Slide 1 of 28 Case Name & Day Restriction of Use: The School of Medicine considers all PBL cases and supporting materials to be secure and intended solely for the educational purposes of the students and faculty of the University of Texas Medical Branch. Students should not access the PBL cases prior to release on the course website. At no time should the PBL cases and supporting materials be copied or distributed. Individuals violating these policies are subject to disciplinary action.

Slide 2 of 28 Background This slide includes: An introduction of the patient from his/her background story up to the reason for the visit (possibly including a history of present illness). Begin a problem list on the whiteboard.

Slide 3 of 28 Past Medical History Continue the problem list (including current medications).

Slide 4 of 28 Family History Continue the problem list (if needed).

Slide 5 of 28 Social History Continue the problem list (if needed). What would you want to learn from the physical exam?

Slide 6 of 28 Physical Exam Review of Systems Physical findings Continue the problem list as needed. STOP and discuss before advancing to the next slide.

Slide 7 of 28 Tasks This slide might include: Can you form hypotheses regarding pathogenesis based on the problem list? List them on whiteboard. Consider VITAMIN ABCDE. What other information would you like to have about the patient to confirm or disconfirm hypotheses? How could you get the information you need? Discuss the above tasks before proceeding to the next slide.

Slide 8 of 28 Additional Information This slide might include: Information from questions asked of the patient Lab values Exhibits Revise the problem list as needed. Prioritize hypotheses based on new information.

Slide 9 of 28 Exhibit 1 This slides will include: Exhibits that are embedded within the case (rather than hyperlinked at the end of the case).

Slide 10 of 28 Tasks This slide might include: Pharmacology Possible treatment choices Additional information needed about this patient Diagrams Discuss the above tasks before proceeding to next slide.

Slide 11 of 28 End Day 1 Please turn off projector using the wall-mounted key pad. Thank you.

Slide 12 of 28 Begin Day 2 Case Name & Day Restriction of Use: The School of Medicine considers all PBL cases and supporting materials to be secure and intended solely for the educational purposes of the students and faculty of the University of Texas Medical Branch. Students should not access the PBL cases prior to release on the course website. At no time should the PBL cases and supporting materials be copied or distributed. Individuals violating these policies are subject to disciplinary action.

Slide 13 of 28 Student Presents Patient Subjective Patient Demographics PMH FH SH ROS Objective PE Labs

Slide 14 of 28 Student Presents Patient Assessment Primary problem Possible etiologies Relation among problems Rationale for interventions and diagnostic tests Plan Current medications Management steps

Slide 15 of 28 Learning Issues Discuss the learning issues and apply them to the case.

Slide 16 of 28 Diagnosis This slide includes: A diagnosis given to the patient and the patient’s reaction/questions. Tasks that should prompt the students to answer any patient questions and to justify the diagnosis given by providing the confirming evidence for the diagnosis or the disconfirming evidence for competing diagnoses. STOP and discuss before advancing slide.

Slide 17 of 28 Treatment Depending on the case, this may take the form of a description of treatment undertaken or a description of treatment options presented to the patient. This may take multiple slides and include patient questions about treatment. STOP and discuss before advancing slide.

Slide 18 of 28 Tasks Such as: Describe the effect of treatment(s) on problems. Describe other effects (possibly unintended) of treatment. Compare cost associated with treatment options. Discuss adherence issues for treatment regimen or recovery time if treatment is surgical. Tasks at this point should include the impact of treatment - medically, psychologically and socially. STOP and discuss before advancing slide.

Slide 19 of 28 End Day 2 Please turn off projector using the wall-mounted key pad. Thank you.

Slide 20 of 28 Begin Day 3 Restriction of Use: The School of Medicine considers all PBL cases and supporting materials to be secure and intended solely for the educational purposes of the students and faculty of the University of Texas Medical Branch. Students should not access the PBL cases prior to release on the course website. At no time should the PBL cases and supporting materials be copied or distributed. Individuals violating these policies are subject to disciplinary action. Case Name & Day

Slide 21 of 28 Student Presents Patient Subjective Patient Demographics PMH FH SH ROS Objective PE Labs

Slide 22 of 28 Student Presents Patient Assessment Primary problem Possible etiologies Relation among problems Rationale for interventions and diagnostic tests Plan Current medications Management steps

Slide 23 of 28 Learning Issues Discuss the learning issues and apply them to the case.

Slide 24 of 28 Patient Follow-Up This slide includes: Follow-up visit including unresolved problems Follow-up lab values where appropriate Stop and discuss before advancing slide.

Slide 25 of 28 Synthesizing Tasks This slide may include: Learning activities, e.g., quizzes, concept maps, etc Are there tasks such as diagrams etc that would help students synthesize the information in this case? Also consider alternate ending scenarios of how might this outcome be different : if the patient were older or younger? had chosen a different treatment option had a concurrent diagnosis of..., etc.

Slide 26 of 28 Theme Issues / Tasks This slide may include: Tasks focused on issues about health care delivery, preventive health, or professionalism that students should consider in reflecting on the case.

Slide 27 of 28 End Day 3 Please turn off projector using the wall-mounted key pad. Thank you.

Slide 28 of 28 Credits Case author(s): Image attribution: