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Theory and Application
of Scripts Method of
Teaching
SAREL VAN AMSTEL
Theory
Scripts
◦
Model in education
◦
Facilitates integration of new incoming
information with existing knowledge
◦
Recognized system for developing the student’s
potential to become a successful clinical practitioner
◦
Efficient and effective
“
Clinical reasoning”
Life long commitment
“
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.
Periparturient
diseases
Housing
Lameness
Biomechanics
Nutrition
Endocrinology
Anatomy
Clinical reasoning
Knowledge organization
Illness scripts
Clinical expertise
Biomedical knowledge
Biomedical knowledge
Basic sciences followed by clinical
training
Disease presentation
Disorganized clinical features
Fail to recognize links
Many hypothetical differentials
Recognize links
Short route to diagnosis
Integration biomedical concepts
associated with clinical information
Meaningful/associative
learning. Related to previous
knowledge within a
framework
Rote learning
Intuitive: Pattern recognition; Experience
Analytical: Evidence ; Biomedical knowledge.
Non-associative
learning/Unretained/not linked
“Illness script” activation
Diagnosis
Hypothesis generation
Intuitive
Case
New
situations/patterns
Biomedical Science
Observation
Physical diagnostic techniques/skills
Probabilistic evidence inferring conclusions
Differentials/ maintaining coherent clinical view
Most likely diagnosis
Diagnosis
Pattern recognition
Analytical
Pertinent background information
Hypothesis testing
Diagnostic verification
Biomedical knowledge;
Observation
&
p
hysical diagnostic techniques; Experience
Clinical reasoning/expertise pathway
Pattern recognition and weighing evidence
Differentials/ maintaining coherent clinical view
Clinical
case
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h
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Within the veterinary curriculum
Pre-clinical
Clinical
P
r
e
-
c
l
i
n
i
c
a
l
Biomedical knowledge base should consist of
content
(the specific
knowledge for any topic) and
structure
(the organization of the knowledge).
◦
teach the basic sciences in a clinical context
◦
introduce patient problems early in the curriculum
◦
CE & case discussions (small groups & class room)
◦
Electives & labs (Simulated models)
VS
◦
Information overload lacking structure
Teach less better!
Nottingham UK
1.
Entire 4 year pre-clinical curriculum is delivered based on clinical context.
2.
Teach in body systems but case based.
3.
Use cases based on a survey of practitioners clinical work-load and represent common
and important diseases by species.
4.
Taught in modules. Clinical Science Module (CSM) (2nd year), Clinical Module (CM)
(4
th
year) during the same 5 weeks of the year.
5.
Enables vertical integration of the curriculum and peer learning
6.
CSM illustrates clinical aspects of the biology that is given in labs and lectures eg,
Stallion with retained testicle: Anatomy of testicle; Mechanism of testicular descent;
Steroidgenesis; Results of the hCG-stimulation test.
7.
CM same case concentrate more on Pathology/ Diagnosis/ Treatment / Management of
the clinical problem.
C
l
i
n
i
c
a
l
Concept mapping
Thinking aloud
Case management
Evaluation
Concept map construction
Cross links new knowledge to previous knowledge within a preexisting
cognitive network.
Infectious claw disease
Digital dermatitis
Can cause
Infertility^
Spirochetes*
produce
Epidermitis*
organism
Zn dependent MMP’s*
control
Antibiotic Topical spray
control
Footbaths*^
Zn sulfate*^
which
CuSulfate*^
Manure
contamination*
Oxytetracycline
pathological Lesion
product
Lameness*^
Mode of Action
< protein synthesis
Depress
Anti-inflammatory
depress
promotes
Aids formation
Inhibit by
Digital necrotizing cellulitis
Foot rot
^ Indicates cross links
3 Main components
Interdigital dermatitis
* Indicates cross links
Clinical teaching strategies based on script theory
Concept mapping
:
Digital dermatitis
Infertility
Spirochetes
Epidermitis
Zn dependent MMP’s
AntibioticTopical spray
Footbaths
Zn sulfate
CuSulfate
Manure
contamination
Oxytetracycline
lameness
< protein synthesis
Anti-inflammatory
Links/cross links
Can cause x2
Productx2
Which
Mode of actionx2
Path lesion
Organism
Controlx2
Produce
Depressx2
Inhibits by x2
Aids
Inhibits
Clinical teaching strategies based on script theory
Concept mapping
:
Digital dermatitis
Can cause
produce
organism
control
control
which
pathological Lesion
product
Mode of Action
Depress
depress
Inhibits
Aids
Inhibit by
Concept mapping
Cross links new knowledge to previous knowledge within a preexisting
cognitive network.
Infectious claw disease
Digital dermatitis
Spirochetes
Epidermitis
Zn dependent MMP’s
Zn sulfate
CuSulfate
Manure
contamination
Oxytetracycline
lameness
Anti-inflammatory
Digital necrotizing cellulitis
Foot rot
3 Main concepts
Interdigital dermatitis
Laminitis. (Total confinement free stall dairies)
Mechanical
Enzymatic/ Hormonal
Abnormal weight
bearing
Hormones/MMP’s
Thin sole
Calving
Nutritional
Rumen acidosis
Sinking P3
Corium concussion
Ulcers/white line
Sole
Overgrowth
Walking surface
Periparturient
disease
Smooth
Rough
LPS/Cytokines/MMP’s
Main pathways
Caused by
Types
Result in
Result in
Result in
Caused by
Mechanism/pathway
Mechanism/pathway
Mechanism
Result in
Mechanism/pathways
Mechanism
Mechanism
Congestive heart failure CHF
Can be classified by pathophysiology as
May be defined as
May be defined as
Is commonly caused by
Can be evaluated by
List of concepts
Diastolic dysfunction
Ventricular inability to eject blood
Coronary artery disease
Cardiac stress testing
Coronary angiography
Ventricular inability to fill
C
o
n
c
e
p
t
m
a
p
p
i
n
g
:
Tool for knowledge organization and representation
◦
Continue to build and revise the same map
◦
Can be used for team based learning
◦
Promotes participation
◦
Builds confidence
◦
Can be used as an assessment tool
Think-aloud strategies
:
•
“Role of the teacher is not to transmit knowledge but to facilitate
learning, encourage spontaneity and engage in mutual enquiry” John
Dewey
(American philosopher, psychologist, and educational reformer whose ideas have been influential in
education and social reform.)
•
Go on “Otter expedition”
•
“Team thinking”. “This is what I am thinking”. “What are you
thinking”
•
Merge biomedical information with clinical concepts
•
Challenge them to challenge your opinions and convictions
Clinical case overview
•
Create sufficient time to review clinical cases seen same/previous day/s
•
Case summary
•
Retrospective analysis
•
Dissect and expose errors making sure the basis/reason for these are
clearly understood
•
Make sure findings are explained and understood including all
physiological linkages
•
Absence of fever in case of pneumonia
•
Significance of one finding in the presence of that finding.
•
Discharging tract on dorsal wall at coronary band
Case management
•
Students should be assigned to manage/encouraged to take
control of their cases
•
Oversee observational and physical exam skills
(What can you see/feel/hear?)
•
Do not provide diagnostic/ treatment plan. Must be justified.
Evaluation
•
Provide or refer to relevant sources of information and encourage to
read consistent with the script approach.
•
Test-enhanced learning:
•
Knowledge-integrated tests and clinical reasoning problems
•
“Puzzlers”
Questions?
Utilizing the Scripts Method, this approach integrates biomedical knowledge, clinical reasoning, and pattern recognition to enhance diagnostic skills and treatment decisions in veterinary students. Emphasizing active learning and continuous professional development, it aims to cultivate expertise in recognizing and managing animal health conditions effectively.
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Presentation Transcript
Theory and Application of Scripts Method of Teaching SAREL VAN AMSTEL
Nutrition Theory Scripts Model in education Facilitates integration of new incoming information with existing knowledge Recognized system for developing the student s potential to become a successful clinical practitioner Efficient and effective Clinical reasoning Life long commitment I acceptas a lifelong obligation the continual improvement of my professional knowledge and competence . Anatomy Endocrinology Biomechanics Housing Lameness Periparturient diseases
Intuitive: Pattern recognition; Experience Analytical: Evidence ; Biomedical knowledge. Clinical reasoning Meaningful/associative learning. Related to previous knowledge within a framework Rote learning Knowledge organization Illness scripts Non-associative learning/Unretained/not linked Clinical expertise Biomedical knowledge Integration biomedical concepts associated with clinical information Biomedical knowledge Basic sciences followed by clinical training Disease presentation Disorganized clinical features Fail to recognize links Many hypothetical differentials Recognize links Short route to diagnosis
Illness script activation Most likely diagnosis Diagnosis Hypothesis generation Diagnosis Hypothesis testing Diagnostic verification Pattern recognition Pertinent background information Analytical Biomedical Science Observation Physical diagnostic techniques/skills Probabilistic evidence inferring conclusions Differentials/ maintaining coherent clinical view Intuitive New situations/patterns Case
Clinical reasoning/expertise pathway Clinical case Biomedical knowledge; Observation & physical diagnostic techniques; Experience Pertinent background information ILLNESS SCRIPT activation Pattern recognition and weighing evidence Differentials/ maintaining coherent clinical view Most likely diagnosis Diagnostic verification Definitive diagnosis Rational treatment/action
How to achieve clinical reasoning How to achieve clinical reasoning Within the veterinary curriculum Pre-clinical Clinical
Pre Pre- -clinical clinical Biomedical knowledge base should consist of content(the specific knowledge for any topic) and structure(the organization of the knowledge). teach the basic sciences in a clinical context introduce patient problems early in the curriculum CE & case discussions (small groups & class room) Electives & labs (Simulated models) VS Information overload lacking structure Teach less better!
Nottingham UK 1. Entire 4 year pre-clinical curriculum is delivered based on clinical context. 2. Teach in body systems but case based. 3. Use cases based on a survey of practitioners clinical work-load and represent common and important diseases by species. 4. Taught in modules. Clinical Science Module (CSM) (2nd year), Clinical Module (CM) (4th year) during the same 5 weeks of the year. 5. Enables vertical integration of the curriculum and peer learning 6. CSM illustrates clinical aspects of the biology that is given in labs and lectures eg, Stallion with retained testicle: Anatomy of testicle; Mechanism of testicular descent; Steroidgenesis; Results of the hCG-stimulation test. 7. CM same case concentrate more on Pathology/ Diagnosis/ Treatment / Management of the clinical problem.
Clinical Clinical Concept mapping Thinking aloud Case management Evaluation
Concept map construction Cross links new knowledge to previous knowledge within a preexisting cognitive network. Infectious claw disease 3 Main components Digital necrotizing cellulitis Foot rot ^ Indicates cross links Interdigital dermatitis * Indicates cross links Digital dermatitis Can cause Lameness*^ Infertility^ Antibiotic Topical spray pathological Lesion which Epidermitis* organism Footbaths*^ product CuSulfate*^ control Oxytetracycline control Spirochetes* Mode of Action Zn sulfate*^ Inhibit by Depress produce promotes < protein synthesis Manure contamination* Zn dependent MMP s* Aids formation Anti-inflammatory depress
Clinical teaching strategies based on script theory Concept mapping: Digital dermatitis Links/cross links Can cause x2 Productx2 Which Mode of actionx2 Path lesion Organism Controlx2 Produce Depressx2 Inhibits by x2 Aids Inhibits lameness Infertility AntibioticTopical spray Epidermitis Footbaths CuSulfate Oxytetracycline Spirochetes Zn sulfate < protein synthesis Manure contamination Zn dependent MMP s Anti-inflammatory
Clinical teaching strategies based on script theory Concept mapping: Digital dermatitis Can cause pathological Lesion which organismcontrol product control Mode of Action Inhibit by Depress produce Inhibits Aids depress
Concept mapping Cross links new knowledge to previous knowledge within a preexisting cognitive network. Infectious claw disease 3 Main concepts Digital necrotizing cellulitis Foot rot Interdigital dermatitis Digital dermatitis lameness Epidermitis CuSulfate Oxytetracycline Spirochetes Zn sulfate Manure contamination Zn dependent MMP s Anti-inflammatory
Laminitis. (Total confinement free stall dairies) Main pathways Enzymatic/ Hormonal Mechanical Caused by Caused by Nutritional Rumen acidosis Calving Walking surface Mechanism/pathways Types Periparturient disease Mechanism Hormones/MMP s Mechanism/pathway Smooth Rough Result in LPS/Cytokines/MMP s Thin sole Mechanism Sole Overgrowth Mechanism/pathway Mechanism Result in Abnormal weight bearing Sinking P3 Result in Result in Corium concussion Ulcers/white line
Congestive heart failure CHF List of concepts Diastolic dysfunction Ventricular inability to eject blood Coronary artery disease Cardiac stress testing Coronary angiography Ventricular inability to fill Can be classified by pathophysiology as May be defined as May be defined as Is commonly caused by Can be evaluated by
Concept mapping Concept mapping: Tool for knowledge organization and representation Continue to build and revise the same map Can be used for team based learning Promotes participation Builds confidence Can be used as an assessment tool
Think-aloud strategies: Role of the teacher is not to transmit knowledge but to facilitate learning, encourage spontaneity and engage in mutual enquiry John Dewey (American philosopher, psychologist, and educational reformer whose ideas have been influential in education and social reform.) Go on Otter expedition Team thinking . This is what I am thinking . What are you thinking Merge biomedical information with clinical concepts Challenge them to challenge your opinions and convictions
Clinical case overview Create sufficient time to review clinical cases seen same/previous day/s Case summary Retrospective analysis Dissect and expose errors making sure the basis/reason for these are clearly understood Make sure findings are explained and understood including all physiological linkages Absence of fever in case of pneumonia Significance of one finding in the presence of that finding. Discharging tract on dorsal wall at coronary band
Case management Students should be assigned to manage/encouraged to take control of their cases Oversee observational and physical exam skills (What can you see/feel/hear?) Do not provide diagnostic/ treatment plan. Must be justified.
Evaluation Provide or refer to relevant sources of information and encourage to read consistent with the script approach. Test-enhanced learning: Knowledge-integrated tests and clinical reasoning problems Puzzlers
