INTRODUCTION PLAN:

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1 FEBS Workshop o Molecular Life Sciece Educatio Kauas, th Jue, 207 DRY PRACTICALS-CASE-BASED DISCUSSIONS A MODEL OF A BIOCHEMISTRY DRY PRACTICAL FOR TEACHING LIVER FUNCTIONS AND BILIRUBIN METABOLISM IN A MEDICAL SCHOOL: STUDENT FEEDBACK Prof. Gül GÜNER-AKDOGAN Izmir Uiversity of Ecoomics School of Medicie Chair, FEBS Educatio Committee Prof. Gül GÜNER-AKDOGAN Izmir Uiversity of Ecoomics School of Medicie Prof. Hüray İŞLEKEL Dokuz Eylül Uiversity-Izmir PLAN: Dry Practicals ; What Does it Mea?? Overview o DEU-SOM PBL Curriculum Model of a Dry Practical i this Curriculum (Liver fuctios ad bilirubi metabolism) Logistics ad Orgaizatito Studet Feedback Coclusios INTRODUCTION Traditioally, scietific traiig icludes, as a major compoet, wet laboratory sessios. It is uquestioable that it makes studets become competet i practical scietific ivestigatio. However, it is difficult to fulfill all of our teachig objectives with wet practicals aloe. There is much to be gaied from cosiderig dry laboratory activities to supplemet ad exted the wet lab experiece. TYPES OF DRY PRACTICLES: Computer-Based Exercises () Virtual Laboratories: example of a dry lab i a chemistry departmet (2) Problem-Orieted Small Group Discussios (3) Laboratory Exercices (Labex) (4) Simulated Laboratory Task (Ezyme Purificatio) (5).PAMULA F, WIGMORE GT & WHELDRAKE JF. Biochemical Educatio 23: CAPON R. Dry Labs Workshop, 2 April 996, Uiversity of Sydey, 3.DAS N & SINHA S. Biochemical Educatio 2000; 28: PURI D. Idia Joural of Cliical Biochemistry 2002; 7(2): CAMESELLE JC, CABEZAS A, CANALES J, COSTAS MJ, FARALDO A, FERNANDEZ A, PINTO RM & RIBEIRO JM. Biochemical Educatio 2000; 28: DRY PRACTICALS: CASE-BASED DISCUSSIONS (SMALL GROUP DISCUSSION ON VIGNETTES ): This iovatio was itroduced i DOKUZ EYLÜL UNIVERSITY SCHOOL OF MEDICINE (DEU-SOM) (IZMIR- TURKEY) with the PBL curriculum i 996.

2 TYPES OF PRACTICALS AT DOKUZ EYLÜL d I DEU-SOM, the practicals ca be categorized as follows: Wet practicals Dry itegrated practicals ivolvig computer exercices Dry practicals ivolvig small-group discussios o vigettes (DEU-SOM has a Laboratory Practicles Committee for the structurig of the laboratory practicals) THE DRY PRACTICAL (SMALL GROUP DISCUSSION ON VIGNETTES) ON LIVER FUNCTION TESTS AND BILIRUBIN METABOLISM The discussio is based o three cases:. Prehepatic jaudice due to sickle cell aemia 2. Post-hepatic jaudice due to cholelithiasis 3. Viral hepatitis VIGNETTES DISCUSSED IN SMALL GROUPS VIGNETTES MAIN SUBJECT AREA(S) LEARNING ISSUES. Sickle Cell Aemia (Prehepatic jaudice) Hemoglobi ad Its Metabolism Itroductio to Cliical Ezymology Hemoglobi types Hemoglobi metabolism Sythesis of bilirubi Bilirubi types Itroductio to isoezymes LDH isoezymes ad cliical use 2. Obstructive Jaudice Jaudice Types ad Mechaisms Liver Fuctio Tests Obstructio jaudice ad differetial diagosis Cocepts ad priciples of liver fuctio tests Use of ezyme profile ad other biochemical parameters i differetial diagosis of jaudice ALP isoezymes ad cliical use 3. Viral Hepatitis Biochemistry of viral hepatitis Liver fuctio tests Diagosis of viral hepatitis Itegrative review of liver fuctio tests 2

3 CASE I PART I A 8-moth-old girl (Sogül Sapmaz) has bee brought to DEU- SOM Pediatrics Outpatiet Cliic because of scleral icterus, fatique ad pallor. The Outpatiet physicia (Dr. Deiz) has oted that Sogül has pallor sice the age of 5 moths, recurret ifectio, aorexia, fatique ad recurret jaudice which regresses spotaeously. Sogül s mother has stated that her husbad ad herself are cousis ad her brother has also pallor ad complais of pai i various parts of his body. Dr. Deiz examis the patiet after the history. Physical examiatio fidigs: Apperace: Axious, always cryig Ski colour: Pale Sclera: Icteric Abdomial examiatio: Spleomegaly (Splee spa is 4 cm) Other systemic examiatios are ormal. Dr. Deiz asked some laboratory tests to determie the causes of complaits. PART II Laboratory values iclude the followig: Whole blood cout: Normal rages (8-moth-old) Hemoglobi:6.5 g/dl g/dl Hematocrit: 2 % % MCV (Mea corpuscular volume):88fl fl Peripheral blood smear: Aisocytosis, poikilocytosis, ormochromia, 4 percet ucleated red blood cells (ormoblasts) (Normal: Normochromic, ormocytic red blod cells ad there are o ormoblasts). Total bilirubi: 4 mg/dl mg/dl Direct bilirubi: 0.9 mg/dl mg/dl Idirect bilirubi: 3. mg/dl mg/dl LDH: 550 U/L LDH : 32 % 7-27 % LDH 2: 40 % % LDH 3: 8 % 8-38 % LDH 4: 5 % 5-5 % LDH 5: 5 % 5-5 % Other liver fuctio tests are ormal. Urie examiatio: Bilirubi: Negative Negative Urobilioge:.2 EU/dL <0.2 EU/dL (EU: Erlich uit) Serum viral hepatitis markers (Hepatitis A;B;C;D;E): Negative EVALUATION OF LABORATORY DATA. Which type of jaudice does this patiet have, prehepatic, hepatic or posthepatic? 2. Evaluate the urie examiatio values. Why is bilirubi egative i the urie? 3. How do you explai the icrease i LDH ad LDH2 isozymes? What is a isozyme? Do you kow ay other isozymes used i cliical laboratory? 4. How do you explai the reaso why other liver ezymes are ormal? 5. Discuss other mechaisms of idirect bilirubi icrease i serum. PART III Hb electrophoresis values are the followig: Hb S: 70 percet Hb A2: 2.5 percet Hb S > Hb A Diagosis: Sickle cell aemia 3

4 The Evaluatio Processes Studets are evaluated by the tutors o the basis of their performace i the discussio sessios. O the ed-module writte exams, there are questios o the topics discussed durig the dry practicals The feedback of studets for each sessio is take at the ed of the sessio by the tutors. The Educatio Departmet coducts a survey at the ed of each year. QUESTIONNAIRE USED FOR STUDENTS FEEDBACK Title of Practicle: Iterpretatio of Liver Fuctio Tests Items tested: Explicitess i the expositio to the objectives Explicitess i the expressio of the steps Sufficiecy of time allocated Quality of learig materials Uderstadig of theoretical cocepts Efficiecy of discussio ad iterpretatio of data Geeral orgaizatio of the practical sessio OTHER COMMENTS: STUDENTS PERCEPTION OF DRY LABORATORY PRACTICALS: (Average results obtaied for a period of three years) Title of Practicle: Iterpretatio of Liver Fuctio tests Items questioed Explicitess i the expositio to the objectives N Meas % % % % % Explicitess i the expressio of the steps Sufficiecy of time allocated Quality of learig materials Uderstadig of theoretical cocepts Efficiecy of discussio ad iterpretatio of data Geeral orgaizatio of the sessio QUALITATIVE ASSESSMENT OF DRY PRACTICALS BY THE STUDENTS STUDENT OPINION I believe that the sessio was very useful; we may ecouter the cases ay time i real life; thak-you very much A very efficiet practical.. I would like them to be more frequet I ca say that this was the best practical of the year; special thaks to our tutor, Dr.. Discussios based o cases are always very helpful;i would like to ecouter more of these i the comig modules Thak-you very much; it was a ejoyable ad very useful practical; i additio, the had-outs were very well prepared; we would like to have more of these sessios A very ejoyable ad useful practical! Thak-you 2 A very good ad useful sessio; thak-you 6 N 2 4 A efficiet practical; a very cosiecous preparatio; thak-you A very useful practical The cases were very well prepared. The discussio of the group was very effective; all of the questios were thoroughly discussed It was a iterestig practical; durig this year, I have observed your progress as a academicia with great pleasure This practical was effective i the reiforcemet of the learig issues of the module; thak-you very much The cases were excellet! A very efficiet practical It was a ejoyable practical I liked it Super This type of practicals are always very useful; thak-you Useful for my uderstadig of the learig issues ad i makig them more clear. Thak-you; a very well structured ad a itegrated practical. It was good; o time to get bored.. It was a excellet practical; we expect them to cotiue. Oe suggestio: you could use both sides of the paper for the cases, to save o paper. Thak-you CONCLUSIONS Ehacig the value of the learig experiece will improve the quality of our graduates ad their ability to operate as professioal scietists. A umber of importat issues must be cosidered i the implemetatio of dry laboratory sessios, icludig questios of itellectual property, teachig efficiecy, effectiveess, ad logistics. Dry practicals based o small group discussios o vigettes are highly regarded i the studets view at Dokuz Eylül Medical School. They brig motivatio, challege ad variety to studets learig process. 4

5 Thak-you! 5