GUIDED DISCOVERY LEARNING
WORKED EXAMPLE
1.1 INTRODUCTION
Welcome to the Guided Discovery Learning library.
The library consists of around 90 problem-based learning (PBL) cases organized by body organ system. PBL has been widely adopted now by newer medical schools to guide instruction using adult learning methods.
Very little use is made of PBL for continuing medical education (CME). We have attempted to construct the cases so that both groups of users can use the same techniques over their professional lifetime.
The materials are organized in the following way:
· Case scenarios: These take the user through a case summary that follows the traditional approach to case presentation: chief complaint, demographics, medical history, physical examination, investigations, management, and follow-up.
· Supporting materials for the cases: these include images, x-rays, heart sounds, video clips etc., and are being added to the cases over time.
· Courses: local knowledge is presented as "factoids" in a card index format electronically, linked to topics in the cases. There over 2,000 learning issues addressed by the cases and the knowledge about these issues are summarized in the course materials.
· Remote or new knowledge: these are represented by links to external sites or by pre-programmed searches. We will discuss more about this in the section on "Further Study".
1.2 PORTAL TO THE SYSTEM
· The portal allows a review of the entire system and its resources.
· There are links to the case register, reviews of the system, the user guide, and an MCQ example for the Web
· There are also links to our internal learning resources, the MedGuide and the Slide Library
· This portal is for the CME/CPD application, not for medical students, where a prescribed syllabus is used through a learning management system (LMS)
Bottom of the portal page
1.3 CASE CATALOG
The introduction is contained in the catalog page itself:
Each case is documented with a case summary of the presentation and what the case is about. This is organized by body organ system
1.4 CASE STUDIES FOR THE IMMUNE SYSTEM
1.5 HOME PAGE WITH DEMOGRAPHICS AND “TRIGGER”
Each of the 90 cases has a set of linked pages. This is the “home page” for one of the cases.
A typical page contains:
Page Header
· An icon representing something about the case (a photo, or lab result) to help you remember the case
· A descriptive tag about the case presentation, e.g. "The pain's in my jaw"
· A brief statement about what the case is about, e.g. "[A 59 year old man with high blood pressure]"
· Demographic characteristics
· A page title e.g. "Chief Complaint" with the case ID (MRN=”Medical Record Number”)
Horizontal tabs describing the content, such as "Demographics", or "Chief Complaint"
A review tab, describing the topics that you should review or reflect on before getting more information from the subsequent pages. Every page has this tab. It includes a clinical reasoning model that is the key to this approach to learning..
A tab for the Discussion Forum, to be described separately
Learning topics and issues
Navigation Menu:
A horizontal menu consisting of links to other pages in the case. Each choice is separated by a vertical bar, "|" The first choice is usually |HOME| or CHIEF COMPLAINT. The navigation menu appears at the bottom of each case page. This would lead to the next example.
Course pages are organized in the following way:
· A title
· A table of contents
· Individual sections from the table of contents clearly marked with a border for navigation
· A BACK button to return to the case
· A CONTENTS button to go directly to the table of contents
· Course content invariably in the form of bullets and short descriptive phrases
1.6 DISCUSSION FORUM
Each case page has a tab for the discussion forum. This is a special application that is "attached" to the page as a note. The discussion forum uses "threaded" discussions, which means that a tree of all the notes is maintained so that you can follow each note and the replies to that note (and the replies to the reply).
These threaded discussions have been shown in extensive study to mimic the process of real-live discussions, but they allow the participants to be uncoupled in time and space. There are a number of post-graduate discussion groups among international collaborators across world time zones that would not otherwise happen. A study of Internet-based CME in Canada among rural GPs showed that the discussion groups were one of the most valuable features of the learning system to the learners.
The discussion forum page has two buttons at the top of the page:
· The ADD NOTE button, to add your own new note to the forum. When you click on this button a form will open to allow you to enter the subject and the text of your note. There is a dropdown menu that allows you to classify the contents of your note (or reply). The default is "Note". This menu is used to label the notes by category ("Pro", "Con", "Important" etc.)
· The SEARCH button, to search the entire forum for keywords. In our experience running these forums for the last five years some of the discussions can get quite long, and this feature has proven to be useful.
· There are other options in a menu just beneath the title of the note.
· The Reply option is probably the most useful of these.
Many of the authoritative resources, such as practice guidelines, are viewable or downloadable in PDF format. This format preserves the exact appearance of the original document. PDF was developed by Adobe Systems, and these files are accessed with the Adobe Acrobat Reader. You may have to download and install the reader from the Adobe Web site
1.7 MEDICAL HISTORY PAGE
This page, and the ones that follow, should be self-explanatory.
Some of the pages have links to “exhibits”, which are mostly graphic images, but include X-rays, heart sounds, and videos.
1.8 INVESTIGATIONS
1.9 FOLLOWUP: OCULAR COMPLICATION
The photo image of the retina is from the fundoscopic exam linked from “Follow-up”.
1.10 LEARNING TOPIC
These learning topic summaries are linked from the scenario pages.
1.11 FURTHER STUDY
Each case contains a page with links to resources for further study. For the most part this page will have the following sections, labelled with a horizontal tab (some have icons). The entire curriculum is organized by body organ system and three major domains: clinical skills, knowledge, & reasoning; mechanisms of disease; and community health and prevention.
· Clinical Skills, Knowledge, & Reasoning: these course topics cover the clinical aspects of the case, and may be accompanied by --
· Clinical Practice Guidelines: obtained from various authority sources. Australian, NZ, and UK sources are given priority, but there are many large libraries of guidelines in the USA and Canada
· Mechanisms of Disease: sometimes referred to "basic science", these are topics that relate to relevant issues about normal and abnormal structure and function, with an emphasis on pathogenesis and pharmacology
· Community Health & Prevention: topics related to "population medicine", such as epidemiology, prevention, and critical appraisal of evidence from research studies, often including --
· Evidence-Based Medicine (EBM) Resources: these include abstracts from the Cochrane Library, or to resources about a particular disease condition, such as the dementia group at Oxford. This section also contains a link to the Health Information Research Group at McMaster University in Canada, and their textbook
· WebGlimpse: this tool allows a fast search to the entire archive of course material maintained on our server. The results of the search, generated from a form, are themselves a Web page. Approximate searches are allowed (to account for spelling differences e.g. haematology/hematology). When completing the form, after including the search term, it is a good idea to check the box "Jump to line", which will take you to the specific line(s) that contain the search term. WebGlimpse also allows for multihop searches, meaning that if the document contains a link, that link will be searched also. This is a powerful tool for taking the best advantage of hypertext and the World-Wide-Web (WWW)
Bottom Half of “Further Study” Page
· PubMed Auto Search: PubMed is provided as a public service by the National Center for Biomedical Information, a unit of the National Library of Medicine (NLM), National Institutes of Health in the USA. The entire MEDLARS/MEDLINE library is made available via the World-Wide-Web. PubMed allows queries to be embedded in Web links, and some of these are made available to you, mostly about management. There is a choice for you to create your own search also. PubMed queries can be time limited, so that a query of the form "Give me all the review articles on Alzheimer's disease, in English, with an abstract, published in the last 180 days" can be constructed. These embedded queries can be used to facilitate the problem of keeping up with the literature. PubMed Central is a newer service that allows access to the full text of journals. NLM is trying to persuade as many journals as possible to make the full-text available, possibly six months after publication, as the NEJM does. See the next section for an example
· WWW Virtual Library: the WWW Virtual Library is a collaboration to bring more knowledge resources to the Web. It is not confined to biomedical subjects
· Suggested Reading: suggested reading topics have been created by the course developers. In some cases these are textbooks and chapters that must be obtained from the library or bookstore. In others they are precompiled references with embedded PubMed IDs that will take you to PubMed. If you are lucky the full-text of the article may be provided by PubMed.
· Web Links: more and more resources are available on the Web, in many cases compiled by associations to improve the management of certain diseases.
· Review of learning issues: Each assessment is preceded by the opportunity to review the learning issues about the case. Major learning issues are clearly marked. If you are able to use the assessment system for credit of any sort a review of the learning issues is advised, as the questions are based on these issues.
· The Assessments
1.12 PUBMED AUTOSEARCH RESULT
1.13 ASSESSMENTS
1.13.1 Clinical
1.13.2 Mechanism of Disease
1.14 READINGS AND RESOURCES
This listing includes the external resources for the learning topics. A mirroring program that copies these links can produce a large file.
1.15 OPEN SOURCE TEXTBOOK
1.15.1 Cover and Bookmarks
This is an example of the HIV Medicine textbook from “Free Books for Doctors”.
Sample Chapter
1.16 APPENDIX: Sample XHTML Source Code
This section is included for those expert readers who are interested in the construction of the pages. This example displays the source code for the first page in the example.
1.16.1 Documentation
· These include Dublin Core meta tags.
· Date, author, and source are inserted by the Concurrent Versioning System (CVS) when the system is hosted on a Unix/Linux platform
<?xml version="1.0" encoding="us-ascii"?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN"
"http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<title>MRN 101 ROBIN HOOD: 1. CHIEF COMPLAINT</title>
<!-- Dublin core meta tags -->
<meta http-equiv="charset"
content="iso-8859-1" />
<link rel="schema.DC"
href="http://purl.org/dc" />
<meta name="DC.title"
content="MRN101: Robin Hood Chief Complaint" />
<meta name="DC.creator"
content="$Author$" />
<meta name="DC.subject"
content="thoracic trauma, wound infection, confidentiality" />
<meta name="DC.description"
content="Chief complaint from PBL trigger" />
<meta name="DC.publisher"
content="Online Medical Education Pty Ltd" />
<meta name="DC.contributor"
content="Medical University of South Carolina" />
<meta name="DC.date"
content="$Date$" />
<meta name="DC.type"
scheme="DCType"
content="Text" />
<meta name="DC.format"
content="text/html" />
<meta name="DC.format"
content="NNN bytes" />
<meta name="DC.identifier"
content="$Id$" />
<meta name="DC.source"
content="$Source$" />
<meta name="DC.language"
scheme="RFC 3066"
content="en-aus" />
<meta name="DC.relation"
content="Musculoskeletal System" />
<meta name="DC.coverage"
scheme="TGN"
content="English-speaking world" />
<meta name="DC.rights"
content=
"Copyright (c) 2002. Online Medical Education. All rights reserved." />
1.16.2 Link to External Stylesheet
The stylesheet is quite elaborate and is not displayed here.
<link rel="stylesheet"
type="text/css"
href="../../CSS/cases.css"
title="Style Sheet for Cases" />
</head>
1.16.3 Body of Page
· The body of the page consists of one single tab, allowing horizontal tabs.
· The first part includes the table header
<body>
<div class="center">
<table bgcolor="white"
border="0"
cellpadding="5"
cellspacing="2"
summary="Scenario">
<thead>
<tr class="tab">
<th colspan="3">
<img src="../../IMAGES/cadu.gif"
alt="[Chest Wound]"
height="34"
width="37"
border="0"
align="left" />
<img src="../../IMAGES/omelogo.gif"
height="44"
width="64"
border="0"
alt="[Logo]"
align="right" />
<p>" He's as white as a sheet "</p>
<br />
<em>[Thoracic injury]</em>
</th>
</tr>
</thead>
· The next section is the table body
· This contains a nested table for the demographic information
<tbody>
<!-- Heading row begin -->
<tr>
<td class="head"
colspan="3"
align="center">MRN101 ROBIN HOOD: 1. CHIEF COMPLAINT</td>
</tr>
<!-- Heading row end -->
<!-- Demographic row begin -->
<tr valign="top">
<td width="10%"
class="tab">DEMOGRAPHIC</td>
<td width="89%">
<table class="sub"
border="0"
width="30%"
summary="Demographic info"
cellpadding="2"
cellspacing="2">
<tr>
<td>Name:</td>
<td>"Robin Hood"</td>
</tr>
<tr>
<td>Age:</td>
<td>Unknown</td>
</tr>
<tr>
<td>Sex:</td>
<td>Male</td>
</tr>
<tr>
<td>Race:</td>
<td>Unknown</td>
</tr>
</table>
</td>
<td width="1%"
class="tab"></td>
</tr>
<!-- Demographic row end -->