:

:

( ) 15 10 5 5 5 8

C-spine X-ray DJD( Degenerative spinal Joint Disease)

Foramen magnum Cruciate motor weakness Rotatory motor weakness Meningioma Degenerative cervical spondylosis Cervical radiculopathy Cervical myelopathy Hydrocephalus

1. 2. 3. Corticospinal tract 4.

47 17 15 Tension headache C-spine X-ray C5-6 degenerative spur disc space narrowing deltoid muscle biceps muscle motor weakness

NSAID DTR muscle power weakness

DTR increased increased sensation 50 70 full extension flexion plain skull film x-ray Cspine MRI foramen magnum well enhanced mass lesion hydrocephalus)

EKG, chest x-ray, CBC ( complete blood count ) cholesterol triglyceride Anxiety

1. 2. Corticospinal tract 3.

MRI tumor Hydrocephalus

1. 2. 3. Angiogram Vascular tumor

Step 1: What is the core theme? The central idea should explicitly express the primary purpose of this learning exercise. Preferably, it is associated with the case title and can be easily remembered.

What are the learning objectives? Leave students with enough room to brain storm the possible learning issues, which can be streamlined into central learning objectives (group objectives) and peripheral objectives (individual interests).

The extended problem New learning issues are incorporated into the problem by adding more relevant scenarios

Step 2:

Step 3: What are the available resources for this problem? A list of resources should be prepared and made available to tutors and students at the end of each problem set. The list needs not be exhaustive.

,,

Patient data Description of patient &/ or family in scenario Personal variables; age, ethnicity, physical appearance & personality traits Relevant health history Laboratory data & radiology results Use a framework (concept mapping) to organize client data

concept mapping

Step 4: Components of The Problem Package 1.The Narrative paragraph(s) 2.Patient data 3.Tutor guide 4.Learning resource list 5.Feedback form

Tutor guide: What constitutes a good problem for novice students? It should be a relevant and realistic clinical scenario It should be brief and clearly written with a central theme for learning objectives

It should be interestingly presented. It should be presented in a balanced manner. It should be oriented for learning via exploration and reasoning rather than solving patient problems, which is not the objective during preclinical years.

Learning resource list Compilation of relevant resources; Clinical experts Community programs & services

Educational materials Texts, Journal articles, key words & databases Audio visual resources Web sites

Step 5: Reviewed by an objective reader who has: A fairly good idea of the curriculum themes and how essential content is sequenced Prior experience writing problems. Familiarity with the clinical orientation of your problem.

A good problem is the one in which the learning issues and learning objectives raised by the learners are in agreement with the broad issues and objectives envisioned by the case-designers.

Step 6: Pilot the Problem Package. Pilot the problem package with two tutorial groups. One with an experienced PBL tutor. The other with a tutor who is less experienced in PBL.

Step7: Revise as appropriate. To maintain currency & relevance of the PBL problem & component parts: Identify resources to add or delete from the list. Usefulness of the problem within the curriculum Comment on currency of diagnosis tests, treatment & health care delivery system.

Step8: Conclusion The problem packages reflect health problems and issues. Students will be exposed to in their current and future practice. Provide learning opportunities to develop problem-solving skills and application of knowledge. Learning by doing.

(Problem-Based Learning, PBL)

PBL 1. PBL PBL (problem).

2 PBL PBL ( population, behavior, life science).

3.

4. PBL (self directed learning).

5.,,

6. tutor

7. tutor tutor tutor

8. wrap up

PBL ( Core theme primary purpose, )

(student preparation and prerequisite knowledge) (instructional goals) (summary) (classroom management) (specific issues of emphasis)

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b. (Tutor guide),, outline c. (key wards) d. (learning issues) e. (guiding questions) tutors f. tutor

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( ) PBL

Case Wrap-Up Powerpoint 10-15 ( )