Transcript Introduction

Clinical Case Study, CCS
Prof. Vladimir J. Šimunović
Teaching methodologies
Lectures
 Tutorials
 Seminars
 Small group learning
 Clinical cases scenario
 Clinical skills laboratory practice
 Interactive software
 Multimedia

Clinical case study (CCS) prepare the
students to solve the problems in the real
world of clinical practice
CCS – methodology based on learning
through problem-solving or clinical
procedures execution
CCS:
•Enhance the efficiency of analytical thinking
•Capacitate students for decision making
•Capacitate students for complex situation solving in
real clinical practice
•Influence to the development of oral communication
skills
•Enhance the capability of the team work
Clinical case study
Augmentation of the knowledge is not a priority
Focus is on understanding of the problem, capacity to
analyze, synthesize and assessment of treatment efficiency
CCS methodology
Traditional lectures are focused on the facts and data
Students are overcharged with too many data
CCS intention is:
•To develop the thinking abilities
•Students learn solving the provblems by joint team effort
•They are not served by ready-to eat information package
•CCS increase the self-confidance and trust to colleagues
CCS example: Introduction
This clinical case, based on the real one from our
practice, is allocated to your group
Your task is to study this case and give us a feedback with answers to questions.
Anamnesis
• Patient A.A is a 45-years old male.
• Principal complain is a general ailment, pronounced in the
lower extremities
• Patient walk with difficulty and clumsy, and speech
disorder were noted
• Problems started 6 months ago and at present he has
problems in writing, stairs climbing and he is not able to
comb the hair.
• Muscle strength in hands is diminishing, he has problem to
dress, button up or to close the zipper
Physical examination
• Twitching and trembling movement of tongue
• Difficult swallowing
• Babinsky reflex prominent, all other are normal
• Generalized muscular weakness, spasticity,
more pronounced in the legs
Diagnostic procedures
• Nuclear magnetic resonance is normal
• Electromyography: denervation
• Blood tests: increased level of glutamate
Physician’s recommendation
(1) Baclofen and Riluzole to alleviate the symptoms
(2) Physical therapy and
(3) Speech therapy.
Questions to be answered
1. Which ailment is presented here?
2. Is there brain damage;? Any particular
disease?
3. Is there any non-neurological reason
influencing the patient’s walking ability?
4. Which brain region is damaged?
5. What influence the movement function?
Questions to be answered, cont’
How the recommender treatment will influence the
brain function?
7. How will influence the existing symptoms?
8. Are you able to explain the present symptoms and
signs?
9. Are you able to connect the clinical picture to any
particular part of the brain or to neurotransmitters?
10. What else can be done for this patient?
6.
Sources of supplied information have to be documented
Differential diagnosis
Neurodegenerative disesases of CNS
1. Multipl sclerosis
2. Alzheimer disease
3. Amiotrophic lateral sclerosis (ALS)
4. Parkinson disease
5. Alcochoolism
6. Huntington disease
Organization of clinical case study
Day1: Introductory lecture
Tutor presents the basic facts on body movements,
and on movements disorders
Organization of clinical case study
Day 2: Cases allocation
Optimal number is 6 groups with 5 students
All teaching materials are at disposal in electronic
and all other forms
Tutor is at disposal all the time, to explain and to
steer the group
Supplementary
materials
Supplementary
materials
Organization of clinical case study
Day 3: Preliminay reports
Each of the groups report its dayly progress
Every studen receive all collected facts and data
Organization of clinical case study
Day 4: Final report
Report content:
1. Summary of clinical case – 1 or 2 paragraphs
2. Answers to all questions
3. Additional information related to the case
Evaluation
• Clinical case summary: 2 points
• Five correct answers: 5 points
• Sources and references citation: 1 point
• Clarity of presentation: 1 point
• Grammar, report formatting, tidiness: 1
point
Highest score: 10 points
Achievements and outcomes
At the end of clinical case study, student would:
• Know brain regions responsible for intentional
motor movement and their control
• Know specifics of different neurological conditions
influencing movement disorders
• Understand the therapeutic options
• Understand the consequences of the damage in
different regions of the brain
Pro et contra
of clinical cases study (SKS)
Advantages
•Development of thinking
capabilities
•Knowledge is not served, but
conquered in the learning process
•Interaction of thinking,
discussing, and quest for
information
•CCS imitate the techniques of
problem-solving the reality
Disadvantages
•CCS is not efficient when
student need to acquire the large
number of facts, data and
principles
•If applied rarely, too
copmplicated both for teachers
and for students
•Do not offer all necessary
information
The tasty dinner is earned, not served one