Fairy tale UDLCO: Rapunzel medical college and Student centered torture v Patient centered learning

Summary : Once upon a time, far far away there was a private medical college, not that long long ago called Rapunzel that used to take paying guests aka PGs. More about that story here https://en.m.wikipedia.org/wiki/Rapunzel, but to summarise it in a nutshell there was a couple who had to send their daughter as a paying guest to the college where she was held captive by a wicked witch called the "college management." The good part is that there were many Rapunzel pgs (RPGs) there, who were similarly tortured by the wicked witch and one day one of them writes an anonymous viral message against the management of Rapunzel medical college and once it reaches a "patient centered discussion" forum it releases pent up emotions in the students who may not always be interested in "patient centered learning" and predictably the business and academic managers of the patient centered learning ecosystem hold the lack of "student" rather than lack of "patient centeredness" responsible for the current ills of the system. 

UDLCO glossary: https://userdrivenhealthcare.blogspot.com/2023/11/glossary-of-user-driven-healthcare.html?m=1

UDLC transcripts :

[6/5, 7:18 PM] Patient Adv 59M CAD Metabolic: 

Must be read by all the upcoming batches 

Hello to all pg aspirants

         Subject :- LOOT OF HARD-WORK 

This is from one of the most frustrated guy from an INSTITUTE in an area far far away from civilization. 

Apart from the reputation of this college , i wanted everyone of you to know the harsh reality and the hardships postgraduates face in this college 

We cannot even call it a college , we can call it as an institution with no morals and no sympathy towards students .

College is full of rules and regulations , and the toxicity extent is unmeasured 

 the day starts with fear of even waking up to go to college and a negative vibe just even after entering the gate

Let me talk about the rules 

1. College has 2 gates which should be crossed before 8:05 in the morning or u will be made to stand out of the college gate for 40 mins before they allow inside the gate

2. There is a class from 8-9 which is known as aetcom and we have to attend it , which is of extremely no use to us , even for this class we have to go into the class by 8:10 or else doors will be closed even if u are standing at the gate . They will close the room door on ur face and Pg’s should beg to open the door again .

3. There is a dress code and every one should wear an id card , if u mistakenly forgot ur id card security wont even allow us inside the gate , the security guards number is some 10 members at both gates and they will have more power in the college than professors, they will make u write in a register if u are late .

4. If u are seen without id card and apron a memo will be issued to Pg’s and if we receive few memos they will suspend us by having a committee on the individual. Even to park a vehicle inside the gate there is a sticker to a car and the car or bike should be owned by the individual or parents , even if the car is on siblings name they wont give the sticker . They will make every postgraduate wait for few months to issue a sticker. They will keep on saying not available now.

5. There will be lot hell of documentation and lot of work to do in short a department will receive nearly 20 circulars to 25 circulars in a single month regarding rules and regulations , if we just want to oppose them they wont even let us speak and will trash us down with no basic respect.

6. There will be atcom everyday ,meets weekly thrice where various departments will be participating one after another over the year and every professor comes from all departments and bash the pg who is presenting developing a sense of uselessness and feeling of unworthy to the individual. Which is kind of disturbing , and it will be a humiliation before every one nearly 120 or 130 people 

7. The college timings are from 8-6 and security wont even allow us to pass the gate even before one minute before 6 , but the faculty will be there from 9-4 only , even after a tiring day they will expect  us to study in the campus from 4-6 where most of us will be exhausted and we cant even find a room to sleep in , op rooms will also be closed by 4:30 and we rome in the campus with zero energy and tons of sweat pushing over due to the extreme heat in this area even after repeatedly asking the management about timings they wont even speak a word to us 

8. Even basic facilities like drinking water and washrooms are also not available to the postgraduates here 

9. Coming to the departments , there are very few departments with faculty , there are few departments which is just managed by only one professor with no assistants and associates   . Taking in par to the pg curriculum there is a significant shortage of staff in every department and there are complete empty wards present inside the campus

10. Every 1st and 3 rd Friday exam will be conducted to all postgraduates and few departments will take strict action if score is less 

11. Clg is very strict regarding the fee and if we will not pay the fee or submit bank guarantee within the time , they will not even allow us to speak regarding our issues and not even permit a single day of delay , our juniors are made to stand out of the gate for nearly 2 hours without even listening to them and send them back by blocking off the biometrics if fee is not paid . Extra fee without receipt is collected from Pg’s and no reason is given to it . They will be asking our entire three years of fee in first year itself.

12. There will be a book in casualty which has night duty Pg’s names in it , the concerned candidate should sign it before 8:10 or a memo is issued to it . Security will take attendance of all Pg’s in night duties thrice a day  and will mark us absent if they don’t find us even for which a memo is issued . There are no dinner breaks from the past 1 month , we will be provided with a coupon where we can claim only uttapam dosa and meals in the night ,which is very heinous of them as departments which have more duties will be seen suffocating inside the clg .

13. There are no proper duty rooms , even fans wont work in many of the rooms . They wont let us keep our own coolers of air conditioners even if we say them we will bear the entire electricity bill of the particular room . Most of the post graduates sleep on chairs in places where air conditioners are available and some sleep on floor as there is no option left. Female Pg’s cry their heart out if they get their periods as no proper washrooms are available in the college. 

14. After the night duty they wont allow us to leave the campus before 8:45 .   How can a person work from 8-8:45 the next day without any basic facilities provided and duty rooms will he closed in the morning . We cannot go out of the campus or use duty rooms if we get sick and thrive in op itself even u have no energy left in your body

15. Every one of us joins pg with LOT OF DREAMS and better future but every individual here is in depression and many has suicidal tendencies due to harsh rules , many postgrads are into drugs to get out of this stress imposed by the college . There is no proper equipment in all the departments and they will just make us do all the paper work without teaching us . Which is of no use 

16. They wont give us stipends even after we do lot of work to the college and there is no basic respect to the doctors in the college

17. During the admissions they will give false promises to parents to get admissions as the management is very greedy about money . MD wont allow any pg near him to speak about the issues facing inside the college

18. Clg will directly blackmail Pg’s with some words such as :- UR PRACTICAL MARKS ARE UNDER OUR CONTROL , and we will fail u if u speak a word 

19. An year ago college made many Pg’s fail intentionally due to very minute mistakes committed by  them 

20. Attendance is strictly monitored and not even a single day is an excuse in the college

    

 *PLEASE JOIN COLLEGE AT UR OWN RISK*

Many of our parents also suffer if we study here and we will get nothing out of it and we will turn out to be a heartless stones by the end of final year.

So please make u enquire properly before keeping this college as an option in the list of counselling 

This is the pain of entire students here and we are helping others not to join in the hell and suffer as we are suffering now.

[6/5, 7:42 PM] Cfhe IIT: Please worry about how to improve patient out comes

[6/5, 7:46 PM] Cfhe IIT: Hi @⁨Patient Adv 59M CAD Metabolic⁩  why are you disturbing all in the group with hate speeches. Can you think of any solution instead of spreading hate speech I feel this is a platform to discuss pajr, patient outcomes please kindly don't post such messages.

[6/5, 7:48 PM] Cfhe IIT: I don't like adult people who are always crying instead of facing the problems and solving them. I think that you are a leadership material but now I am forced to change my opinion about you.

[6/5, 7:50 PM] Academic LLM : I feel it's important for all of us to realize what our team members are going through else we can't achieve QI without addressing these issues.

[6/5, 7:54 PM] Cfhe IIT: I agree with you sir. But can we solve problems instead of complaining. I want to share one of my observations Our sisters in icu have a 10 liter water can they get water every day because they cannot buy water bottles. They offered me water when I had the same problem. They solved the problem.

[6/5, 7:54 PM] Cfhe IIT: We can achieve alot if we can start solving problems instead of complaining, non cooperation etc it only exposes over insecurities.

[6/5, 7:55 PM] Cfhe IIT: https://www.rejectiontherapy.com/100-days-of-rejection-therapy

[6/5, 7:55 PM] Academic LLM : So how do we solve the PGs problems and make them happier learners?

[6/5, 7:57 PM] Academic LLM  : 👆Can we try to solve the 20 problems listed here with consensus of all the PGs?

[6/5, 7:58 PM] Cfhe IIT: I am working on a solution already but want to engage problem solvers with leadership skills creamy layer not much worried about others soon you will see the implementation

[6/5, 7:59 PM] Cfhe IIT: I have sent an email today to management

[6/5, 8:02 PM] Cfhe IIT: People should be happy from inside it's not our job to please them or make them happy. We can take care of better learning if some one is willing to collaborate all others probably drain your energy better not worry too much

[6/5, 8:05 PM] Cfhe IIT: I met some good people in our team were really good happy no matter what happens out side disturbs them

[6/5, 8:05 PM] 10PushComm21: Management already knows all these issues from the start and nothing wil change with an email

This is ... and there will never be a change which will make a student happy or no rule will be implemented to make student life better

They only try to make our life miserable

[6/5, 8:08 PM] Cfhe IIT: I liked you when you were very honest with me, I saw you jumping ahead to serve patients i felt good about you.  All this denial thoughts stopping you from reaching your full potential

[6/5, 8:10 PM] Cfhe IIT: I spoke to security people day before yesterday got their version why they were rude before going home just to find out why they are behaving like that

[6/5, 8:11 PM] Unknown Medical Student: Can you also stop complaining on why Pgs are complaining and instead solve problem or be a happy learner 😅

[6/5, 8:11 PM] Cfhe IIT: We also did same you did with out any hassle

[6/5, 8:14 PM] Cfhe IIT: First 4 days I did not take bath, first day I was thrown out made to stand out side under hot sun got sun stroke, never got good cooperation just got who ru looks from every one? But slowly I solved lot of these same problems very comfortably doing my work

[6/5, 8:16 PM] Cfhe IIT: I slept on the floor and sneaked into college thanks 2021 pg helped me to get inside thanks to him.

[6/5, 8:16 PM] 2021 PG: Because u have nothing to loose from this college if u go against the management

[6/5, 8:16 PM] Pg 2021: There is no version or reason to allow them to be rude with doctors who are working overtime and already overburdened

They talk to us like we are their servants

Why should it be such a hassle for us to even go for lunch or even leave campus after our hectic day of work

Security never stop a patient attender shouting on us they only stop us from entering campus or leave campus

They are not appointed for protecting us rather the reverse happens in our campus and we should all putup with those harsh words from security because they have the higher authority than a treating doctor or faculty here

Please dont tell us there is an explanation for it and u found out their version

[6/5, 8:18 PM] Cfhe IIT: We had same experience initial days but we sorted them out

[6/5, 8:18 PM] Cfhe IIT: I had doctors in my team as well

[6/5, 8:19 PM] Cfhe IIT: We were very happy have good relationship with security guys, management doing our work with out disturbing any one

[6/5, 8:20 PM] Cfhe IIT: You should get some Rejection therapy to get out of stress

[6/5, 8:26 PM] Unknown Medical Student: I only see how a monkey is trained set in a cage

Just like in five monkey experiment

[6/5, 8:31 PM] 2020 Med Pg: As u are in very good terms with college,the only thing which makes a huge difference in PG’s life in the hospital is letting them out at 4:00pm

Can u make that one change in the college ??(Then everyone will be a happy learners)

[6/5, 8:32 PM] Unknown Medical Student: He can only learn sir he cannot solve 🥲

[6/5, 8:45 PM] Cfhe IIT: I don't care much about you politics I care about patient outcomes my team I will do anything for them including the above not much worried about others

[6/5, 8:48 PM] Cfhe IIT: Don't have any intention of draining my energy

[6/5, 8:49 PM] 2020 Pg: @⁨⁩ sir 

What is ur opinion on making PG’s to stay till 6:00pm,When they are already drained out by 4:00pm

Their effective usage of time got shrunken

We can solve 80% of PG’s Problems.

[6/5, 8:50 PM] Pushed Communicator 1N22: Finally u got the thing

U r no way related to the issues here and u dont have to drain your energy 

U just stay hungry over and for your work and not ours

[6/5, 8:54 PM] Cfhe IIT: 🙏 sure bro

[6/5, 10:09 PM] Patient Adv 59M CAD Metabolic: That's a forwarded message in medical group.

Thanks for free advice anyways

[6/5, 10:17 PM] Patient Adv 59M CAD Metabolic: Let's start by your startup clearing PGs financial and academic debts and addressing their personal and professional issues.

We will write an MOU for your startup for lifelong free service

[6/5, 10:19 PM] Cfhe IIT: Try to evolve Anyone can complain list all problems, and cry like a baby  be a man solve some problems 👍 be confident I have solved lot of these problems if you want consultation on problem solving available per hour fee basis 😀

[6/5, 10:20 PM] Patient Adv 59M CAD Metabolic: Well said.

This year a 56year old cleared and joined MBBS.

We support you to be the next guy.

And then clear NEET PG as well after 6 or 7 years

[6/5, 10:24 PM] Cfhe IIT: Why to study when I can collaborate with good doctors or hire them I don't reinvent the wheel only immature kids do it

[6/5, 10:24 PM] Cfhe IIT: I don't care much about degrees I respect person with problem solving abilities

[6/5, 10:26 PM] Patient Adv 59M CAD Metabolic: Okay.

Nice

[6/7, 9:40 AM] Academic LLM  : 👆Did a long thematic analysis around this PG's outcry and subsequent posts around it here and just sharing the biased learning summary from that analysis:

"Here (and I guess in most private medical colleges), the problem with the management is they are student centered and a few slow learners (unfortunately a judgemental term, better could be unmatched learners), keep them on their toes everyday as they try to engage in all kinds of draconian student reforms discussed in the forwarded message yesterday to tighten the noose around those unmatched learners! My guess is 80% of matched learners have to pay the price for 20% of those unmatched. 

On the other hand if they had taught students to focus on patients all these student problems could have been resolved so easily as then both would be working together on the same side of the table for the benefit of the primary beneficiary of medical education (patient)?

CC licence: https://commons.m.wikimedia.org/wiki/File:Johnny_Gruelle_illustration_-_Rapunzel_-_Project_Gutenberg_etext_11027.jpg#mw-jump-to-license

UDLCO: Darjeeling mountains, batasia loop dimensionality reduction and optimising clinical complexity

UDLCO transcripts:

[06/07, 08:49] rb: Our supposed three dimensional reality, is actually an infinite series of two dimensional planes and sometimes when we are trying to navigate our existential blocks in moving forward, the solution lies in turning backward to shift our plane (aka frame shift) and then again move forward and upward.

Here's the video of the process:

https://youtu.be/YDhcgUOTIqQ?feature=shared

And here's the story:

 In 1879 while building the Darjeeling railways over the steep Himalayas, work progressed in phases, with short distances being covered and tried. Hurdles were aplenty. The train could not negotiate the hair pin bends at several points. It is said that Herbert Rumsey, the contractor in charge of laying the tracks, was stuck for a solution. It was while he was ball dancing with his wife that her innocent remark showed a way out to his problems. All she said was that a backward turn, like in ball dance, could see him out of a corner. With that, the idea of Z reversals, a double loop at Chunbhatti and a single one at ‘Agony point’, were born. The Batasia Loop, to negotiate the steep descent, also came about from the same theory.

Unquote: https://www.tribuneindia.com/news/archive/arts/quiet-chugs-the-toy-train-352550

Here's a complementary video by a school student explaining dimensionality in a simple manner:

https://youtu.be/eGguwYPC32I?feature=shared

[06/07, 09:54] AI: Quite often folks worry about Batasia loop - proximal to Ghoom, the highest railroad station in India

The sticking parts actually show up near Sukna, that's where the tracks begin their climb. 

By the time the climb to Kurseong is done, the ghosts of Dowhill start haunting. 

Only if folks are willing to walk up Makaibari road, and take the trip to Darjeeling on muleback the loops and blocks are avoided. 

Nice video. Thanks for sharing. 

The problem was not as much in Batasia loop - Sweden draws carriages up a cantilever of rack and pinion. 

The issue is with the ticket counters at Sukna, maybe earlier Siliguri Jn, maybe even NJP where the journey purportedly begins for all tourists. We locals just take the bus from near Mahananda bridge via Hill Cart road. 

Now it's for folks to understand where the system, schooling, and experience pathways to entrepreneurship lie in India! 

For others, visit the Darj Hills with a local and the experience will be very different. 

(Palani ghat of Kodai is the nearest analogy. The train analogy shifted to Ooty)

[06/07, 09:58] rb: Fantastic analogies drawn to health IT! 👏👏

1) Avoiding complex loops!

Perhaps case based reasoning and predictive analytics could work here to show red flags to avoid?

2)It's not the anatomy always but the billing counters!

3) Local physicians and caregivers such as family members and the patient themselves are important stakeholders

[06/07, 10:07] PN: I am working with a renowned orthopaedic and the team believe that tracking of Vitals in longitudinal way will give AI a boost to give predictions , but making his fellow practitioners and hospital to believe that record vital of the patient not the prescription paper but on a device failed. We are still struggling to record vital for patient longitudinal when they visit clinics, hospital and we believe Google fit will be available everywhere..😉

[06/07, 10:12] rb: It's not just what are scientifically labeled as vitals (largely reflecting internal medicine)that are vital to optimising healthcare

Sometimes there are external medicine factors that are more important to capture to derive precision medicine actionable insights . For example, patients life events before and after the illness

CC licence: https://commons.m.wikimedia.org/wiki/File:Batasia_Loop_of_Darjeeling_Himalayan_Railway.jpg#mw-jump-to-license

During the last leg of our internship in the year 1993

Rakesh Biswas

Professor of Medicine at Kamineni Hospitals (company) (2017–present)Updated 5y

It was our community medicine posting during the last leg of our internship in the year 1993 and we had managed to get leave from the hospital to take a trip to the Sikkim Himalayas (off course we couldn't have mentioned that in our leave application).

We made the customary trips to Gangtok, (the 15 rupees thali in Jain Dharmashala was unforgettable as we were also on a budget) and Tsangu lake (it was the first time some of us were touching the snows and a customary snowball game was in order between the four interns and one Geographer who worked for the National Atlas). The image of Tsangu lake you see above was clicked in 1993 by Basubandhu, the geographer and all the other images here below are taken by him in 1993.

Finally we decided that a trip to Sikkim would be incomplete without a trek.

Some of us had already done the Yuksom Zongri circuit earlier, plus it wouldn't suit our budget in terms of time (limited internship leave etc) and so on our way back to Siliguri, after our bus had crossed over from Sikkim to district Darjeeling, we got down from the bus at a place called “27 miles.”

The first thrill to the place, which looked like it was in the midst of nowhere, was the rickety ropeway we needed to ride (made out of a wooden precarious bench it was unlike any ropeway we rode before).

Once we rode the ropeway marvelling at the exotic birds flying over the jungle canopy below, we also crossed the river Teesta (branching into Relikhola) and once we deboarded the ropeway bench we took a dip in the pristine river just before we began the trek.

The place near the river was called “Samco farm” and the trek to Samtahar was steep and gruelling but enjoyable at the same time and when we finally appeared to reach our destination we were covered by a “white out” mist that didn't allow us to visualize any of the homes in that sleepy hamlet and all we had were some audio cues of barking dogs that told us that we had arrived into human habitation.

As we were interns on a budget we had already decided to try and find out if they would allow us to sleep in their “primary health center” PHC, which we were lucky to locate in the midst of the mist and were greeted there by a kind “sister in charge” who agreed to shelter these urban interns for the night in her PHC.

Image of the white out in Samtahar taken by Basubandhu in 1993

The next day morning is actually the real answer to the A2A here.

A young primi was brought to the health center with delayed labor and luckily one of us interns had finished his obstetrics posting and had delivered sufficient amount of babies to gain enough confidence to manage the situation and even when the sister in charge of the PHC appeared to panic and ask if they could refer, he stood resolute that they could get the baby out and it was a matter of time.

I'm sure that intern wouldn't have dreamt of taking that risk today but in 1993 his blood was younger with all the enthusiasm needed to drive his aspirations. At that moment his reflexes appeared to declare that he should just keep his hands over the baby's crown which had been trying to free the rest of it's body for quite some time.

And finally after what seemed like an eternity the rest of the baby's body obliged but there was no sound from the baby and it appeared listless but then a few mouth to mouths (through a gauge piece) later, there it was, the most pleasurable cry of a child that promises to live.

It was a girl and all the villagers in that matriarchal village (that strongly valued a girl child above a boy) rejoiced (contrast that with the desolate silence this intern had experienced in his own urban hospital when he announced, “its a girl”)

The villagers treated the interns to a sumptuous lunch perhaps as the interns had saved them from carrying the mother through much more gruelling treks through steep hills to an urban hospital in the plains where it may have become too late by the time they could have reached.

Image of Basu Bandhu playing with children in front of the PHC.

That intern who took the biggest risk of his life has become a Professor now and wonders if he he would be able to take the same risk now.

What was it that gave him the confidence to do that in internship? Was it the faith in the eyes of the villagers, the other difficult alternatives?

Is it because urban patients have more alternatives that they would not be able to put the same amount of trust in their doctors, trust that may have made their doctors more confident for the better (or unfortunately yes even for the worse)?

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Devanshu Panwar

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Mahatama Gandhi's list of CBME competencies

From his autobiography and other's testimonies:

1) CBME procedural competence in surgical dressing and administration of medicines:

"His early experience in healthcare started when his father was suffering from a fistula; he was one of the attendants to his father. He had duties, which mainly consisted in dressing the wound, giving medicine to his father and compounding drugs whenever they had to be made up at home. Gandhi was thus initiated into  medical service!"

Unquote 

2) AETCOM CBME cognitive competence in helping patients and prompt referral for further help:

From his Autobiography, “The question of further simplifying my life and of doing some concrete act of service to my fellowmen had been constantly agitating me, when a leper came to my door. I had not the heart to dismiss him with a meal. So I offered him shelter, dressed his wounds, and began to look after him.” But later he was sent to the government hospital for indentured labourers. He further said, “I longed for some humanitarian work of a permanent nature."

Unquote 

3) AETCOM CBME cognitive competence in history taking and case presentation as well as perceiving healthcare as a calling and finding mental peace as a currency for job satisfaction:

"The work of dispensing medicines took from one or two hours daily, and I made up my mind to find that time from my office work, so as to be able to fill the place of a compounder in the dispensary attached to the hospital… This work brought me some peace. It consisted in ascertaining the patient's complaints, laying the facts before the doctor and dispensing the prescriptions. It brought me in close touch with suffering Indians…”

Unquote

4) CBME procedural competence in Obstetrics:

"There was no time to summon a doctor or nurse because Kasturba got the labour pain so suddenly and the birth came quickly. Once again the birth was difficult but this time Gandhi delivered the baby safely all by himself! Devadas, Gandhi's last son, was born on May 23, 1900. Gandhi said, “The birth of the last child put me to the severest test. The travail came on suddenly. I had to see through the safe delivery of the baby. My careful study of the subject in Dr. Tribhuvandas’ work was of inestimable help. I was not nervous."

5) AETCOM cognitive and procedural competence in Infectious disease epidemic management:

South Africa 1904 , Sjt. Madanjit sent a note to Gandhi saying, “There has been a sudden outbreak of the black plague. You must come immediately and take prompt measures, otherwise we must be prepared for dire consequences. Please come immediately.” The municipality thanked him for this prompt action and supplied him with disinfectants and also sent a nurse. He gave medical aid and cleaned the patient's beds, sat by their bedside at night and cheered them up."

Unquote 

5) CBME procedural competence in Patient transport and administration of medications:

"Gandhi recollected the services rendered in the Boer War, “We soon got work and that too harder than we had expected. To carry the wounded seven or eight miles was part of our ordinary routine. But sometimes we had to carry badly wounded soldiers and officers over a distance of twenty-five miles. The march would commence at eight in the morning, medicines must be administered on the way, and we were required to reach the base-hospital at five. This was very hard work indeed.” 

6) AETCOM CBME procedural competence in silent service driven empathic communication:

"The good Doctor told us that he could not induce Europeans to nurse the Zulus, that it was beyond his power to compel them and that he would feel obliged if we undertook this mission of mercy. We were only too glad to do this. We had to cleanse the wounds of several Zulus which had not been attended to for as many as five or six days and were therefore stinking horribly. We liked the work. The Zulus could not talk to us, but from their gestures and the expression of their eyes they seemed to feel as if God had sent us to their succour.”

7) CBME competence in actionable empathic buy in of a doctor patient relationship:

"Gandhi had a glum, ferocious, uncommunicative African jail mate attendant. One day, he was stung by a scorpion. He was screaming like anything and Gandhi saw this intolerable pain. He immediately took the African's hand and washed it clean and he started sucking the injured area. He was extracting the poisoned blood as much as he could and spitting out. He was relieved from pain. Gandhi applied tincture and bandaged his arm. He became Gandhi's devotee thereafter."

8) CBME cognitive competence in observing procedures (see one, do one, teach one, skipping the latter two):

"Noted in Gandhi's diary on May 15, 1947, “Manu has a severe stomach-ache, she also had vomiting and is running temperature. I therefore called in the doctors who examined her. Manu's complaint was diagnosed as appendicitis. I had her removed to the hospital immediately. She will be operated upon at night. Watched Manu's operation at the hospital. Mridula and Madu were keeping her company. But they were not allowed inside the operation theatre. I had put on a surgical mask and watched the whole operation."

Unquote 

9) CBME competence in medical decision making (such as to operate or not to operate):

In the letter to Jaisukhlal Gandhi, father of Manubehn Gandhi, on the next day, Gandhi said, “I had suspected even in Delhi that it was appendicitis. I had hoped that treatment with mud-pack would help her to get well. But it did not help her sufficiently. I, therefore, called in the doctors yesterday. They advised an operation, and I therefore got her operated upon.”

Unquote 

10) Competence in making career choices:

"It was Gandhiji's elder brother who dissuaded him from pursuing medicine because he said their father would have disapproved of the decision; since the Gandhis were Vaishnavas, they would have nothing to do with dead bodies. His brother suggested instead, it would be wiser to study law and become a barrister, which is what Gandhiji did."

"Later though, even as he practised law, Mahatma Gandhi continued thinking about visiting London to study medicine. However, in 1909, he wrote to a friend saying he had heard from certain doctors that they had killed about fifty frogs while studying medicine. He said, if so, he had no desire to do the same, because he neither wanted to kill nor dissect frogs."

Unquote 

11) CBME competence in enterprise and innovation:

"With the help of three colleagues, Gandhiji put all the patients in a vacant house and took on the role of both doctor and nurse. Even though they did not have the means needed to manage a situation of this magnitude, they did all that they could to help. The Council, on their part, provided a vacant godown for the patients; however, this building was unkempt and filthy. Gandhiji and his colleagues not only cleaned up the building, they also raised money to buy a few beds and other necessary things by reaching out to charitable Indians. Soon, an improvised temporary hospital was set up. The local authorities sent a nurse, who arrived with brandy and other hospital equipment. Instructions were given to provide frequent doses of brandy to the patients. Gandhi had no faith in the beneficial effects of brandy and, with the permission of Dr. Godfrey, who was the doctor in charge, he put three patients who were prepared to forego brandy under the earth treatment, which required applying wet earth bandages on their heads and chests. Two of these patients survived. The other twenty died in the godown. Gandhiji said it was impossible to ascertain how the two patients who had agreed to the earth treatment were saved, but this incident enhanced his faith in the earth treatment as well as strengthened his skepticism for the efficacy of brandy as a medicine."

Unquote

12) CBME competence in putting prevention above treatment:

"I overeat, I have indigestion, I go to a doctor, he gives me medicine. I am cured, I overeat again, and I take his pills again. Had I not taken the pills in the first instance, I would have suffered the punishment deserved by me, and I would not have overeaten again. The doctor intervened and helped me to indulge myself. My body thereby certainly felt more at ease, but my mind became weakened."

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13) CBME Competence in designing rural medical learning and practice centers:

"He said the halls for treatment and experiment should be surrounded by huts that could serve as residences for patients and children who were being treated there. He also said the sanatorium should grow fruits, flowers, food grains and vegetables, that it should have cattle sheds and roads good enough for vehicles. He also suggested having a gymnasium, a tank for bathing and other facilities. Gandhiji said it was best to avoid procedures that required electricity, such as hot and cold water and steam regimens."

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1-9 points above have been quoted from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515737/, which again has collated quotes from sources such as:

1. Bandopadhyaya A. Bahuroopi Gandhi. Popular Prakashan, Bombay. 1964 [Google Scholar]

2. Gandhi A. Mumbai: Jaico Publishing House; 2000. Untold Story of Kasturba. [Google Scholar]

3. Gandhi M. New Delhi: Publications Division, Ministry of Information and Broadcasting, Govt. of India; The Collected Works of Mahatma Gandhi; p. 20002001. [Google Scholar]

4. Gandhi MK. Ahmedabad: Navajivan Publishing House; 1927. An Autobiography or The Story of My Experiments with Truth. [Google Scholar]

10-13 have been quoted from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515724/

Notes:

Abbreviations used:

Competency-based medical education (CBME).

CBME is an outcomes-based approach to the design, implementation, and evaluation of education programs and to the assessment of learners across the continuum that uses competencies or observable abilities. The goal of CBME is to ensure that all learners achieve the desired patient-centered outcomes during their training.

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https://www.aamc.org/about-us/mission-areas/medical-education/cbme

AETCOM: An Indian abbreviation coined by the Indian medical council, a medical education regulatory body, which stands for Attitude, Ethics and Communication and is designed as (AETCOM) modules to develop a foundation of positive attitude, ethics and communication in the Indian medical graduate.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9480674/#R11

"Gandhi was able to walk about 79000 km in his lifetime which comes to an average of 18 km per day and is equivalent to walking around the earth twice."

https://en.m.wikipedia.org/w/index.php?title=Practices_and_beliefs_of_Mahatma_Gandhi&wprov=rarw1

Past lectures on "Indian informal healthcare" , Patient centered CBME as a game changer, Generalism in medical education and The ultimate "role playing in education" in the search box in our departmental website here: medicinedepartment.blogspot.com

Creative commons license: https://commons.m.wikimedia.org/wiki/File:Gandhi_suit.jpg#