1. فرحناز کمالی عضو هیئت علمی دانشکده پرستاری مامایی

2. What is problem based learning? Is not problem solving but it uses appropriate problem to increase knowledge and understanding

3. Generic skills and attitudes Teamwork Chairing a group Listening Recording Cooperation Respect for colleagues views Critical evaluation of literature Self directed learning and use of resources Presentation skills

4. What happen in a PBL tutorial?

5. Step 1:identify the problem Step2:explore pre-existing knowledge Step3:generate hypotheses and possible mechanism step4 :Identify learning issues step5: Self study Step6: re-evaluation and application of knowledge to the problem Step7:assessment and reflection on learning

6. ROLLES PLAYS OF ALL PARTICIPATS Tutor Scribe Chair Group member

7. TUTOR Encourage all group members to participate Assist chair with group dynamic and keeping to time Check scribe keeps an accurate record Prevent side-tracking Ensure group achieves appropriate learning objectives Check understanding Assess performance

8. Hallmark of successful tutorial Student centeredness Ground rules Team work Dialogue between tutor and case-writers

9. SCRIBE Record points made by group Help group order their thoughts Participate in discussion Record resources used by group

10. CHAIR Lead the group through the process Encourage all members to participante Maintain group dynamics Keep to time Ensure group keeps to task in hand Ensure scribe can keep up and is making an accurate record

11. GROUP MEMBER Follow the steps of the process in sequence Participate in discussion Listen to and respect contributions of others Ask open questions Research all the learning objectives Share information with others

12. Trigger material for PBL scenarios Paper based clinical scenarios Experimental or clinical laboratory data Photographs Video clip Newspaper articles All or part of an article from a Scientifics journal A real or simulated patient A family tree showing an inherited disorders

13. How to create effective PBL scenarios Learning objective Stage of curriculum and level of student Sufficient intrinsic interest or future practice Integration of knowledge Stimulate discussion Open ended problem Promote student to gather information from various resources

14. PBL in curriculum design Entire curriculum Individual course

15. Advantage of PBL Student center Generics competencies Integration Motivation Deep learning Constructivitist approach Practical work Stimulate real-life experiences

16. Disadvantage of PBL Tutors who can’t teach Human resources Other resources Role models Information overload Time consuming unguided

17. Criteria for PBL problem construction Stimulating thinking,analysis, reasoning Assuring self –directed learning Using previous basic knowledge Proposing a realistic context Leading to the discovery of learning objectives Arousing curiosity Choosing topic related to public health Assuring a contextual detail Choosing an appropriate vocabulary

18. Scenario A 35 year old part nurse presented to her general practitioner Dr X with a six month history of weight loss (12.5kg).when questioned she said she was eating well but had diarrhea. She also felt exhausted and had developed insomnia.on further questioning she admitted to feeling increasing hot and shaky and to having muscle weakness in her legs particularly when climbing stairs. she was normally well and had not seen the doctor since her last pregnancy eight years ago.

19. Free thyroxin 49.7 pmole (normal range :11-24.5) Total thyroxin 225nmol (normal range:60-150) Thyroid stimulating hormone 0.01(0.4-4)

20. Dr X referred her to endocrinologist where initial investigation confirmed a diagnosis of Graves disease she was treated with carbimazole and propranolol for the first month followed by carbimazole alone.

21. Learning objectives 1-describe the clinical features thyrotoxicosis and Graves disease 2-Interrpret thyroid function and pituitary thyroid axis 3-List the type of treatment for thyrotoxicosis, indication,mode of action and potential effects