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IMPLEMENTATION OF INDUCTIVE PEDAGOGICAL TECHNICS IN DEDUCTIVE MEDICAL EDUCATIONAL SYSTEM
Dermendzhiev Tihomir Mishev
Chief assistant - Department of Microbiology and Immunology, Pharmaceutical faculty, Medical University, Plovdiv, Bulgaria
Peshev Zhivko Vladimirov Koleva Mariya Stoyanova
AssiMant - Department of General and Clinical Pathology and Forensic Medicine, Medicine Faculty, Medical University, Plovdiv,
Bulgaria
ABSTRACT
Teaching of all medical disciplines by using the deductive method consifls of presentation of fludy material as thematic lectures that are followed by practical lessons. In this type of organization of the training process, fludents are put in the position of passive participants of education [1]. Unlike the traditional deductive approach in inductive the fludents participate actively in learning new material, they develop skills of analytical thinking, synthesis of information, making interrelationships, research and deal with unknown situations. The main source of inductive approach in medical education is the provision of a case (clinic-morphological observation), and fludents are supposed to rationalize, underfland and solve it by their own. This training method presents in the deductive educational syflems, but takes a very small place of the pedagogical arsenal. In Medical University - Plovdiv the Department of Pathology has expanded the use of clinic-morphological observations in fludents education since 2011. The results from fludent's opinion survey show increased interefl and positive assessments about discussion of cases during each practical lesson.
Keywords: Medical education, deductive and inductive teaching, traditional curriculum, PBL curriculum, clinic-morphological observation.
Introduction: Political and economic situation in Bulgaria in the early 20th century inculcate the medical training to flarts as the model of the Russian educational syflem with deductive training methods mainly (traditional curriculum). Therefore, the medical training plan flarts with the basic sciences (chemiflry, physics, biology, anatomy and physiology) through the firfl two years, after that goes on to preclinical disciplines (microbiology, clinical laboratory, radiology, pathophysiology and pathology) and the lafl two years of the medical training are focused towards clinical medicine [1,2].
In contrafl, Anglo-Saxon methods of training in the medical schools are basically inductive. The beginning flarts in the 1890 as an informal discussion of an idea get from Low Faculty in Harvard where the method of Simulated case was used in the training of low fludents. This is the way for practical lessons in medicine training to occur, based on clinic-pathological conference (case reports) [8]. Today they are at the base of modern inductive training practices and continue to be the mofl important form of the clinical training in the medical schools all over the world. Therein, the mofl advanced curriculums (McMafler and Masflricht Universities) are based on PBL curriculum [5].
Only one of the five Medical Universities in Bulgaria has integrated and functioning alternative of the deductive educational syflem - PBL curriculum in Pleven in the academic year 2000-2001. It is partially horizontally integrated and
flructured in organ-syflem blocks. The basic sciences concepts are learned repeatedly in clinical disciplines of undergraduate medical education [8].
A point of contact between deductive and inductive educational syflem is fludying of many cases (simulated cases, clinic-pathological conference, clinic-morphological observation). In the medical schools with traditional curriculum this method is usually introduced after the second year of medical education, and in the universities with PBL curriculum it is based mainly on training cases.
In Bulgaria the firfl textbook with case reports requiring diagnosis came out in 1989 under the title "Repetitorium pathologoanatomicum [10]. In the next 20 years text descriptions of the cases had been included in practical manuals and collections with examinational queflions like SBAs (Single befl answer queflions).
In 2011 the Department of General and Clinical Pathology of Plovdiv expanded its training methods and sources and introduced new and compulsory training manuals. Every fludent during the pathology course has an access to a wide range of illuflrated clinic-morphological observations, that are discussed on every practical lesson [3].
Purpose: To invefligate the fludent's opinion from different medical specialties in the Medical University - Plovdiv about the benefits from expanded fludying of clinic-morphological observations.
Materials and methods: The practical lessons of pathology for fludents of medicine and dental medicine are held to a flandard algorithm. Every fludent works with its own practical manual that includes the protocols of all lessons. In the end of each topic there are text descriptions of 2 or 3 clinic-morphological observations with queflions of which the fludent mufl answer. Every practical manual is accompanied by a CD that consifl
the clinic-morphological observations from all lessons [1, 2]. Each case is illuflrated by colorful images of the gross organ changes and hiflological findings (Fig. 1) and the fludents have the opportunity to get familiar with them while they are getting prepared for the upcoming practical lesson.
Figure 1: Example for Clinic-morphological observation (Case report).
Protocol № 13
20. The autopsy of a 32-year old man showed abundant yellowish exudate covering the large hemispheres. The exudate 'entered' the adjacent sulci and the meninges were edematous and hyperemic. The brain tissue was also edematous, hyperemic
and gliflening (picture 20-1). Microscopically leptomeninges were infiltrated with great number of neutrophil leucocytes. Thrombosis of venous vessels and local hemorrhages were also found. In cerebral cortex was seen pericellular and perivascularedema (picture 20-2).
picture 20-1
picture 20-2
1. Set the diagnosis ?
2. What is seen in meninges on microscopy ?
3. Point two diseases that can complicate with the pictures described above:
21. The autopsy of a man died from acute rheumatism - a new attack, the pericardial sac was covered with grey velvet-like membrane. At some places, the membrane appeared fibrillary (picture 21-1). Microscopically on the epicardium was seen fibrin layer with rough net-like flructure, composed of intertwined
fibrin fibers. Among them were included lymphocytes, plasma cells and leucocytes. Capillaries of epicardium were dilated and
hyperemic - inflammatory hyperemia (picture 21-2).
picture 21-1
picture 21-2
1. Set the diagnosis !
2.What other complication of this disease would you expect if the patient survived the present attack ?
3.How can you prove the composition of the membrane ?
22. During the medical examination of a 29-year old man, febrile with heavy headache, accelerated heart beat and sore throat, the doctor found purulent angina complicated with peritonsillary abscess.
1. Is it possible to have the same complication as described in case 20? Why?
2. Is it possible to have the same complication as described in case 21? Why?
3. What therapy would you prescribe: a) tonsillectomy; b) antibiotics; c) physical therapy; d) pain relief; e) immune Simulation.
Student (Signature):
Assiflant (Signature):
Every CD consifl a single file with "Topics for extracurricular practice (Fig. 2). They are presented as thematic, well-illuflrated clinic-morphological observations, with queflions that require answers. Some of the cases are discussed in the negotiation lessons, other part of them are used at the time of sectional lessons in case there is no autopsy while others remain for homework [3].
Figure 2: Topics for extracurricular practice
Topics for extracurricular
., This [ could do in ihe 3rd course of my study! T
Brain hemorrhage and painful small joints 7 7
Thanato genes is, started with jdutidl» ... T
-Landing- of invasive cardiology T
The parents are indecisive. the child is suffering ^J*
Instead of parturition ....
What did admiral Nelson died from ? T
The good part is that we don't choose our end ... ^T
Your heart is aching, but in the end your head is blowing T
Even the CEASER-ean section DO£StsTT HELP ^
The dangerous charm of strawberries T
From pleural effusion to convulsions- What is it ? hT
Too much ado foi nothing f Y
Not only smoking harms 7
Pop folk singers also suffer T
Hammering at one place, cracking at another ..... ™ Immunohistochemistry: difficult term, practical approach 7 Tumor occlusion of inferior cava vein 7 Something is winding in the left ventricle T Impetus to a cellular immaluration ^
On the walls of both corridors and rooms in the training corpus are placed educational panels and powers with case reports from scientific congresses and conferences. During the course of pathology training every fludent has the opportunity to get familiar with individual cases. Some of them are discussed during the practical lessons.
Results: The introduced ways of presentation of clinic-morphological observations have some advantages and disadvantages. They are the aim of the survey which includes 442 anonymous fludents (Chart 1, 2).
Chart 1: Need of clinic-morphological observations.
from III year who fludy pathology (26,20%). On the third place The results of the survey show that graduated doctors (33,40%) are fludents of medicine IV year, who fludy clinical pathology consider the benefits of including more clinic-morphological (19,70%). The lafl one should realize the benefits of the cases, observation in the medical training. The next largefl group of but the interefl of third year fludents from the firfl contact with respondents that have the same opinion is fludents of medicine the cases probably is the reason for the positive responses. The
fourth place is for fludents of Dental medicine with 12,50 % . The lafl place is taken by pharmacies with 8,20 %. Pathology is the only one discipline that gives them the basic image for
diseases during their whole course of education in the faculty of Pharmacy.
Chart 2: Training panels and poflers (Student's answers are in % of all participants and some of them give more than one answer)
Students from all specialities assess the educational panels and case reports as a useful source of information, moflly these are the fludents of medicine fludying clinical pathology (73,30%). Students of dental medicine is the group that read mofl Clinic-morphological observations (43,70%), and fludents of pharmacy pay attention of the cases at leafl (16,30%). It is almofl equal the diflribution of fludent's groups of pharmacy (32,70%), medical fludents - III year (29,70%) and medical fludents - IV year (33,60%), who think that cases enrich the knowledge with rare clinic-morphological observations. On this queflion lower score give only the fludents of dental medicine (19,70%). The same group of responders assess the training panels as kitschy and uglify training corpus (11,40%). Cases make difficult moflly the fludents of medicine from III year (14,50%) and fludents of pharmacy (10,20%), who think that the presented cases should be predominantly with propaedeutic trend .
Discussion: Academic medicine with traditional curriculum is under pressure. The reasons are found in revolutionary changes in the area of healthcare in recent decades, the need of educational reform, appreciation of the medical profession, budgetary conflraints and many unsolved medical and ethical issues [4]. The process of European integration requires a significant adaptation in education. Increased fludent mobility also Simulates the changes in the field of medical education. Medical schools that offer training programs with a focus on active teaching are preferred, because they increase knowledge and success of fludents. [7, 8]. Problem-based learning (PBL) or problem-oriented learning (POL) are basic topics in international
discussion for modern teaching in the area of medicine. There are successfully created hybrid curricula that integrate PBL and traditional curriculum. Implementation of an integrated program in education is very difficult and complex process, because it requires adminiflrative planning, coordination with university aims and with the philosophy of the school. Introduction of integrated program assumes eflablishment of a special committee to develop new curricula, to define the methods of teaching and examination. Introduction of integrated program means breaking with traditions and a complete reconflruction of educational activity in the University [6]. For some fludents the inductive approach is more appropriate as they are researchers and like the unknown and experiments. Others need the educational flructure and are not able to work in an unknown situation. The inductive approach is not panacea, it is a valuable method for teaching and presenting new material [5, 9].
Conclusion: Inductive approach of training can be combined with deductive approach as well as they both can be alternated. It is not necessary the two educational syflems to compete each other or to be opposite. There is a way of interaction between them, based on synergy. Useful and effective educational methods and sources of inductive educational syflem can be integrated easily and successfully in the deductive syflem without major changes in educational syllabus and schedules of medical schools.
Literature:
1. Bivolarski I., B. Anavi, Dimitrova D. Computer resuscitation of the practical training in pathology. Blagoevgrad, Year-book Science, Education, Art, ISSN-1313-5336, Vol. 6, Part 2, p. 205-212, 2012.
2. Bivolarski I., Dimitrova D., Anavi B. Visual interactive education of general and clinical pathology. Union of scienti^s in Bulgaria - Plovdiv, series Medicine, Pharmacy and Dental medicine, ISSN-1311-9427, p. 165-169, 2013.
3. Bivolarski I., Mihaylova V, Alakidi А. Virtual autopsy in the pathology training - a surrogate for direct sectional observation. Журнал Евразийский Союз Ученых (ЕСУ), ISSN 2575-7999, 3 (12):23-26, 2015.
4. Bosman F. Academic medicine: dream or nightmare?. Croat Med J. Aug;45(4):371-4, 2004
5. Gallo P., d'Amati G., di Gioia C. et all. Teaching anatomical pathology in the undergraduate curriculum in Medicine: the experience of 'C Course', Sapienza University, Rome. Pathologica 103(2): 27-31, 2011
6. Guilbert. Guide pedagogique pour les personnels de Sante. Geneve, 1990.
7. Damjanov Iv., Fenderson Br., Hojat M. et all. Curricular reform may improve fludents' performance on externally adminiflered comprehensive examinations. Croat Med J; 46 (3):443-448; 2005.
8. Radionova Z., Hriflova P. Comparative analysis of the acquired clinical skills assessment of undergraduate medical fludents in a problem-based learning and traditional curricula. International cross-induflry research journal & Perspectives of Innovations, Economics and Business, 6 (3):120-122; 2010.
9. Radionova Z., Hriflova P. Opinions of fludents and teachers about the learning behavior of medical fludents in an innovative Problem Based Learning and traditional curriculum. Journal of Biomedical & Clinical Research, 1 (1):62-66; 2008.
10. Velev G., Gurdevski M., Georgiev A. et all. Repetitorium pathologo-anatomicum - editor prof. M. Zlateva, Medicine and Physical Training, Sofia, 1989.
НAУЧНO - МEТOДИЧECKИE OCНOВЫ ЭKOЛOГИЧECKOГO ВOCПИТAНИЯ Ш^ЛЬНИ^В В OTO^CCE OБУЧEНИЯ
МAТEМAТИKE
Бeкбoлгaнoвa Aлмa Куcaинoвнa
кaндuдam пeдaгoгuчecкuх HayK, KœaxcKuù гocудaрcmвeнный жeнcкuй пeдaгoгuчкcuй yHueepcumem г.Aлмamы
Дaулeткулoвa Aйгуль Утeгeнoвнa
кaндuдam пeдaгoгuчecкuх HayK, KœaxcKuù гocудaрcmвeнный жeнcкuй пeдaгoгuчкcuй yHueepcumem г.Aлмamы
Тoлeухaнoвa Зaурeш Мaхceнoвнa cm. прeпoдaвameль кaфeдры MameMamuKu, Ka3 гoc жeн ПУ г.Aлмamы
АННОТАЦИЯ
В статье рассмотрены вопросы экологического образования школьников в процессе обучения математики. Педагогические методы развития экономического мышления у школьников. Показана необходимость сотрудничества педагогов и родителей в формировании жизненной позиции ребенка.
ABSTRACT
Thß q^S^ns of е^поптейа1 education йМеШъ in teaming mafematics. Tsaching methods development of есоттк thinking in йийеШз. Thß ^œssity of соорегайоп of teachers and parents in shaping thß vita1 position of Ше chi1d.
Ключевые слова: экологическое образования, экономические проблемы, природа, ппроблема, информация.
Keywords: environmenta1 education, economic prabkms, the nature of the ргоЬ1ет, information.
XXI вeк- этo врeмя oбecпoкoeннocти мирoвoгo coo6-щecтвa вoпрocaми oкружaющeй cрeды, измeнeния климaтa, oпуcтывaния, рaзрушeния экoлoгичecкoгo бaлaнca, кoтoрыe ярто прoявляютcя и в Кaзaхcтaнe.
В пocлaнии прeзидeнтa cтрaны Н.A.Нaзaрбaeвa к нaрoду Кaзaхcтaнa oтмeчaeтcя, чтo «Кaзaхcтaн 2030 гoдa дoлжeн cтaть чиагой и зeлeннoй cтрaнoй, co cвeжим вoздухoм и прoзрaчнoй вoдoй. Прoмышлeнныe oтхoды и рaдиaция бoльшe ж будут прoникaть в нaши дoмa и caды. Нaши дeти и дeти нaших дeтeй будут жить пoлнoцeннoй жизнью в здoрoвых уcлoвиях» [1].
Пoэтoму aктивизaция пoиcкa путeй рeшeния экoлo-гичecкoй прoблeмы, вcecтoрoннee иccлeдoвaниe иcтoричecкoгo oпытa рeгулирoвaниe oтнoшeний oбщecтвa и прирoды рaccмaтривaютcя кaк нacущныe и aктуaльныe нaучнo-прaктичecкиe зaдaчи.
В филocoфcкoм ocмыcлeнии вoпрocы взaимooтнoшe-ний oбщecтвa и прирoды внутрeннe, cвязaны c прoблeмoй Чeлoвeкa гак чacти и oбщecтвa, и прирoды. этa прoблeмa яв-ляeтcя цeнтрaльнoй вo вceм кoмплeкce глoбaльных прoблeм coврeмeннoгo мирa, пoэтoму нe мoжeт вызвaть coмнeний нeoбхoдимocти фoрмирoвaния экoлoгичecкoй oтвeтcтвeн-нocти у пoдрacтaющeгo пoкoлeния. К coжaлeнию, eщe нeдocтaтoчнo ^ara^ecEra шaгoв прeдпринятo в этoм нaпрaвлeнии в Кaзaхcтaнe.
В шкoлaх Кaзaхcтaнa cущecтвуeт мнoжecтвo прoблeм. cвязaнных c экoлoгичecким oбрaзoвaниeм. Вce oни являются cлeдcтвиeм нeдocтaткa или oтcутcтвия хoрoшo рaзрaбoтaн-ных прoгрaмм и учeбникoв для oтдeльных учeбных дте-циплин. Трaдициoннo мнoгo выдeлeнo экoлoгичecкoгo мaтeриaлa для прeпoдaвaния биoлoгии и химии. Ocтaльныe прeдмeты cтрaдaют ecли ж oтcутcтвиeм, тo нeдocтaткoм
