Edited: March 2010 REPRODUCTION SYSTEM MEDICAL FACULTY HASANUDDIN UNIVERSITY

PBL MODULE
For Students

Given to the 4th Semester Students of Hasanuddin University Medical Faculty

Reproduction System Medical Faculty Hasanuddin University

2010

STUDENTS TASKS
Problem Based Learning (PBL) tutorial activities demand students to be highly active assuring the goals and objectives of the module are accomplished according to the designated objectives, as well as to achieve the desired competition. Therefore, the study process are designed as follows: 1. After reading the above scenarios thoroughly, the students must discuss the cases in a leader-led group discussion. This group discussion is aimed to identify the problem(s) by developing relevant questiones to the corresponding scientific concept and theory. Students are expected to define keywords which are derived from the above scenario. These 2 times group discussions will be couched by a tutor. At the end of each module session, students are obligated to submit an individual discussion report which then be precented in a pleno discussion. 2. Conducting a self study, which is performed out of the class either by a group discussion or by the student solely in the library using text books, lecturers handouts, journals, or electronically using slides, videos or through the internet. 3. Conducting a self-coached group discussion (without tutor) to analyze the recently found information. The schedule will be defined by the group itself. 4. Consulting the problems revealed during the PBL to the experts for a better understanding 5. Attending provided experts lecture for unsolved problems

PROBLEM SOLVING PROCESS

In a leader-led group discussion, the students are expected to solve the problems in the scenarios by conducting these following 7 jumps of problem solving process: 1.Clarifying the un-clear terms stated in the scenario, then defining the keywords/key statement(s), or concept 2.Identifying the basic problem of the scenario, by creating some leading important questions 3.Analizing the problems by answering the above questions 4.Classifying the answers and retrieve a summary(s) 5.Developing study objectives that must be achieved by the students during the case discussion 6.Looking for other additional information related to the above cases 7.Reporting the result of discussion completed with the summary

ACTIVITIES SCHEDULE
Prior to the first tutorial meeting, students are clustered into a group of 15-17 students. 1. First meeting in a general class lecture; the lecture delivers a one way communication of lecturing followed with asking question session Objective: explaining the module and how to complete the provided tasks developing several discussion groups. During this first meeting, the modules will also be distributed to the students. 2. Second meeting: first tutorial meeting, the first leader-led group discussion. Both the leader and the secretary are chosen by the students themselves. The meeting is facilitated by a tutor. Objectives: choosing a group leader and secretary brain storming for step 1 to 3 distributing tasks for members of the group 3. Third meeting: the second tutorial meeting, similar to the first tuturial meeting. Objective: to report the self-study result, continued with classifying, analyzing and synthesizing the recently found information and accomplish the PBL process to the fifth step 4. Self-study, either together with other students in a group discussion or solely. Objective: Collecting other new necessary information 5. Self discussion, relatively similar to the tutorial discussion. If no further information is required, this session can then be used to prepare groups report and presentation. 6. Fourth meeting, a pleno discussion and expert meeting, conducted in a general class in which students report the final results of each groups discussion, and clarifying things that remain unsolved by the groups. Groups report and individual discussion report are written according to the order provided in the students working sheets. 7. Each student is obligated to do a report on one specific disease that relevants to his/her groups scenario. This individual report is written in a complete report style as Individual Case Report. 8. Last meeting: Case Report, conducted in a general class in which each student presents him/her case. Important Notes: One copy of the group report, individual discussion report and individual case report are all due to be submitted to the Reproduction System PBL Coordinator via each of the groups leader All reports will be assessed by the correspondance expert, and then returned back to the students for further correction After corrected, two copies of all the above reports must be re-submitted to the Reproduction System PBL Coordinator Students are obligated to make copy of other groups and students report since some of the final exam questiones will be based on these reports.

TIME TABLE I 1st Meeting Explanation II 1st Tutorial (Brain Storming, classifying, analyzing and synthesizing) III Self Study Collecting additional information, Practical Work, CSL IV 2ndTutorial (Reporting classifying, analyzing and synthesizing) V Lecture, Consultation VI Last Meeting Panel Discussion, Expert Meeting

LEARNING STRATEGIES A. Textbooks and Journals

a. Obstetry & Ginecology
1. Winkjosastro H, Saifuddin AB, Rachimhadhi T. Ilmu kebidanan. Edisi ke-3. Jakarta. Yayasan Bina Pustaka Sarwono Prawirohardho. 1997 2. Dutta, DC. Text book of obstetric. 4th ed. Calcutta: New Central Book Agency. 1998 3. Oxorn, H. Human labor & birth. 5th ed. NewYork. The McGraw-Hill Companies. 2000 4. Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC, Hankins GDV, et all. Williams obstetric. 20th ed. Canada; Appleton & Lange. 1997 5. --------. Understanding your body during pregnancy Mayo Clinic.com Special to CNN.com,June25,2004. 6. ---------. Kehamilan normal, persalianan normal,dan bayi baru lahir normal. Buku Acuan Nasional Pelayanan kesahatan Maternal Dan Neontal,Yayasan Bina Pustaka Sarwono Prawiroharjo Jakarta,2001, hal 89-100,133. 7. Rosenthal,M A normal labor and delvery. WebMD Medical Refernce fromThe Gynecological Sourcebook by arrangement with The NTC Contemporary, Publishing Group IncCopyright1999 by M.Sarah Rosenthal 8. --------. Understanding your body during pregnancy Mayo Clinic.com Special to CNN.com,June25,2004. 9. ---------. Kehamilan normal, persalianan normal,dan bayi baru lahir normal. Buku Acuan Nasional Pelayanan kesahatan Maternal Dan Neontal,Yayasan Bina Pustaka Sarwono Prawiroharjo Jakarta,2001, hal 89-100,133. 10. Rosenthal,M A normal labor and delvery. WebMD Medical Refernce fromThe Gynecological Sourcebook by arrangement with The NTC Contemporary, Publishing Group IncCopyright1999 by M.Sarah RosenthaL 11. Greer IA, Cameron I T, Magowan B, Roberts RN, Walker JJ. Vaginal discharge. Problem-based Obstetetrics and Gynecology. London. Churchill Livingstone. 2003. p. 37 9 12. Winkjosastro H, Saifuddin AB, Rachimhadhi T. Ilmu kandungan. Edisi ke-3. Jakarta. Yayasan Bina Pustaka Sarwono Prawirohardho. 1997

b. Microbiology
1. Baron EJ, Peterson LR, Finegold SM. Bailey and Scotts Diagnostic Microbiology, 9th Edition Mosby, St. Louis, 1994. 2. Brooks GF., Butel JS., Morse SA. Jawetz, Melnick, and Adelbergs Medical Microbiology, 23rd edition, Internatiopnal edition, MacGraw-Hill, Kualalumpur, 2004. 3. Inglis, TJJ. Microbiology and Infection. Chuchill-Livingstone, Sydney, 2003. 4. Joklik, W.K., Willett, H.P., Amos, D.B., Wilfert, C.M. Zinsser Microbiology, 20th editon, Appleton & Lange, Connecticut, 1992. 5. Mims, C., et all. Medical Microbiology, 3rd edition, Mosby, Sydney, 2004. 6. Ryan, KJ., Ray, CG. Sherris Medical Microbiology, an Introduction to Infectious Diseases, 4th edition, McGroww-Hill, Singapore, 2004 7. Virella, G. Microbiology and Infectious Diseases, 3rd Wlkins, Tokyo, 1997 edition, Williams and

c. Paediatrics:
Buku Ajar Neonatologi, IDAI 2008 Nelson Textbook of Pediatrics, 18th ed, 2007 Current Diagnosis and Treatment in Pediatrics, 18th ed, 2007 Turnbulls Obstetrics, 3rd ed, 2001 Fetal Medicine: Basic science and Clinical Practice, 21th ed, 1999 Gibson RS. Principles of Nutritional assessment, 1990 Fanaroff, Neonatal-Perinatal Medicine Cloherty JP, Eichenwald EC, Stark AR, penyunting. Manual of neonatal care. Edisi ke-6. Philadelphia: Lippincot William & Wilkins;2008. 9. Gomella TL. Neonatology, management, procedures, on-call problems, diseases, and drugs. Edisi ke-5. Boston: McGraw Hill; 2007. 10. Lissauer T, Fanaroff A. Neonatology et a Glance. Blackwell Publishing;2006. 11. Merenstein Gb, Gardner SL, penyunting. Handbook of Neonatal Intensive Care. Edisi ke-.6. Mosby,2006. 1. 2. 3. 4. 5. 6. 7. 8.

d. e. f. g. h. i.

Clinical Pathology Phyisiology Histology Anatomy Parasitology Pathology Anatomy

B. Handouts Other source: VCD, Film, Internet, Slide, Tape - --------. Understanding your body during pregnancy. Mayo Clinic.com Special to CNN.com, June25, 2004. - Vaginal discharge, Female Health. Palo Alto medical Foundation. Available from : http://www.pamf.org.

Vaginal discharge. Aetna InteliHealth. Harvard Medical School, consumer healh information. Available from : http://www.intelhealth.com. Vaginal discharge, knowing the difference between normal discharge and infections. Mc Kinley Health Centre. University of Illinois. Available from: http://www.mckinley.uiuc.edu/mhc.html Cing, S. Nguyen PH. Vaginitis. Emedicine. Available from: http://www.emedicine.com.

C. List Of Lecturers
NO 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 29. LECTURERS DEPT. EMAIL dsorayariu@yahoo.co .id TELFON

dr. Nusratuddin Abdullah, Sp.OG

dr. Deviana Riu, Sp.OG dr. Theophilus Buranda, MS dr. Nurdin Mappewali dr. Yusuf Manguma Dr.dr. Wardihan Sinrang. dr. Danny Suwandi, Sp.PK, Ph.D. dr. Baedah Madjid, Sp.MK Prof. Dr. dr. Suryani Asad, Sp.GK dr. Frans Liyadi, Sp.Rad dr. Gunawan Arsyadi, Sp.PA dr. Jaya Langkara Tanra, Sp.JK, Ph.D. dr. A. Sastri, Sp.KK dr. Djauhariah Madjid, Sp.A(K) dr. Ikhsan Madjid, MS Prof. Dr. dr.John Rambulangi, Sp.OG dr. Ny. Retno B. Farid, Sp.OG dr. Ny. IMS. Murah Manoe, Sp.OG dr. Ny. Zusanna S. Pakasi, Sp.OG dr. H. Syahrul Rauf, Sp.OG dr. Umar Malinta, Sp.OG dr. Eddy Hartono, Sp.OG

Obgyn Obgyn
Anatomy Biochemistry Histology Physiology Farmakology Microbiology Nutrition Radiology PA Psychiatry Kul-Kel Pediatric IKM Obgyn Obgyn Obgyn Obgyn Obgyn Obgyn Obgyn

081342752561
04115013746 081342436444 0811442224 08124226777 0811444577 0816251891 0811444326 08152535240 08152506861 0810811410193 08164388981 08124217393 0811446616 0811444077 08124251618 0811413641 0816278841 0816255713 0811416070 0811449975 0816254905

baedahm@yahoo.co m

dr. Mardiah Tahir, Sp.OG dr. St. Maisuri T. Chalid, Sp.OG dr. Eddy Tiro, Sp.OG dr. David Lotisna, Sp.OG dr. Efendy Lukas, Sp.OG

Obgyn Obgyn Obgyn Obgyn Obgyn

0811410595 0811463780 08124181322 081524109828 08124122090

REPRODUCTION SYSTEM MEDICAL FACULTY HASANUDDIN UNIVERSITY

PBL MODULE
For Students AMENORRHEA

Given to the 4th Semester Students of Hasanuddin University Medical Faculty

Created By: dr. IMS. Murah Manoe, SpOG (K) dr. Deviana S. Riu, SpOG

Reproduction System Medical Faculty Hasanuddin University

2010
7

MODULE 1

AMENORRHEA
INTRODUCTION

Reproduction system provides 4 PBL modules which are completed with scenarios of not having menstrual period (amenorrhea), abnormal labor and delivery (dystocia), vaginal discharge (flour albus), and low birth weight baby. These scenarios are designed to trigger as well as to motivate the students to study and discuss not only the main problems of the scenarios, but also everything that considered associated to it, scientifically. With this Module 1 Not Having Menstrual Period, students are expected to be able to understand the physiological as well as pathological mechanism which causes a woman does not get menstruation. Students also are expected to understand the related problems due to this symptom and the necessary treatment. Based on data, it is shown that about 10% of pregnancies undergo complication during the pregnancy as well as the labor process. Therefore, a good antenatal care is needed. Module 1 is focused on pregnancy process, and it is expected that students know the process of pregnancy and understand problems associated with pregnancy. Learning process in PBL covers activities such as meeting with tutors, self-learning by finding information from experts, books, journals in the library or through internet, skill lab activities and making and presenting discussion result report from PBL. It is highly expected that with this PBL, students can be more active to find the answers and put an effort to solve the problems that can be found in the community.

Revised: Makassar March 2010 PBL Coordinator of Reproduksi System FK-UNHAS dr. IMS. Murah Manoe, SpOG(K) dr. Deviana S. Riu, SpOG

MODULE 1

AMENORRHEA
General Instructional Objectives
After learning this module, students are expected to be able to explain about the cause and pathophysiology of not having a menstrual period and its treatments.

Learning Strategies
1. 2. 3. A leader-led group discussion, facilitated by a tutor A leader-led group discussion, without a tutor CSL: 3.1. Systematic anamnesis of patient with chief complaint of not having menstrual period 3.2. Physical examination of patient with chief complaint of not having menstrual period Practicum Work: 4.1. Clinical Pathology: Regular Urine and Blood Test 4.2. Anatomy of the reproductive system 4.3. Histology of the reproductive system Experts consultation Experts lecture in a general class Self-study activities in the library with books, magazines, slides, tape recorders, videos or the internet.

4.

5. 6. 7.

CASE SCENARIO I Ms. Ani, 15 years old, came to a clinic due to not having menstrual period. Physical examination reveals mammae growth (+). SCENARIO II Mrs. Sinta, 28 years old, P0A0, came to a clinic due to not having menstrual period. She occasionally gets her menstrual period after 2 3 months. She has been married for 2 years now.

REPRODUCTION SYSTEM MEDICAL FACULTY HASANUDDIN UNIVERSITY

PBL MODULE
For Students ABNORMAL LABOR AND DELIVERY/ DIFFICULT LABOR (DYSTOCIA)

Given to the 4th Semester Students of Hasanuddin University Medical Faculty

Created By: dr. IMS. Murah Manoe, SpOG (K) dr. Deviana S. Riu, SpOG

Reproduction System Medical Faculty Hasanuddin University

2010
10

MODULE 2

ABNORMAL LABOR AND DELIVERY/ DIFFICULT LABOR (DYSTOCIA)

INTRODUCTION
Reproduction system provides 3 PBL modules which are completed with scenarios of not having menstrual period (amenorrhea), abnormal labor and delivery (dystocia), and vaginal discharge. These scenarios are designed to trigger as well as to motivate the students to study and discuss not only the the main problem of the scenarios, but also everything that considered asscociated to it, scientifically. The second module is focused on abnormal labor and delivery, which is well known as the cause of about 80% of maternal death in developing countries. This calculation is not actually representing the whole picture since lots of other maternal death cases are sometimes classified as due to other dystocia complications e.g., postpartum hemorrhage, uterine rupture, and sepsis. Moreover, dystocia may also lead to fistula developing, which can be such a psychosocial burden to a woman. With this module, the students are expected to understand the basic consept and theory of dystocia, the complications that might occur whenever dystocia takes place, how to identify one, as well as recognizing the effect to the mother and the fetus. This PBL process includes tutorial meetings (facilitated by a tutor), self study; by looking for some additional information through the expert meetings, books, and journals either from the library and or the internet, and then presenting the result in a pleno discussion. We strongly hope that this module can be very useful in motivating the students to be more active in solving the problems that they most probably will encounter in their community.

Revised: Makassar March 2010

PBL Coordinator of Reproduksi System FK-UNHAS dr. IMS. Murah Manoe, SpOG(K) dr. Deviana S. Riu, SpOG

11

MODULE 2

ABNORMAL LABOR AND DELIVERY/ DIFFICULT LABOR (DYSTOCIA)

General Instructional Objectives
After learning the module, the students are expected to have the ability in explaining the principal concept of knowledge of dystocia, the symptomps and signs, the complications both to the mother and the fetus, and able to deliver any required treatment to the patient.

Learning Strategies
1. A leader-led group discussion, facilitated by a tutor 2. A leader-led group discussion, without a tutor 3. CSL: - Obstetrical examination - Gynecologic examination - IUD insertion and removal skills 4. Practicum Work: - Clinical Pathology: Regular Urine and Blood Test - Anatomy of the reproductive system - Histology of the reproductive system 5. Experts consultation 6. Experts lecture in a general class 7. Self-study activities in the library with books, magazines, slides, tape recorders, videos or the internet.

CASE SCENARIO I
A 40 year old woman, in labor for her first child, was reffered to the Hospital by a PUSKESMAS midwife because no progress in her delivery process. Physical examination revealed vital signs in normal range, top of fundus utery was 2 fingers below prosesus xyphoideus, fetus back at the mothers left side, lowest head part has not entered the pelvic. Distance of symphysis pubic and top of fundus utery 38 cm, mothers abdominal circumference 98 cm. Fetus heart beat 130 bpm. Contraction 3 times in 10 minutes with duration of 40-45 seconds.

SCENARIO II
A woman, 35 year old, in labor for her third child, and no progress in her delivery process. Physical

MODUL 3 : KEPUTIHAN

examination revealed vital signs in normal range, top of fundus utery was 3 fingers below prosesus xyphoideus, fetus back at the mothers right side, lowest part was the head, with 2/5 position (in terms of fifth). Distance of symphysis pubic and the top of fundus utery 37 cm, mothers abdominal circumference 95 cm. Fetus heart beat 130 bpm. Contraction 2 times in 10 minutes with duration of 30 - 35 seconds. Cervix opening 4 cm, intact amnion sack, descent process in
accordance with Hodge 2, sufficient pelvic size.

12

REPRODUCTION SYSTEM MEDICAL FACULTY HASANUDDIN UNIVERSITY

PBL MODULE
For Students VAGINAL DISCHARGE

Given to the 4th Semester Students of Hasanuddin University Medical Faculty

Created By: dr. IMS. Murah Manoe, SpOG (K) dr. Deviana S. Riu, SpOG

Reproduction System Medical Faculty Hasanuddin University

2010

13

MODULE 3

VAGINAL DISCHARGE
INTRODUCTION
Reproduction system provides 3 PBL modules which are completed with scenarios of not having menstrual period (amenorrhea), abnormal labor and delivery, and vaginal discharge (flour albus). These scenarios are designed to trigger as well as to motivate the students to study and discuss not only the main problems of the scenarios, but also everything that considered associated to it, scientifically.

Module 3 is focused on vaginal discharge. Almost every woman has suffered from this disease throughout her life. Besides physiologic, vaginal discharge can be pathologic that can cause serious complications if it is not correctly treated. With this module, students are expected to know the cause of flour albus, the pathophysiology, examinations that are needed, treatments, complications, education and prevention.

Learning process in PBL covers activities such as meeting with tutors, self-learning by finding information from experts, books, journals in the library or through internet, skill lab activities and making and presenting discussion result report from PBL. It is highly expected that with this PBL, students can be more active to find the answers and put an effort to solve the problems that can be found in the community.

Revised: Makassar March 2010

Reproduction System PBL Coordinator, dr. IMS. Murah Manoe, SpOG (K) dr. Deviana S. Riu, SpOG

14

MODULE 3

VAGINAL DISCHARGE
General Instructional Objectives
After studying this module, students are expected to be able to explain the cause, pathomechanism, signs/symptoms, the way to diagnose, treatments, complications and epidemiology and also prevention of this vaginal discharge/flour albus in women.

Learning Strategies
1. A leader-led group discussion, facilitated by a tutor 2. A leader-led group discussion, without a tutor 3. CSL: 3.1. Systematic anamnesis of patient with fluor albus 3.2. Inspeculo assessment of patient with fluor albus 3.3. Endocervix secret sample taking 3.4. Vaginal discharge wet sample taking 4. Practicum Work: 4.1. MIcrobiology 4.1.1. Vaginal discharge gram staining: Identifying clue cells, positive gram microbes, negative gram microbes, comma negative gram 4.1.2. Endocervix secret gram staining: Identifying intracellular negative gram diplococcus 4.1.3. Identifyng the growth characteristic of N. gonorrhoe and C. albicans 4.2. Pathology Anatomy: Pathologycal appearance of cervisitis and vulvovaginitis 4.3. Clinical Pathology: eosinophil count 4.4. Parasitology: microscopic appearance of Trichomonas vaginalis 4.5. Anatomy 4.6. Histology 5. Experts consultation 6. Experts lecture in a general class 7. Self-study activities in the library with books, magazines, slides, tape recorders, videos or the internet.

CASE
Scenario: I Mrs. Ita, 30 years old, PIIAO, comes to a Polyclinic with vaginal discharge, which she has been experiencing frequently. Sometimes it is accompanied with itchy sensation. At the moment, she is on ADR contraception. Scenario: II REPRODUCTION SYSTEM Ms. Ita, 22FACULTY years old, comes to Puskesmas with fish odor vaginal discharge. At the MEDICAL moment, she is on her final exams period. HASANUDDIN UNIVERSITY

15

REPRODUCTION SYSTEM MEDICAL FACULTY HASANUDDIN UNIVERSITY

PBL MODULE
For Students LOW BIRTH WEIGHT BABY

Given to the 4th Semester Students of Hasanuddin University Medical Faculty

Created By: dr. Dwi Bahagia F., PhD., Sp.A dr. Ema Alasiry, Sp.A Prof. Dr. Djauhariah, SpAK

Reproduction System Medical Faculty Hasanuddin University

2010
16

MODULE 4

LOW BIRTH WEIGHT BABY

General Instructional Objectives

After studying this module, students are expected to be able to explain the cause, pathomechanism, signs/symptoms, the way to diagnose, treatments, complications and epidemiology and also prevention of low birth weight baby case.

Learning Strategies
1. 2. 3. 4. 5. 6. 7. A leader-led group discussion, facilitated by a tutor A leader-led group discussion, without a tutor CSL Practicum Work: - Clinical Pathology: Experts consultation Experts lecture in a general class Self-study activities in the library with books, magazines, slides, tape recorders, videos or the internet.

CASE
Scenario: A baby boy was delivered spontaneously (normal birth) in Puskesmas by a 40 year old mother. Birth weight 1500 gram, Ballard score 20. The moment of labor, the baby was crying spontaneously, the amnion sack was broken when labor, clear, without any odor. The baby was fed 2 hours subsequent to birth, but it looked weakly sucking. Four hours after birth it started to have difficulty in breathing, breathing frequency: 70 times/minute, with subcostal retraction, not cyanotic. Grunting expiratory was found on auscultation. Its temperature was 36,3OC. Two days later, its face and chest looked yellow.

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