The Wellcome Tropical Institute has assisted countries in the tropics to establish viable systems of continuing medical education, particularly for young doctors practising in rural areas. As part of this strategy the Institute has developed material for use in distance learning. The first attempt to apply the problem-based learning approach to written material for use by an individual learner in the absence of a tutor led to a trial in Ghana, Kenya and Pakistan to compare a conventionally designed module with a problem-based learning module on the same topic for their respective acceptability, effectiveness and efficiency. The design, implementation and results of these three comparative trials are presented.
tion is summarized. The importance of rest, the control of pain, the use of oxygen, aminophylline, digitalis, quinidine sulfate, procaine amide hydrochloride, glyc¬ eryl trinitrate (nitroglycerin), and anticoagulant therapy are discussed. The treatment of associated shock is also outlined. Moderate to severe shock with systolic blood pressure below 80 mm. Hg may become irreversible or refractory to all methods of treatment within an hour.The need for early and energetic treatment with vaso¬ pressor drugs, plasma, or whole blood is thus indicated. The use of various vasopressor agents, particularly arte¬ renol, is discussed in detail. Intravenously administered saline solutions, plasma, or blood may be valuable ad¬ juncts. Clinical experience has demonstrated that arte¬ renol or other pressor amines reduce the mortality of acute myocardial infarction to a significant though limited extent.330 Brookline Ave. (15).
This paper discusses the new five-year undergraduate medical course at the University of Newcastle in Australia. Extensive examples are included to illustrate the analytical approach which has led from the specification of programme objectives to the design of a course with complete integration of the basic and clinical sciences from the beginning to the end of the course. Lectures are replaced by individual and small group learning centred around a carefully designed sequence of medical problems. Projects in the community are designed to lead to the attainment of specified competences in relation to problems of groups in the population. In addition, educational experiences in interviewing, physical examination, special investigation and therapeutic intervention techniques, as well as competence in design-measurement-analysis-reporting in medical practice and research are integrated with problem-based learning. Students see patients in hospitals and in the community from the beginning of the course. While clinical competence in problem-solving and management is a major aim, students are expected to demonstrate a thorough grasp of the underlying basic sciences, including behavioural science, by providing scientific reasons for their decisions and actions. As the Newcastle graduate is expected to demonstrate a humanistic attitude to his patients, an ability to deal with problems, a willingness to continue his own education and to collaborate in team work, the Faculty places emphasis not only on the medical content of the course, but also on the educational process.
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