STEP 1

   Present the case scenario 
   Allow time for students to think and consolidate their thoughts. Their silence might mean they are  thinking.        

   Initiate discussion by asking the Trigger question:
            "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 asking..
            What do you think about the suggestion of (Name of student)? 
            Do you agree with ( Name of student )?
            What are your thoughts about this issue , ( Name of student) ?
            Does everybody agree with the approach we shall take?

STEP 2

   Trigger the discussion on the pathophysiology
   Encourage them to list LEARNING ISSUES
   Encourage the students to use the blackboard to illustrate their
           point. This helps consolidate their thoughts. 

STEP 3

   Trigger the discussion back to the patient. Ask for the Differential
            Diagnosis.
   Encourage the listing of the differential diagnosis based on the
            mechanism rather than on the disease entities.
            e.g. Mechanism of Edema

STEP 4

   Based on the listed differential- trigger the students to ask for additional 
           information from the history or PE that will help rule in or rule out
           their differential diagnosis

STEP 5

   Based from the information gathered, trigger the student to validate
           their hypotheses.
   Help them focus on the important cues-by asking them to come up
           with the list of important cues in the history and PE

STEP 6

   Challenge the students to make the diagnosis
   Encourage them to make more LEARNING ISSUES by 
          challenging some other issues not in their list? E.g. Why is there no ascites here?
   Ask the student to synthesize the whole discussion in a few words.

STEP 7

   Close the session. Ask students to critic themselves. Comment on how they could have done better.   

   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.  

STEP 1

    Reconvene the students after their SDL period

    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 sharing.     

Encourage reactions from the rest of the students.

STEP 2

   Professional skills  (ex. Abdominal Examination)
           Demonstrate how to do a Abdominal Physical examination
           Test for Ascites
           Test for blood flow in assessing superficial abdominal vein engorgement
   Have them  do a return  demonstration of the procedure and critic their skills

   Radiological Evaluation
            X-ray of the abdomen - Plain
            Point the landmarks
  Venogram of the inferior vena cava. If not available use diagrams

STEP 1

   Assign students to patients in the hospital or OPD with similar complain as the module case. 
   Allow the students to do PE and history taking from a real patient
   Have a bedside conference with the student, demonstrating the skill of PE & History taking
   Have the students return demo
   Convene students in a separate room, & have them critic each others' skills.
   Ask students to submit a case report complete with discussion
           (see standard format)