Draft version 2022-01-04, ES /
- Medical education is a challenge, particularly in remote regions.
- A very large set of medical knowledge is already available
everywhere on Internet as "Open Data", similar to traditional
"lectures" listened in a passive way.
- Having access to the facts, the next level of education is
training. Tele-training is important in order to provide training in
remote areas for junior doctors, medical students, nurses, etc...
who could not afford to go abroad.
- Continued education for healthcare professionals, as medical
students, junior doctors, nurses, etc... making health education
available and affordable in remote regions.
- Applied research about how to work as a collaborative team across
internet. Evaluation of new paradigms of healthcare, as today
made possible by means of new informatics technologies, i.e. more
than simple simulations of old paper era methods.
- The main question is here the training in "medical methodology",
i.e. how to handle medical information
- Proposed Medical Methodology:
- "Problem Based Learning" (PBL):
- Access to medical knowledge is necessary and student can
well find knowledge on Internet. They can read it at
own timing and they do no need to attend many
"lectures". However the study of dry theoretical
knowledge require a lot of motivation. Electronic documents
over internet are far more affordable and can more easily
maintained up to date.
- Assuming the availability of knowledge, the main question
is training how to learn to manage the problems of a
patient. Therefore the recommended approaches "Problem
Based Learning", http://en.wikipedia.org/wiki/Problem-based_learning
, a method already in use in several universities.
- The goal is also to learn to learn as as life long
- "Iterative Care Model":
- The first step is a set of complaints and/or abnormal
- At any point in time, given this available information
about the patient, try to formulate explicit assessments
about the current understanding of the "health
issues". Initially one or several hypothesis with
their current degree of belief. Anyhow a health issues
are points of concern, either abnormal observations to
be understood or diagnoses to be treated.
- Given the current identified issues, take a decision
about what to do next:
- Request for more information ?
- Prescribe a treatment ?
- The "results" of these actions will augment the
knowledge about the patient and lead to the next
- From an educational point of view, interesting discussions
may arise here about the motivation of such "orders", in
- Expected benefits
- "Global Medical Costs", a notion including multiple
factors as time, risk of unwanted side effects, money,
- Virtual care team:
- The exercise proposed to students is to play in front of
graphs as a kind of virtual multidisciplinary care team in
charge of a common patient, while the members of the team
are located anywhere in the world across Internet.
- A virtual meeting should not be very different from a
physical meeting. Rather than to raise a hand in order
to ask the word, one will type a line or press a button.
- Roles of typical team members:
- The goal is here to define roles. However one
person may often play more than one role. Team
should be not be too large, maybe not more than a dozen
- Patient representative:
- Someone should represent the patient. In a
telemedicine scenario the patient is by definition at
- The patient representative should and be able to
answer questions from other members of the team:
- He should have access to the complete patient
record. However he should answer to the
questions one at a time and not disclose the final
diagnosis in advance.
- In case of contact with a real patient, he should
ask questions to the patient on request of other
- This role could be plaid maybe by the tutor, maybe by
a student or maybe by a nurse.
- Medical students:
- Trying to play the role of a GP.
- Junior doctors:
- Seeking continued training,
- Multidisciplinary team:
- Assistants specialists:
- Trying to play the role of a specialist.
- Other healthcare professional may also participate, as
nurses, social workers, etc...
- The moderator manage the discussion allocating the
microphone to only one participant at a time and taking
care that everybody will have an opportunity to speak,
to write on the white board or present some documents.
- Who is willing to speak will "raise the hand", now by
means of a button.
- Tutor or coach:
- The tutor has more medical experience and coordinate
the discussion when necessary. At the same time he
could be the moderator.
- The tutor is not intended to provide himself extensive
"lectures" during team meetings, but to provide
references to relevant medical knowledge in function of
the current case. This knowledge is expected to be
studied by the students before the next meeting a few
- The participation of a teacher in training sessions is
- The role of the professor is to provide access to
quality virtual courses:
- to prepare and maintain courses made available on
- to recommend links to relevant courses already
available on internet from other sources.
- The secretary takes care that the conclusions of
discussions will be properly documented. The
formulation of these conclusion should appear
immediately on the screen of all participants. who could
sometimes make remarks in case they would disagree.
- From a training point of view explicit step by step
documentation is very important. This will also
provide the possibility of critical reviews the
- Typical scenario:
- Of course imaginery anonymous patient stories.
- Start with the reasons for encounter:
- A short summary about why the patient, or his relatives,
did ask for care. This is in fact a provisional
problem list as seen by the patient himself.
- White board:
- The white board contains views on the current patient
- Start with a kind of dashboard, showing the problem
definitions as far as known up to now.
- Possibility to navigate and zoom on details.
- In principle divided in 3 aspects, which can be zoomed and
- Factual observations:
- Some facts are available about the patient, i.e.
what the patient did answer to questions, what was
found by examination,as well the result of technical
tests from labs or images processing
departments. This information is coming from
the "patient representative" in answer to previous
questions from the students.
- Health Issues:
- Current version of the assessments based on the
- Care plan:
- Overview of ongoing orders in function of the
identified issues. This including considered
orders with their priority level.
- Anybody may ask questions and provide comments.
Questions will be answered by the patient
representative. In some case with a delay simulating
the time necessary to get results from lab or XRays.
- Main scenario:
- While in general about 10.000 different information
requests could be required, the critical recurrent question
is " Given what is already
known, WHAT TO DO NEXT ? ".
- Meeting coordination:
- One speaker at a time according to the list of persons
having asked the microphone by means of a button.
- Comments by means of a keyboard, should appear as "chat"
with a colored background, one color for every
participant. The tutor should have an easy
recognizable presentation (a reserved color ? a specific
character size ?)
- The discussion about a case could be phased in several
successive meetings, maybe once a week. The purpose is
here to give time to the students in order to seek
fundamental knowledge about the challenges they did just
- In such a once a week meeting, a few different patients
could be followed, like the morning review in the rooms of a
department in hospital, going from one bed to the next one.
- Everything will be recorded and could be plaid back.
- It should be possible to go back at an earlier point in
time, in order to try an alternative path of events.
- Implementation context:
- The scenario is similar regardless of the context.