Generalism in Medical Education What and Why Rakesh

Generalism in Medical Education: What and Why? Rakesh Biswas Department of Medicine, LNMCH, Bhopal

Learning Objectives: • What Generalism? (Problem Statement) • Why Generalism? (Problem Statement) • How Generalism? (Solution) • Transformation (Solution)

What?

Generalism: Differentials? • Professionalism? • Specialism? • Scientism? • Alternative. . . ism

Generalism: Road Map? • Role Models? • Problems? • Optimization? • Transformation?

In General ‘Role Models’ Painter, sculptor, architect, musician, mathematician, engineer, inventor, anatomist, geologist, and writer. http: //commons. wikimedia. org/wiki/File: Francesco_Melzi_-_Portrait_of_Leonardo_-_WGA 14795. jpg

In General ‘Role Models’ This "Wizard of Menlo Park“ developed many devices that greatly influenced life around the world http: //commons. wikimedia. org/wiki/File: Thomas_Edison 2. jpg

In General ‘Role Models’ Physicist, Biologist, Botanist, Archaeologist, Fiction-Writer, Left studying Medicine from University of London http: //commons. wikimedia. org/wiki/File: Jagadish_Chandra_Bose_1926. jpg

Practical?

Can we train people to become Generalists? Or are they born and not made?

A school for Generalists? http: //www. banglapedia. org/Images/Shahintiniketan. jpg

Core Characteristics of a Generalist? • Multidisciplinary Abilities (Jack of All trades? ) • No well defined comfort zone (Restless? ) • Cannot be typified ( Non-professional? )

Core Competencies of a Generalist? • Life Inputs: • Ability to access variety of Inputs supported with Imagination (Knowledge) • Life Processing: • Courage to be different, Collaborator, Continual Carer (Attitude) • Life Outputs: • Expresses Ability to solve a variety of problems and create new tools (Skills)

General. . . ism as a Profession? General. . . ism ‘in the’ Professions (Healthcare, Hospitality)? http: //upload. wikimedia. org/wikipedia/commons/b/b 8/Tajik_dastarkhan_meal. jpg

General. . . ism as a Profession Healthcare http: //curriculum. racgp. org. au/images/curriculum/learninglife. gif

When someone says that he is ‘doing obstetrics’—or whatever, this should not hide the fact that much more is being done besides, not just a little of each of medicine, psychiatry, gynaecology and paediatrics, but also a good deal of work to elicit and act upon the patient’s unspoken hopes and fears. Oxford handbook of Clinical Specialties 9 th edition

At the operating table he must concentrate minutely on the problem in hand; but later (and before) he must operate on other planes too, in social and psychological dimensions so as to understand how the patient came to need to be on the operating table, and how this might have been prevented. Oxford handbook of Clinical Specialties 9 th edition

Who is a Generalist Health. Care Professional?

Who is a Specialist Healthcare professional?

List of Healthcare Specialties • For example: • Clinical Anatomy, Physiology, Biochemistry etc • Clinical Pharmacology, Pathology etc • Obstetrics and Gynaecology, Orthopedics etc • Neurology, Cardiology, Neurosurgery etc

List of Generalist Healthcare branches • For example: • General Medicine • Family Medicine • General Surgery • Paediatric Medicine/Surgery

Do all doctors need to be generalists?

Why?

Why do all doctors need to be generalists? Because the only other option is to become a Specifist/Partialist.

Why do all doctors need to be generalists? Super-Generalist Super-Specifist/Partialist • Life-long-learner hungry for knowledge • Learned and full of knowledge • Makes new connections • Defends own territory • Right AND Left brain thinker • Right OR Left brain thinker • Part of a whole, Empathetic • Whole of a part, Distant • Fearless , embraces social issues • Avoids social issues

An important problem in medical education today is that specifists are training MBBS students to become specifists like themselves?

If we really want to participate in MBBS training we need to have a generalist mindset to orient ourselves to patient-based-learning PBL?

Super Generalist MBBS: What it isn’t

Super Generalist MBBS: What it isn’t

Generalism: What it is

MBBS Super-generalist: The final product?

Learning Competencies: At the end of the course students will be able to obtain… An overview of clinical problem solving: The student will learn to prepare a patient problem list, identify an anatomical and etiological diagnosis and as one of the stakeholders in the patient’s care facilitate a positive relationship between the patient and his/her primary -secondary-tertiary health professionals through efficient and optimal knowledge sharing between all these stakeholders)

Learning Competencies: At the end of the course students will be able to obtain… Information pertaining to clinical history and examination The student will learn to… assist and facilitate the process of examining the patient’s narrative and also process other information obtained through physical examination with and without the help of modern technological tools such as radiological imaging and laboratory parameters reflecting the patient’s internal chemistry)

Learning Competencies: At the end of the course students will be able to obtain… A mastery on information related to anatomy, radiology, physiology and biochemistry that is necessary to reach an anatomical, functional and molecular diagnosis for a given clinical problem at hand.

Learning Competencies: At the end of the course students will be able to obtain… • A life long approach and strategy to discover these essentials while practicing online and offline clinical problem solving beginning with the case at hand travelling right down to basic anatomy, physiology and biochemistry in context of patient-based information collected from clinical, radiological and laboratory data. )

Learning Competencies: At the end of the course students will be able to obtain… An approach to solve problems around diseases of: Cardiovascular system (Cardiology) Respiratory system (Pulmonology) Renal and genitourinary system (Nephrology, Urology) Hematological system (Hematology, Immunology) Nervous system (Neurology) Gastrointestinal system (Gastroenterolgy) Reproductive system (Men’s and Women’s health) Skin and Integumentary system Cognitive system (Psychology, Psychiatry) Musculoskeletal system (Rheumatology, Orthopedics)

Learning Competencies: At the end of the course students will be able to obtain… A Mastery on the essentials of pathology and microbiology that is necessary to reach an etiological diagnosis A life long ability to discover these in the context of solving their patient’s problems)

Learning Competencies: At the end of the course students will be able to obtain… A mastery of the essentials of Pharmacology, EBM and Net-searching that is necessary to formulate a solution and treatment plan An ability to actively discover these life-long in the context of solving their patient’s problems

Learning Competencies: At the end of the course students will be able to obtain… A realization that the process of patient based learning through clinical problem solving largely involves: Actively collating patient experiential narratives on a variety of health problems by localizing them into anatomical areas of origin such as blood disorders or cardiovascular etc. and Searching the net for evidence based (or similar experiential narrative based) information to delve deeper into the problem toward the endpoint of being able to make a positive change in the concerned individual’s health outcome.

MBBS Super-generalist: The final current product?

Who is closer to the Patient? • Patient’s relative • Generalist Physician • Specifist Physician

Would a specifist want to have the skills of a generalist? • All specifists (as all humans) are likely to become a chronic patient’s relative someday • Being a chronic patient’s relative requires negotiating a wide-network of collaborating clinicians and different kinds of knowledge optimized to the patient’s requirements and care continuum • This is also the prime activity of a generalist physician?

Why Generalism? • Enables professionals to get closer to their patients • Enables professionals to obtain continuity of care information from the patient’s network of relatives, generalists and specifists • Enables a patient to benefit from the best of specifism and generalism

The case against being a Generalist Super-Specifist/Partialist Meeting a variety of patient requirements can be time consuming? Specifism/partialism may have evolved to manage work life balance? Generalists may lose power overspending themselves in their quest to do and learn? Specifists conserve their energy in a smaller area and gain more power?

Optimizing Generalism? Can generalists achieve a work life balance and yet continue to do all the variety of quality of work they aspire to? Can we fix the current power imbalance between generalists and specifists?

How?

Exploring Roots of Medicine • Medicine evolved from the first human cry for help from his/her fellow human? • Initially we were all generalists and then as knowledge expanded we became more and more partial and specific • We have come to the point where we are unable to see the Elephant

The root of the problem? • The source of the problem lies deep within our current medical education system • Our current medical education trains us to think partially and specifically in terms of disease

Can we change the game?

Medical Education’s Bloom Game Level 1: R emember Level 2: U nderstand Level 3: A pply (Experience!) Level 4: A nalyse Level 5: E valuate Level 6: C reate

Change the game: Begin playing at Level 3 • Feel free to check out level 1 and 2 whenever you need to • Remember you don’t really need to be good at level 1. Use a few memory tricks (mnemonics, association whatever).

Global Health Elective playing Level 3: Join Us?

Generalist Learning sessions online From Yogesh Jain On Sun, Aug 24, 2014 at 12: 45 PM, i have this 30 year old woman who weighs 25 kg, has a BMI of 12. 7, and has sputum positive tuberculosis. on admission she had a pressure of 84 by 50.

Generalist Learning sessions online From Yogesh Jain On Sun, Aug 24, 2014 at 12: 45 PM Even before we could start on specific treatment with antituberculosis medicines, high calories and protein food, she developed hypothermia (temp of 95 degrees F) along with intractable hypotension.

Generalist Learning sessions online

Generalist Learning sessions online

Utilizing Generalism: Panel discussion • How do we ensure that we utilize Generalism toward the benefit of our patients and teach the same to our students? • Can we use Generalism to integrate Medical Education and Practice?

Transformation? • Can Generalists take up a specialty or skill? • For example a Family physician with a procedural skill in ultrasound? • Can specialists take up a generalist skill? • For example collaborating to solve patient-centred problems with an EBM supported online network providing continuity of care and information?

Are doctors true generalists? Tell me are you serious? Can doctors really do everything? No if you ask them to repair mobile phones or computers they may not be able to.

Are doctors true generalists? • Doctors engage solely in human trouble shooting • They are not true generalists in that sense • However it is imperative that all doctors have the right balance of generalist and specifist qualities

Transformation: Engaging all Generalists to collaborate • Become part of a Global Patient Centred Network • Let each patient receive care-continuity through a network led by a generalist physician • Care-continuity is ensured through a lifetime online patient record managed and moderated by the generalist

S So what? trengths Weaknesses Opportunities T hreats

The beginning

Let’s begin rakesh 7 biswas@gmail. com