Tashkent medical academy f. I. Shukurov case stady

The purpose of the given case is development in the student - users of a case of abilities application of this or that kind of a method of inspection of gynecologic patients. Skills of a choice of tactics of conducting, to diagnostics, rendering of the urgent help, rational transportation and poststationary rehabilitation of gynecologic patients.

The decision of a prospective case will allow students to reach following educational results:

 To Develop abilities of an estimation and the analysis of methods of inspection at all women.

 To Fulfil ability of a choice of correct algorithm of actions for diagnosis statement.

 To Master skills of necessary diagnostics and rendering of the emergency help

 To Seize skills of independent decision-making in the present state of affairs

 To be able to spend the qualified poststationary rehabilitation

The situation At routine inspection at the patient of 48 years is revealed a non-uniform hilly uterus increased to 6 нед. Complaints does not show. Cytologic researches-ferruterous giperplazio endometrae.

The previous medical/surgical anamnesis:

From the transferred diseases - frequent простудные diseases;

menzis since 12 years, sexual life since 24 years, marriage 1.

Pregnancy-3, without complications.

Allergies are not present.

Family/sots. The anamnesis: married, does not work, does not smoke, does not drink.

Epid.аnamnezis

In contact to infectious patients was not,

Preparations of blood did not receive

Inektsionnuju therapy denies

Fizikaly survey: Integuments of usual colouring. Consciousness clear, position active.

Pulse regular - 80-85/min, the HELL 120/70, аускультация hearts - in norm, pathological noise it is not revealed,

Frustration of breath are not present, auskultasio - in lungs of changes are not present.

The inspections spent in CRH, have shown:

Нв-100 г\л, insignificant лейкоцитоз-9.4,

The general analysis of urine in norm.

Questions and tasks

What are necessary additional methods of research for diagnosis specification?

What research is necessary and for spending probably in the present state of affairs in the conditions of CRH?

What your diagnosis also prove it?

Conducting tactics?

The task: On the basis of the analysis of conditions of the woman it is necessary to make the preliminary diagnosis, to spend necessary methods of diagnostics, to make the well-founded decision for the further conducting women with a uterus myoma.

II. Methodical instructions for students

2.1 Problem:

 The Choice of tactics of conducting women with a uterus myoma.

2.2. Subproblem

 The appearance Analysis

 The Analysis of the anamnesis and preliminary events being aetologic the factor in development from a uterus myoma.

 The survey Analysis

 The Choice of necessary methods of diagnostics

 To Correlate the received results and to carry out differential diagnostics

 To Come to the certain decision of problems in the conditions of CRH

2.3. Algorithm of the decision

The appearance analysis includes following research

 - Survey of a skin and visible mucous

 - The person (eyes, language)

2. The anamnesis analysis

 - The transferred diseases

 - The family-social anamnesis

 - Theobstetrico-gynecologic anamnesis

3. The survey analysis

 - Ps, the HELL, frequency of breath, integuments

 - auskultion heart and lungs

 - Survey in mirrors

 - bimanual survey.

4. A choice of necessary methods of diagnostics

 - ULTRASONIC

5. To come to the certain decision of problems in the conditions of ЦРБ

 - Treatment if necessary

 - Rendering of the urgent help

The instruction to independent work under the analysis and the decision of a practical situation

Sheet of the analysis of a situation

Work stages	Recommendations and councils
1. Acquaintance with a case	At first familiarise with a case Reading, do not try to analyze a situation at once
2. Acquaintance with the set situation	Once again read the information, allocate paragraphs which have seemed to you important. Try to characterise a situation. Define that in it important, and that is minor.
3. Revealing, a formulation and a substantiation of a key problem and subproblem	Problem: the Choice to tactics of conducting and definition of necessity of hospitalisation of women with a uterus myoma.
4. Diagnostics of the analysis of a situation	At the situation analysis answer following questions: What circle of the widespread and dangerous diseases, are accompanied with a uterus myoma. With what it is necessary to carry out differential diagnostics and to define most plausible reasons of occurrence a uterus myoma. what methods of diagnostics are necessary for applying, make and prove the inspection plan at level ЦРБ. What additional consultations of narrow experts are necessary for statement of the definitive diagnosis? define degree of necessity of the subsequent supervision (medicamentous and not medicamentous treatment)
5. A choice and a substantiation of ways and means of a solution of a problem	List all possible ways of the decision of the given problem in the present state of affairs
6. Working out and permissions of a problem situation	Diagnose, will solve a problem in the conditions of CRH

III. THE VARIANT OF THE DECISION OF THE CASE THE TEACHER - КЕYSOLOGY

«A skeleton of fish»

Asymptomatic fibroids Excessive bleeding Dysfunction of adjacent organs

Myoma

Interstitial Submucos Subserous

Graphic structure of an organizer.

Кластер

IV CASE - TECHNOLOGY OF TRAINING AT THE SEMINAR

4.1 Model of technology of training

Theme	Methods of inspection of gynecologic patients
Quantity of hours - 6 hours	Quantity of the trained: 8 persons
The form of educational employment	Seminar on expansion and deepening of knowledge, working off of abilities to tactics of inspection of women with gynecologic diseases.
The seminar plan	Introduction in educational employment Actualization of knowledge Work with a case in мини - groups of Presentation of results Discussion, an estimation and a choice of the best variant of strategy the Conclusion. An estimation of activity of groups and students, degrees of achievement of the purpose of educational employment
The purpose of educational employment: Deepenings of knowledge on tactics of conducting women with gynecologic diseases. Development of ability of an estimation, the analysis of a situation, a choice of tactics of conducting, to diagnostics, rendering of the urgent help, rational transportation and poststationary rehabilitation of women with a uterus myoma
Problems of the teacher: to fix and deepen knowledge by an estimation and the analysis of situations and the general condition of women with gynecologic diseases to develop ability of a choice of correct algorithm of actions for diagnosis statement. to develop skills on rendering of emergency help to Develop skills of independent decision-making at conducting women with gynecologic diseases in the conditions of CRH	Results of educational activity: estimate and analyze a situation and the general condition of women with gynecologic diseases choose algorithm of actions for diagnosis statement. develop skill of independent decision-making at conducting women with gynecologic diseases in the conditions of CRH develop algorithm of actions the emergency help if necessary
Training methods	Cases-stages, discussion, a practical method
Tutorials	Case, methodical instructions
Mode of study	Individual, face-to-face, work in groups
Training conditions	Audience with a hardware, adapted for work in groups
Monitoring and estimation	Supervision, blitz poll, presentation, an estimation

Technological card of the educational employment based on a case.

Stage and the work maintenance	Activity
	The teacher	Students
Preparatory stage	Explains appointment a case - stages and its influence on development of professional knowledge. Distributes materials of a case and acquaints with a situation analysis algorithm (Methodical instructions for students see). Gives the task independently to carry out the analysis and to bring results in «Sheet of the analysis of a situation	Listen Independently study the maintenance of a case and individually fill sheet of the analysis of a situation.
I stage. Introduction in educational employment (10-15 mines)	1.1. Name an employment theme, the plan, its purpose, problems and planned result of educational activity. 1.2. Acquaints with an operating mode on employment and criteria of an estimation of results (instructions for students see)	Listen Conduct corresponding records
II stage the basic 60 mines	2.1. Proves statement of a problem and a situation choice - an urgency. Spends quiz on purpose to make active knowledge trained on a theme (the appendix №1): List the reasons of occurrence of gynecologic diseases? What complications are possible at untimely diagnostics of gynecologic diseases? 2.2. Divides students into groups. Reminds the maintenance and case problems. Acquaints (reminds) with work rules in group and discussion rules. 2.3. Gives the task, specifies correctness of perception of the task (the appendix №2): With what it is necessary to carry out differential diagnostics and to define most occurrence plausible reasons gynecologic diseases. The methods of diagnostics applied in the conditions of CRH Tactics of conducting and treatment of women with gynecologic diseases. 2.4. Coordinates, advises, directs educational activity. Estimates results of individual work: Sheets of the analysis of a situation. 2.5. Will organise presentations following the results of the done work under the case decision, discussion. The organizer of discussion: asks questions, remarks, reminds a theoretical material 2.6. An organizer - algorithm of actions DSHE in the present state of affairs (the appendix №3) 2.7. Informs the variant of the decision of a case (the appendix №4)	Answer questions, discuss, ask specified questions. Share on groups Discuss, carry out the joint analysis of an individual problem, define the major aspects of a situation, the basic problems and ways of their decision, make out results of the decision Represent variants of a solution of a problem of 10-15 mines Questions after the presentation termination, choose an optimum variant Develop uniform system, discussion
III Summarizing of employment, the analysis and estimation of 20 mines	3.1. Generalises results of educational activity, declares estimations individual from teamwork. Analyzes and estimates group, marks the positive and negative moments. 3.2. Underlines value a case - stages and its influence on development of the future expert	Listen. Can spend a self-estimation and express the opinion

The table of an estimation of individual work with a case

Participants	Criteria and estimation indicators
	The analysis of a current situation max 1,0	Problem substantiation max 0,5	Choice of ways and means of a solution of a problem max 0,5	Detailed working out of measures on decision realisation max 0,5	The general point (max 2,5) *
1.
2.
№

* 2,0 - 2,5 points - are excellent", 1,5 - 2,0 points - are good",

1,0 - 1,5 points - are satisfactory",

Less than 1,0 points - are unsatisfactory"
System of an estimation of variants of a group solution of a problem.

 Each group receives two estimated points. It can give them at once all to one variant of the decision or divide on two (1:1; 0,5:1,5; etc.), not including an estimation of own variant of the decision.

 All got points by each variant of the decision develop. Wins the decision which has typed the greatest quantity of points. In disputable cases it is possible to take voting.
The table of an estimation of variants of a group solution of a problem, point

Group	Alternative variants of a solution of a problem
	1	2	3	№
1.
2.
№
The sum

Estimation of presentation of the offered decision

Group	Completeness and clearness of presentation (1 - 20)	Nagljad-nost having appeared-lennoj presentations (1 - 20)	Masso-vost and activity of members of group (1 - 20)	Originality predla-gaemyh decisions (1 - 20)	Reception-lemost to legislative norms (1 - 20)	Total sum of the typed points (max 100)
1.
2.
№