and relevant investigation reports sent directly by patients or with the help of local social workers.

The patient information collected, is first anonymized by assigning scientific botanical names (mashed up with geolocation) in the eHealth system. The system with its wide volunteer based network of medical professionals discusses, resolves and shares pertinent management approaches along with sharing evidence based approaches while weighing the pros and cons of each to reach to a solution most applicable to the patients’ needs, wishes and availability. Once solved the new case is sent a solution to the care seeker and is stored as another practice based evidence solution that can be used for future case matching.

While one arm of the network focuses on improved patient care to the underserved rural population of India, the impact on medical students is an equal if not greater function of the UDHC system. Utilising the tools made available via social networking and discussion groups with a wide variety of experienced doctors as guides directing the dialogues and analysis of evidence collected by students and members, the system allows a systematic conversational and problem based learning, through learning about patient care as well as searching for and selecting the best evidence based care applicable to resource poor settings. Students not only are an active component of the discussions, but the case based discussions slowly unfold around the students’ perspective and their responses as they deliberate among themselves as well as specialists in the field who pipe in with their own inputs too, without driving the students towards any particular path or end goal. The asynchronous and non-rigid conversational learning is the highlight of the system as it fosters arguments and counter arguments with students reading up on the requisite literature to give credence to their viewpoint. At the end of it all the co-ordinator or the teacher moderator sums up all the opinions on the basis of available evidence and comes up with a collaborative management plan.

This allows a unique system of learning through real world patients, it also teaches the students how to critically appraise available evidence along with being a part of the management process. The symbiotic process is the one that drives the system forward, as starting from patients who want a solution to their ensuing problem to a medical professional who wants a second opinion, it is an interface that builds on one another. The discussed cases can be sent as case reports to journals which serve as an added incentive to the students who receive a tangible benefit for being an interested component in the process.[6]

Although the final management decision is taken by the primary care physician and the medical students are observers in the system, the varied insights they provide along with evidence based informational support helps him in delivering the final information to the patient. The students meanwhile enjoy a ringside view of the entire process of decision making in healthcare complete with its good and bad outcomes that raises in them the necessary emotions and empathy which promotes a holistic approach to learning through appreciative inquiry, rather than the prevalent rote textbook based approach.

There are considerable limitations to such networks, the foremost amongst them being sustainability. Being a system driven by volunteers, monetary concerns as well as a sustained network of physicians willing to provide time for such a venture is noteworthy. Patient identity and security are paramount, all efforts are continually directed towards the anonymization as well as removal of any links to the patients’ identity in keeping with HIPAA guidelines. Furthermore, with limited time amongst students between coursework and research work, a continued problem-based learning approach may falter.

Over time, the network hopes to expand to every low resource setting globally. The system will assist physicians by predicting similar previously solved health cases from publicly available case history (BMJ etc) as well as existing Patient case history (referred as Patient Journey) to leverage their knowledge in solving the unsolved health issue. This prediction and recommendation feature will use Google Prediction service as the AI provider. A truly integrated conversational learning style hopes to be inculcated in students over the usual didactic lecture schemes usually practiced, in order to give students more insight to actual problems faced in practice.

Ross, S. (2011) A Lexicon for User-Driven Healthcare. International Journal of User-Driven Healthcare, 1(1), 50-54