Administrative problem TB control
The medical officer in charge of a hospital was writing the 1998 annual report. She compared the data of 1998 with previous years and saw that the total number of patients admitted and treated at the OPD for TB had clearly increased in the last few years:
How had the hospital coped with this increase? She was interested in finding out how many of the TB patients who had started their treatment at the hospital, were cured. She wondered how to go about it.
Step 1. Clarification
Maybe a student likes to know whether only new TB cases are meant or all TB cases. As no more information is available, one must assume that it concerns all cases.
Step 2. Analysis
The underlying problems in this case could be defined as:
Step 3. Explanations / hypotheses
Step 4. Formulation of learning objectives
The following learning questions may be formulated:
After discussion between the tutor / facilitator and the group, the list of learning questions is limited - in line with the course objective "Treatment outcome of TB" - to just the questions 5 to 8.
Step 5. Individual self-directed learning
Using the table: Proces of formulation of self guided learning objectives, a student may decide to approach the problems as follows:
Questions 5 and 6 "how does a TB register and TB PRC look like?"
These questions concern understanding of factual information, but also of the process of treatment, recording and reporting and thus the structure of the recording system.
The resources for this study would include:
The product of the study may be:
The assessment of this part of the study would focus on the understanding of the structure and use of the PRC and register. This assessment could be through the use of simulation data (case study) or by observation during a field visit to hospital or clinic.
Question 7 "what information is needed to assess the treatment outcome of TB?"
Concerns again factual information and understanding of the process.
The resources are similar to those for questions 5 and 6.
The product of the study could be a presentation to the other students which data from the register (or PRC) to collect and how to analyze.
The assessment could be done by requesting students to make a cohort report during a field visit to a TB clinic or by using a (simulated) register at the training centre.
For question 8, "what is the role of sputum examination in assessing cure rate?"
Most learning will be facts and steps in the process of the TB treatment routine.
The resources are similar to those for questions 5 and 6; with perhaps in addition to the TB register the lab. Register.
The product of the study: presentation to the others of the routine sputum checks.
The assessment: also the cohort report.
Step 6. Synthesis and application
The study of these questions will result in all students of the group to know and understand the TB PRC, TB register, perhaps lab register as well. The procedure for analyzing treatment results for quarterly or annual cohorts of TB patients should be understood.
Armed with this new knowledge, students could now undertake to solve a similar problem by studying real data from a hospital nearby, a clinic or even a whole district. Trainer could also prepare a case study based on above used problem (as indicated under assessment in step 5.).