AbalaTips101: Effective SGDs, Case Reporting 101 -->involve Active Learning

 Hello again everyone Magandang araw maligayang pagbasa sa Dok AbalaTips, Good day welcome to Dok AbalaTips we'll discuss one of the components of Active Learning which is SGDs, Case Conference such as CPCs, Ward Reportings, etc........... since this is a part of Active Learning, for a thorough discussion of the process of Active Learning please click here for the blog for active learning.....

Disclaimer: This AbalaTip is not intended to invalidate or to mention that your learning method is wrong, but rather this is a guide and to emphasize the advantages of active learning in medical school

For a quick review of active learning, here is the Modified NTL Pyramid 

Taken and Modified from Education Corner

Look fof the SGDs, Case Reportings (Clinicopathologic Case Conference included here is on Discusion which is 50% (which helps retain 50% of the information that we have learned in the medical school) because we are discussing via applying what we had learned let us recall some of the ways that involve SGDS from the Previous blog (Taken and Modified from University of Melbourne)

• Change the format of information- example a long paragraph in Harrison or Nelson or Katzung , or Harper turn them into diagrams, bullets, or tables 
• Write and Draw frequently- make summaries, glossary or picture taking (for example summary of your Physiology, or Draw for example what you had learned in Legal Medicine)
• Practice Labeling, Diagrams- usually done in SGDs Case discussions, Laboratories, Practicals) [you can use the blog about visualizing your lessons in this blog here

Lets have a quick recall of the tabulation of active vs passive learning

Criterion	PASSIVE LEARNING	ACTIVE LEARNING
PowerPoint slides	Print out and follow along during class. Highlight key slides as the professor goes through them.	Print out and read before class. Take additional notes in your own words during class. Condense each slide into a flashcard to repeatedly quiz yourself with.
Lecture notes	Write down exact words that the professor says during class. Look through notes a few times before the exam.	Summarize key points in your own words during class. Write questions you have in the margins and go to office hours asap to clarify. Re-write the same concepts in different words when reviewing.
Textbook	Look at examples from class as you complete problems. Write down what the instructor/MD professor tells you to write during office hours.	Try to solve problems on your own without looking at examples and take note of where you get stuck or make a mistake. Rework the problem by yourself after asking instructor/colleagues/MD for help. Try to “teach” a similar problem to the instructor/colleagues/MD so they can understand and correct your thought process.
Readings and Articles	Highlight headings and topic sentences as you read	Change chapter headings and topic sentences into questions and look for key points throughout the paragraph that address those questions. Summarize each paragraph in 1-2 sentences in your own words. Discuss the reading with a classmate and ask each other questions.

**Taken and Modified from John Hopkins University Active vs Passive Learning (https://academicsupport.jhu.edu/resources/study-aids/active-versus-passive-learning/)

Look at the section of Active learning in both Lectures, Textbook, Readings and Articles (Journals) which mentions you report to your class (or patient during your clerkship) what you have learned in the case. Look at the PowerPoint section in active reading saying you read it according to your own words based on what you had understand not on repeating what the lecturer had said. This where SGDs, and any reports would come into play?

Lets take a look first a case and apply active learning into this case

Ex. 

A 40y/o M comes in with 

CC: bulge, scrotal area 

HPI: 3 weeks PTC, noticed a manually reducible bulge on the left scrotal area, non erythematous, non painful, no consult done, no medications taken

During the interim still patient did not felt any pain however when he walks it becomes difficult due to the bulge which makes him uncomfortable until

 Few hrs ptc, persistence hence consult

PMHx: unremarkable

FH: unremarkableo

PSHx: (+) smoking- 10 pack years

PE: Awake conscious coherent not in distress

VS 110/80 36.4 18 67

(+) non tender soft mass- left scrotal area

Labs: CBC: unremarkable 

Pelvic utz shows bowel alongside the left inguinal sac

you will be given a paper like this next step is that you will discuss in a small group discussion your case that was given such as Differentials, Main Diagnosis, Reason, Discussion, Treatment and you will defend your case. but lets make it an active learning reporting scenario 

First is the History, apply your correlation, in which you will apply one subject to the other (refer to PPCMD2 Horizontal-Vertical Learning with Clinical Correlations blog for proper orientation to this to understand this part here) [link with permission]

For the case as a reader I know already what is in your mind already but, to rule in or out of dfferential diagnosis thats why I put a link on how to correlate its because of correlating other subject or a basic subject, example Surgery, I will link, anatomy, physiology, pathology, clin med, IM pharma onto the case based on what I learned, going back to the question, what will your diffrential diagnose, then anatomy, what involves that structure, (lets assume no radiology was given in the case, lets base on purely on History and PE of the patient in the case then go back to your basics, then I can rule in and rule out some of the entity which may not be related, rule in and rule out a case as if your working on a problem that needs to be solving, as we said by looking into Schwatz, Sabiston, Ferris' don't just read, but relate it into the problem. I will give guide questions here and try to answer this 

1. How is the entity related to the disease presented by the patient?

2. How common will be this diagnosis A or diagnosis B in relation to the case?

3. What are the signs and symptoms that may rule out then rule in that disease?

4. Are there any comorbidities presented? How about the lifestyle, occupation of the patient?

5. Is the disease acute or chronic?

Given those consideration this is where you will check into the textbook and correlate into the case via problem solving method, trying to understand how the case is related 

Next is the Main Diagnosis, why rule in and rule out is included? now will also include your justifications which is will be the discussion

Discuss not in the terms only that ahhhh this is what is on the textbook but rather what you understand on the material.

Example in the case above, which is a case of Left Inguinal Hernia, now we knows its an inguinal hernia first in the definition this is what students typically do, tho in the past I was also intially guilty at this

Text taken from Sabiston 21st Ed. 

Its very long, aside that I copy then I will reread it, it enpasses already into passive learning, to make it an active learning let us simplify the terms above into this

Now what I did, I reworded or shortened into the paragraph of based on what I understand, next is the types usually there is a direct and indirect for example we do this in the PowerPoint

Comment, good the table is good its part of active learning borders and usually students will also add this 

Taken from Sabiston Textbook of Surgery 21st Ed.

Yes its a good drawing to appreciate the difference of types of hernias but i just realized we can make this into a more simpler drawing, make a drawgram (hehehe I just invented this word) put a landmark on those

Now lets simplify it into a diagram

Diagram representation 

Based on the description now I simplified it (Active Learning) and so on......... the gist here is to have a grasp of active learning............... or create a mnemonics

Indirect- Indernal

Direct- Exdernal

C- Femoral agad

Next is the classification Tables (just like in this topic)

Nyhus classification of Hernias

How about lets simplify that table how, mnemonics

Here are my mnemonics for this table

Type I- Norma1- I just type the 1 as l

Type II- turn it into this sign = then as you can see floor and roof, does not reach the floor

Type III

Let me give you and exercise, how will you treat the patient, what are complications in the case above

Moving forward for 1st yrs it will be much much simpler in terms of what you need to know or grasp is to know your basics, grasp basic knowledge about the important concepts of normal human body and apply it to some selected abnormal human body, tho you will be more yearned towards knowing the normal human body

Ex. I will be given a case or an SGD regarding a nerve impulse or in tagalog daluyan ng kuryente sa nerve ng tao

Nerve Impulses, Berne and Levy Physiology 13th Ed.

In Physiology, your professors will be asking you if you are in a Small Group Discussion Regarding Nerve impulse and I read textbook for example Berne and Levy or Guyton, they have a very long discussion regarding this, but look at the pattern on how they do it, is in a narrative form like story telling 

there will be some terms there that will be tempting to highlight or include in the trans BUT WAIT.... that is PASSIVE LEARNING to make it ACTIVE LEARNING, let us translate this into a term we can understan

If merong impulse or isang signal mula sa utak papunta sa isang parte na yun example me nahawak ka then me pupuntang signal pabalik (impulse) na magpapagalaw sa iyong mga ion na parang isang bateya na me positive at negative (usually cation and anion) pag pumasok sa loob ang mga positive baba ang pagkakaiba ng dalawang parte sa loob at labas (depolarization) pag nagpantay yan at sa dulo mas naging positive sa loob dun maguumpisa ang kuryente na kung saan me mararamdaman ka (sensory) or magsisignal sa muscle mo (motor) - or sa ingles action potential me dalawa pa yan me parte pa na kung saan kahit bumababa ang agwat ng dalawang potensyal kahit bigyan pa yan ng impulse walang mangyayari,bababat bababa pa rin yan (Absolute Refractory Period), pag sobrang baba na pag me inapply akong impulse jan dahil me nagsara ang K gate tataas ulit yan (relative refractory period)

Moral Lesson here: I reported and I studied based on what I have understand not on what I just read from the book again Active Learning

Exercise

Instruction: please read the chapter of Membranes and Action Potentials in Guyton and Hall 14th Edition and try to explain again for active learning in your own words, on what is the mechanism of action potential at the cellular level

Again: Understand, Correlate, Simplify, then Tagalog as if you will report in an Small Group Discussion

Figure 1 in relation to Figure 2

Figure 1

Figure 2

Conclusion: Active Learning is very helpful in studies, Good luck kaya nio yan mga Future MDs