Important issues in user driven E-learning

Ethical Feasibility

• Would it be right to let individual patients become possible prey for unscrupulous maverick rogue physicians lurking on the web? Real life physicians who remain a pillar of strength for an individual patient need not be replaced as much as virtual life need not replace real life. Evidence based guidelines should continue to function as a good parameter to judge the validity of the information collected by the individual user driven by his needs.

• How relevant is this individual patient/health professional user driven model in a famine stricken world where humans struggle for food and water under the watchful gaze of vultures waiting expectantly for their death?  We may not have an answer to this at the moment.

Technical feasibility

Present technical problems with the method proposed

• Time consuming –recording of daily processes with a PDA at best can be telegraphic information (as in the previous mentioned example) rather than detailed thought narratives. In the near future this may improve with wearable web interfacing devices.

• Language shall remain an important impediment not just in terms of the spoken tongue but even in terms of interpreting symbolic languages like that of mathematics or statistics.

• Interpreting information feedback-Once the information needs are identified and fed back to the individual user interpreting and using it would again be a highly individual exercise and although we would have loved the information to simulate a structured absolute truth, in the complex real world there may be multiple versions of truth that may vary according to individual user needs (4). The evidence based health care movement at present fights a gradually losing battle to establish an absolute unchanging structure of medical truth that is generalized to all users on the basis of statistically averaged health outcomes from controlled trials. Critical appraisal is the term for this variety of statistically generalized interpretation but it has demonstrably failed to consistently satisfy the multidimensional needs of the individual patient.

• Need for a better web interface: While individual user/authors write, think, and modify their elogs a PDA may be grossly inadequate to sustain such an activity. We need a web interface where pages can be turned and information gleaned from multiple pages at one glance, an essential step in multidimensional learning which the present one dimensional scroll panel in PDAs can hardly provide.

• Privacy and copyright Issues- Patient privacy shall always remain a thorny issue. Privacy is a way of blocking learning. As long as we want to remain private we do not want any one to learn about us. In that case wanting to meet our information needs and learn and yet remain private is a contradiction in terms. If patient’s or health professionals want to learn and meet their information needs they have to share their information with a network.

Even something as personal as a letter is not personal anymore with the advent of email that can be easily forwarded, shared and not only that our individual personal letters or E logs (that the present proposal banks on) are being used by search engines to advertise depending on the information needs contained in our letters or E-logs. A useful excuse for this is to compare it with post cards in the post office where the postman can read our mail but generally doesn’t bother to. The future of information age doesn’t seem to have much allowance for privacy and privacy in future will become a direct antagonist of information (unless the future brings in a new era of information withholding technology).

All said and done allowances have to be made for preserving patient anonymity with due attention to omit particulars that may make it possible to identify users.
Speaking from the viewpoint of a developer or vendor of the solution (arising from this proposal) as the individual user continues keying his/her own logs every day he or she would need to take the necessary precautions and responsibility to protect his/her own as well as the privacy of others he mentions in his/her own write ups. However we shall still need information withholding technology to resolve the issue where the patient data needs to be seen by the caregivers managing the patient as discussed in the sample log 3 but at the same time withhold patient particulars from the individual on the www who still can access the patient’s care giver narrative.

Each individual user as a node may retain copy right as authors of the initial information generated by their own daily processes and fed as e-logs to the network.

Each and every individual is the author of his own destiny (as well as his own web log) that reflects his life processes and decisions that can shape his future.
The present proposal is an attempt to help make those decisions

Present status of described approach

Bottom up knowledge translation and present day top down medical realities:

How individual medical learners utilize their answered information needs would be the beginning of another process in continued bottom up development in health care positively complimenting the present pedagogic top down approach that dominates current medical learning.

How they compliment each other and the role of this solution in helping present day health care may be illustrated by another parting anecdote (considering the fact that this article is already thriving on them).

I have kept it telegraphic on purpose:

“A bottom up husband and a top down wife. Husband… happy go lucky, take it easy, wife…perfectionist, hates the way her husband does the dishes with left over grease etc (…minimal according to husband). Wife insists on doing the dishes herself. Husband’s bottom up solution? Wash the dishes when his wife is not looking and leave them on the wash basin for his wife to give the finishing touches.”

Let this bottom up, multidisciplinary, qualitative, web based solution at least make a beginning in helping to lessen the health care burden of present day top down, focused, quantitative, modern health care (before we can even think of more ambitious goals of a web solution changing the practice of medicine).