Vignette #1

Looking in: Structure and Function of Body Systems

The professor is chewing gum, and class has not yet begun. Students are milling around the room, conversing with one another. The professor lowers the screen, and the slide titled "Motor Systems: Pyramid" appears.

Although class has officially begun, the professor states, "We are actually stalling for time and waiting for more handouts. There is a practical exam for neuroscience coming up, but not until the last day of the course. We will meet in the wet lab on Friday at 8:30 and will cut up some brains; there will be lot for your family. This will be mainly for amusement; we're just going to cut them up. So watch for that email announcement about the lab. We only have one brain per group. Take some precaution. Formaldehyde is fairly toxic, especially to your eyes and skin."

The professor begins the presentation. "Today we are going to talk about motor systems, mainly the anatomy of the ears and eyes and voluntary movement, all of which can be broken up into voluntary reflexes. Everything begins in the cortex." He describes the pre-central gyrus and states he'll cover the structures and functions involved in voluntary movement, show the neural pathways, and the entrance and exit points.

First, he shows the transverse brain stem. "This is the most difficult part of the brain; it is interrupted by lots of fiber." He does not face students while he shows slides.

The professor continues to explain what structures appear in the brain and how the angle of cut will reveal specific structures. He quickly explains the functions of selected structures in the brain. "If you are following along in the book on page 104, here you will see the cerebral peduncle." He shows the longitudinal fiber of the pons and highlights on the slide the pontine nuclei. The professor tells students that rather than using the term "superior peduncle," it is now called the "longitudinal fibers of the pons." He shows them another, larger slide of the previous slide, and then he draws an illustration on the board, but he does not identify the structures.

Throughout the lecture, the side of his body faces the audience. "The left side of the brain controls the right side of the body. Everything crosses over, and not everything has this arrangement in the visual space." He continues to explain the structure of the brain and illustrate on the white board. "You rarely have control of the individual muscles, because it is all organized at a neuronal level," the professor states. He shows a slide that illustrates the basal ganglia and points outs the subthalamic nucleus and the substantia nigra, "which appears white and is always in the same place." He compares "substantia nigra" to moon pie and asks the students, "Do you know what a moon pie is?"

Next, he discusses sensory cerebellum input. "When you talk about motor systems, you have to think about the cerebellum. No one knows much about it, but the cerebellum is important to programming muscles to move at certain rates and velocities in movement." He continues, "The primary fissure separates the cerebellum into anterior and posterior lobes, sometimes called hemispheres." He points out nodules, explains their functions, and continues to disseminate information rapidly while facing the screen. "So the cerebellum is going to get a lot of sensory input."

He continues to provide an overview of structures and functions of the brain without pause. "We talked about this earlier." His voice trails off. "Remember that the cerebella peduncles connect the brain stem. The other source of cerebellum input is the cerebral context. All of this information isn't very good until we do something with it. Then there is the cerebellum output. The Purkinye cells are going to relay this information, and the output path of the cerebellum is the superior cerebellum peduncle that crosses over the path and passes into the red nucleus. Some of the other passes over into the ventro-lateral nucleus."

He concludes. Following the presentation, the professor presents five slides (without identifying information) and asks students to identify structures that he discussed during this session. He pauses between each slide, yet none of the students respond.

     1. Describe the way in which the teacher provides instruction.
     2. What are some instructional strategies that the instructor could have used to promote critical thinking skills?

 After you answer these questions, you may wish to review Appendix A.



Vignette #2

Looking in: Evaluation of Clinical Judgment

The professor dims the lights in the classroom and says, "This month we are going to talk about dental malpractice." He tells students that he does dental malpractice with about ten firms around the state. "I've got a case that I'm going to pass out to you at the end of the class for your homework. As you read this, you'll get a sense of how these things unfold. Bear with me. I am going to discuss some basic law information first."

He reviews types of public and private law, and he shows the purpose and characteristics of public and private law on PowerPoint slides. He points out different types of private laws (contract, property, and tort) and defines tort as "a civil wrong against an individual." He describes negligence: "duty of care." He continues to read from slides and asks, "Are there any questions?" Without pausing, he continues, "If you have any questions, OK, but don't make them too hard."

Next, he describes standard of care and explains that there are things customary in patient dental care. Following this, he discusses the definition of malpractice and continues to provide an overview of legal terminology and legal procedure. He points out to students that when they are reviewing a plaintiff's petition, it is important to not write anything down, and that they should first discuss the information with the attorney. "If you write anything down at this point, it will be introduced as evidence."

The professor continues this overview with a discussion about statutes of limitation. "Well, you say, "˜Ya know, I don't want to know all this stuff.' However, when you get that diploma you're supposed to know all of this stuff. Lawsuits are expensive. It is hard to practice when you have a lawsuit hanging over your head, and they will charge you for every single minute they are working on your case. It is a very involved process."

He describes advantages of a settlement. "Litigation is civilized warfare, because you can't go out and shoot each other at noon anymore." He explains that the revenge factor is prominent in most lawsuits. He concludes the presentation with a George Bernard Shaw quote, "the greatest problem of communication is the illusion that it has been accomplished." The last slide reads: Questions? Sub group assignment.

     "Does anyone have any questions about your assignment? You won't need any library stuff. I hope you think that this is kind of interesting. See you Thursday."

     1. Describe the way in which the teacher provides instruction.
     2. What are some strategies that the instructor could have used to promote critical thinking skills?

After you answer these questions, you may wish to review Appendix A.



Vignette #3

Looking in: Oral Medicine

The professor greets his students. "OK, good morning, everybody." Without pausing, he asks for two volunteers. Two students volunteer and walk up to the front of the room. One student reads a patient case aloud, while the other student writes on the board the relevant details.

The student writes "inflammation" on the board. "When we see inflammation, what do we think of?" the professor asks. One student replies, "Abscess." The professor repeats her reply and adds "cellulitis."


Symptoms      Dental concerns
32 yr male      abscess
       increased swelling upper right eye tooth
Medical history      Clinical exam
GERD-takes prilosec      Type 2 diabetes dialenese daily
Allergic reaction to PCN and Keflex      intra and extra oral swelling-no meds

The professor asks, "Why did the patient have the pain before the swelling? This is very important information, because the patient may call you in the middle of the night before pain occurs." The professor tells students that the patient has swelling contained in intraoral space. "When you see radiolucenox, what does this mean? The tooth is necrotic; it is an abscess. If the tooth is nonrestorable, what's the treatment?"

"Extraction," the students reply. "Right," the professor says. "The patient has a 101.5 degree temperature. Guys, does he have a fever?" Students reply, "Yes."

"Is it a high fever?" the professor asks. "We aren't going to discuss the case right now. Look up Dialenese and Prilosec in the oral pharmacotherapeutics book. You can get it from your book or computer. Think about drug interaction, antibiotics, and analgesics. What about anti-hypertension drugs? Then think about the effect of infection on diabetes and diabetes on infection. Remember the meaning of two-way interaction. I expect you to be ready on Friday. If you have any questions, raise your hand." The class is silent. "OK, great."

     1. Describe how the teacher provides instruction.
     2. What are some strategies that the instructor used to promote critical thinking skills?

After you answer these questions, you may wish to review Appendix A.



Vignette #4

Looking in: Endodontics

Another professor presents the following case to the students. She states that a patient presents and complains of sensitivity to hot and cold in the maxillary right quadrant. The patient asks the dentist for a pain prescription. The professor asks the students, "What is the next step? Write on a sheet of paper what questions you have before proceeding with this case."

After giving them two minutes to write their questions, she asks students to share what they have written. After five seconds, nobody has volunteered to share. She continues to wait and probes the students by asking other questions. "What are you thinking? What other information do you need?"

Twenty hands are immediately raised. One student shares, "I would want to do a percussion test." The professor states, "Good. Now, what else?" Another student replies, "Does the patient have sinus problems?" Another student volunteers, "I would want a radiograph." The professor asks, "Why?" Another student suggests that the area be palpated. Next a student asks if this patient has had previous endodontic treatment. Another student asks if the patient has any deep cavities. One student asks if the patient has a drug abuse history.

The professor asks the students to form groups of four, rank the suggestions that have been provided from most important to least important, and come up with a differential diagnosis.

The professor moves from small group discussions back to the large group. She puts a radiograph on the board. The radiograph shows radiolucency on tooth #4 at the apex and that the tooth has had previous endodontic treatment. The professor then asks each student to write down how he or she would communicate diagnosis, treatment plan, and cost to the patient.

     1. Describe how the teacher provides instruction.
     2. What are some strategies that the instructor used to promote critical thinking skills?

After you answer these questions, you may wish to review Appendix A.