STEPS IN CONDUCTING AN ASSISTED TUTORIAL DISCUSSION
Present the case scenario
Allow time for students to think and consolidate their thoughts. Their silence
might mean they are
Initiate discussion by asking the Trigger
"How would you like to approach this case?"
Allow students to
think loud. Do not interrupt while they are talking.
Simply keep the discussion going by
What do you think about the suggestion of (Name of
Do you agree with ( Name of student
are your thoughts about this issue , ( Name of student)
everybody agree with the approach we shall take?
Trigger the discussion on the
Encourage them to list LEARNING
Encourage the students to use the blackboard to
point. This helps consolidate their thoughts.
Trigger the discussion back to the patient. Ask for
Encourage the listing of the differential diagnosis
mechanism rather than on the disease
e.g. Mechanism of Edema
Based on the listed differential- trigger the
students to ask for
information from the history or PE that will help rule in or rule
Based from the information gathered, trigger the
Help them focus on the important cues-by asking them
to come up
the list of important cues in the history and PE
Challenge the students to make the
Encourage them to make more LEARNING ISSUES
some other issues not in their list? E.g. Why is there no ascites
Ask the student to synthesize the whole discussion in a
Close the session. Ask students to critic
themselves. Comment on how they could have done
Appreciate students who have done
well. Point out politely the weakness of some.(E.g.some who are quiet) Assign
the learning issues by requesting for volunteers who will look into the matter
more in-depth. Volunteers are better than topics being assigned to
students. Agree on the schedule for the next meeting. Advise students to
come back with prepared audiovisuals (sketches or diagrams) and to
provide their classmates a copy. Their sharing should not be more than 2
minutes. It has to be brief, concise and direct to the point. They are to
provide the source of their reading material as well.
Reconvene the students after their SDL
Ask one student to review the case and the
issues discussed in the previous session.
Ask students to
share their discovery on the learning issues assigned, and to discuss or
share them not more than 2 minutes each . This will help students to
focus on important issues only and to discard unnecessary information in their
Encourage reactions from the rest of
Professional skills (ex. Abdominal
Demonstrate how to do a Abdominal Physical
for blood flow in assessing superficial abdominal vein
Have them do a return demonstration of
the procedure and critic their skills
X-ray of the abdomen -
Point the landmarks
Venogram of the inferior vena cava. If not
available use diagrams
Assign students to patients in the hospital or OPD
with similar complain as the module case.
students to do PE and history taking from a real patient
bedside conference with the student, demonstrating the skill of PE & History
Have the students return demo
students in a separate room, & have them critic each others'
Ask students to submit a case report complete with
An elderly man presenting
with edema of the lower extremities and back with prominent superficial veins of
the lower limbs, abdominal wall and thoracic
HOW TO OPEN THE DISCUSSION
How would you like to approach
discussing this case?
Are there any other
alternative approach that you have in
Why do you prefer to approach
this case this way?
HOW TO TRIGGER DISCUSSION ON PATHOPHYSIOLOGY OF
What is Edema? What causes Edema? What are
the forces that causes
shifting from the intravascular to interstitial ?
Why don't we list them in the board while we rationalize the
for each of the
HOW TO TRIGGER DISCUSSION ON DIAGNOSIS?
Based on the causes of edema, what
would your differential diagnosis be?
information in the history or PE do you wish to
Why did you want to know that information? How
will that help in
the diagnosis of this
Why was there edema of the LE and superficial
vein engorgement of the
Abdomen and chest wall
but no ascites?
HOW TO TRIGGER CONSOLIDATION OF THE
Let us synthesize the case: What were
the important critical points
of this case. List them down in the board.
Out of these issues, what cues would you consider strongly to
you make the
Based on the added information from the History
and PE, how would
Validate your differential
HOW TO TRIGGER DISCUSSION ON THE ANATOMICAL BASIS
How was the venous blood from the lower half of the body able to
by pass the obstruction in the inferior vena
Would you expect that deep veins as
well as superficial veins be involved?
What are the superficial veins
involved? Which are the deep veins involved?
Review the tributaries of
the inferior vena cava and the anastomotic connections that would allow the
necessary collateral circulation in this case.
specific characteristic of the development of this condition prevented a more
serious or perhaps disastrous crisis to the patient?
occlusion be more serious at the level of the Lumbar Vertebrae 1 or
What additional problems would you expect to observe if the
obstruction were at the level of LV-1 ?