THE SMALL GROUP

TUTORIAL PROCESS
Emiliana G. Carmona, M.D., F.P.P.S.
 The Seven Jumps
1. Clarify terms to be explained.
2. Explain the problem. List the phenomena to be explained.
3. Explain the problem. Produce as many different explanations for the
phenomena as you can think of, using logic, common sense and prior
knowledge.
4. Arrange the explanations proposed. Produce a coherent description of
the processes, that, to your thinking, underlie the phenomena.
5. Formulate learning goals. These are the bases for self-learning search
for information
6. Attempt to fill the gaps in you knowledge through individual study.
7. Share your findings with your group and try to integrate the
knowledge acquired into a comprehensive explanation for the
phenomena. Check whether you know enough.
 The Problem-Based Learning Process
Problem Small Group Discussion
-Description of the phenomena -Activation of prior knowledge
-Prepared by team of experts (What do we already know)
-Directs learning activities - Formulation of learning goals
(What do we still need to know)

EXCHANGE OF INFORMATION SELF-STUDY

Did we acquire a better understanding -Learning resources
of the process involved in the problem? - Integration of knowledge
from different disciplines
 Small Group Tutorial for Levels 2 and
3
1. The Trigger - short concise statement of the case to be discussed.
Contains just enough information to stimulate your prior knowledge
and generate hypotheses.
5-year-old girl with edema or edema
2. Definition of terms
3. Identify the problem - What is the cause of edema?
4. Hypotheses generation – broad explanation of the trigger in general
terms according to:
a. Anatomical structures involved
b. Biochemical/physiological mechanisms
c. Pathology behind the possible causes or etiologies
This discussion in Session 1 is based on the data given in the trigger.
(What are the advantages of hypothesizing in general?)
Example: Trigger - edema

Hypotheses Generation:
a. What are the structures involved in the
development of edema?
kidneys, liver, heart, blood vessels
b. How is edema produced or generated?
(Biochemical or physiologic mechanism)
hypoalbuminemia, increased hydrostatic
pressure, increased capillary permeab
c. What are the causes:
1. Kidney - nephrotic syndrome, AGN
2. Blood vessels – Allergy, Dengue Fever
3. Liver – Liver Cirrhosis
4. Heart - Congestive Heart Failure
- 5. Initial Inquiry Stage
- The students now mimic the reality of patient interaction by formulating
the questions they would normally ask the patient in the history-taking
interview.(Compare with preceptorial)
- Explain why you are asking for the piece of information; how or why it
might be related to the patient’s problem
- patient’s clinical history is gradually revealed
6. Hypotheses Organization
•-Based on evidence given in the patient’s history,
review and reorganize the listings of hypotheses to discuss the
most likely entity to explain the problem
 7. Inquiry Plan for Physical Examination
and Diagnostic Tests
•Before the session ends, the students list what PE findings are most likely
in the light of the history data and what laboratory and ancillary tests may
help to confirm the most likely hypothesis. Explain why these might be
expected or how it can help in diagnosis.
(Explanations are based on pathogenesis of the dis.)
•Finalize learning goals and report in Session 2.
 SESSION 2
1. Discussion of learning issues –anatomy, biochemistry, physiology,
pathogenesis and pathology are discussed in early session 2. This
focused discussion should explain what is happening to the patient and
why manifestations differ in every etiology discussed. (Discussion should
always go back to the patient)
2. Physical Examination findings are revealed gradually as sought by
students.
3. Inquiry plan for diagnostic confirmation. Why requested.
4. Diagnostic decision. Will be based on:
a. Clinical presentation
b. Mechanisms of disease
c. Evidence from data given
•5. Management as Learning issue. What are the goals and options for
immediate, short term and long term management of the patient? General
terms only. Details in Session 3. List learning goals.
Immediate Goals Options
mobilize fluids diuretics
Short term
establish the diagnosis labs
Long term maintain remission steroids
 SESSION3
Discussion is centered on management modalities (actual and ideal)
The diagnosis is discussed thoroughly to include everything from
epidemiology to prevention.
• THANK YOU