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Archive for October, 2011

Creating secondary learning resources from the BMJ Case Reports through social-media based discussion groups

28 Oct, 11 | by Emma

Social Networks like Facebook and the recently unveiled G+ besides the obvious connotations of helping to connect with friends, family and co-workers, have wider and rather far reaching implications in the domain of Healthcare which is traditionally dictated by strict one to one communication between the attending doctor and the patient.

However with the Internet being a vast treasure trove of each and every kind of resource, reliable information is not solely confined to the medical tomes available to practicing physicians. With the changing times the modern age physician too needs to adapt. Hence the term user is confined not only to the patient but includes medical students, physicians, nurses and allied healthcare workers. In fact it is anyone who carries a fingerprint in the virtual domain and who has a certain agenda in the conversation that occurs.

Tabula Rasa, Latin for clean slate clearly exists to present a platform for doctors, medical students , patients and ‘users’ on the popular social network Facebook. Anyone who has a Facebook user name can join in the discussions. (

What sets User Driven Health care (UDHC) apart from Evidence Based Health Care (EBHC) is that while EBHC solely concentrates on pre-existing data or literature to reach a conclusion, UDHC tries to propagate both pre-existing evidence as well as individual inputs from doctors or people who may have prior experience in contextually dealing with the same topics.
The UDHC hypothesis is that interactive conversational learning between multiple stakeholders in health care (such as patients and health profession students) who present a topic related to a case uncertainty or a general uncertainty around treatment decisions can create stimulating secondary learning resources in medicine.

From the perspective of a medical student, this is, learning without any pre-existing structure or a rigid framework. It enables them to face real life clinical problems and solve them in a step by step approach. By not following any particular set of rules it simulates the uncertainty that they may face as practicing physicians.

One such case involving “A Young Man with Fever and Lymph Node Enlargement” in the BMJ case reports was chosen for an interesting discussion. (
The clinical problem is gradually opened, layer by layer, through the discussions generated by the participants and the original poster. The responses from the participants sometimes rely on their background knowledge and sometimes draws on foreground knowledge with evidence based links to further information supporting their contention. Responses have been edited for relevance to avoid repetition.

This is an exploratory approach in creating stimulating medical education resources in the form of interactive conversational learning between medical students and facilitators who dissect a case previously published in BMJ to which the students do not have access so as to bring out the learning points in an exploratory manner. Through these conversations, students discover the subject and learn actively along with a facilitator who gradually guides them through the case based problem. BMJ Case reports presents a unique platform for this case based PBL (problem based learning) activity. In this illustrative example this has been done by the students and facilitators in a nearly asynchronous manner on a web based forum. We hope these illustrative samples attract other teaching institutions to pilot a similar strategy.
A departure from traditional methods of education, this may help students to think in a free uncluttered manner, which is miles different from the rigid structured thinking that is generally instituted in them through conventional structured learning approaches. By promoting lateral thinking, it prepares them to face situations that they may frequently encounter later on as a practicing physician.

We invite the reader to place their comments on whether this could be a valuable secondary learning resource toward contextual medical learning in the near future.

Tamoghna Biswas, Medical College, Kolkata, India
Kaustav Bera, Medical College, Kolkata, India
Rakesh Biswas, People’s College of Medical Sciences, India

Pathology: Symptomatic malignant melanoma presenting as multiple gastrointestinal polyps

27 Oct, 11 | by Emma

A 66 year old gentleman who presents with nausea and intermittent diarrhoea is found to be anaemic. Gastroscopy and colonoscopy show multiple polyps but these polyps are a manifestation of an unusual pathology discussed here in some detail.

Seema Biswas

Symptomatic malignant melanoma presenting as multiple gastrointestinal polyps

Pathology: Spontaneous adrenal haemorrhage in pregnancy

20 Oct, 11 | by Emma

Here, the authors describe the case of a 20 year old lady 38 weeks into her pregnancy who experiences sudden onset chest and abdominal pain and presents with hypovolaemic shock. She undergoes emergency caesarean section but the cause of shock is not the most obvious pathology…

Seema Biswas

Spontaneous adrenal haemorrhage in pregnancy

Pathology: Topical treatment of contact dermatitis by pine processionary caterpillar

12 Oct, 11 | by Emma

Here a 65 year old gentleman who presents with pruritis of both forearms is found to have an unusual allergy. The pathology and mechanism of reaction is described in detail.

Seema Biswas

Topical treatment of contact dermatitis by pine processionary caterpillar

Unusual Injuries: Cerebral laceration with stiletto

5 Oct, 11 | by Emma

A 43 year old woman is injured after being stamped on the head with a stiletto. After initial treatment for a laceration to the eyelid she returns a month later with diplopia and headaches. There was more to this injury…

Seema Biswas

An unexpected injury – cerebral laceration with stiletto

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