Working Together PBSG-ED. Series on Clinical Education for Health Professionals

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1 s Clcal duca Halh Pssals Wkg Tgh P- PRACTIC A MALL ROUP - UCATIO h://hs.mcmas.ca/acdv/bsg-d.hml Issal duca ad Cllaba Amg Halh Pssals P R Iduc P- s Ths scal ss mduls s ddcad hacg h ducaal sklls busy clcal achs. Th mduls vd cug duca a cas-basd ma ha maks judcus us h ms c ad bs duca vdc avalabl. ag m al-l xamls achg ad lag suas, h mduls hav b dsgd m dscuss wh cllagus aud challgg ssus/dlmmas ha a lkly as wh wkg wh las. Th us s s lc ad vd us sklls ag h way slcd chags ha ca mv achg ad lag. Cllaba ca b all lays h halh ca sysm, hacg ca ad say as ad mvg wklad ad jb sasac halh ssals. I ca als hl las dvl sv ssal bhavus ad am wk xs. Tachg ad mdllg a cllabav aach las wll cvy ad c h auds, kwldg ad sklls hy d bcm cllabav acs h uu. Pacc Challgs: Lmd us clcal achs assss/lc h w ssal cllaba. Las a ucla abu h sc acc/l d sss. ucual bas (.g., schdulg, m) ham ssal cllaba. Ths mdul ams hl clcal achs: Rlc h w ssal cllabav bhavu ad cvly l mdl hs bhavu las. Facla las udsadg gadg h sc acc/ l h ssals. Idy us ach cllabav ca ad addss sucual bas. vld cllaba wh: Th Fuda Mdcal Pacc duca La Fda u l éduca médcal cu xc Pacc Iga PLP PAP Lag Objcvs w Kwldg UCATIOAL MOUL 3%6* (' 3URJUP IRU )FXOW\ 'HYHORPHQW 0F0VWHU 8QLYHUVLW\

2 Wkg Tgh: Issal duca ad Cllaba amg Halh Pssals Cas 2: Hsal Ou-a Clc Tam: Physcas, mdcal suds, uss, scal wks, hamacss, dcas, ccuaal hass FIITIO Issal duca (IP) Issal duca ccus wh w m sss la wh, m ad abu ach h mv cllaba ad h qualy ca. 1 CA A busy hsal-basd subscaly clc has may sds ad mdcal suds. A h cml ach clc day, h am ms a wa-u sss dscuss usadg ssus aud a ca. ug h mg, h hysca cvs a ug call m hs as wh ds mdcas dd. Th hamacs s askd ck u h mdca ad bg back h clc. Wh sh cgzs ha h a s h clc as m ha day, sh says: Ths s u as, s my jb. Th hysca sds: Yu wk m, ad yu jb s d wha I ll yu d. A a w mus, bh dvduals alz hy a sdg ly h sss h day ad algz. val las adg h clc ha day a susd a h xchag, bu d cmm. Cas 1: Pmay Ca Tam Physca, sd, us ac (P), dca Wha a sm h ssbl acs ha culd b lucg h ssal bhavus dmsad hs ac? Cllabav Pa-cd Pacc Cllabav a-cd ca s dd as a acc a, a way halh ca ssals wkg gh ad wh h as hac a ad amly gals ad valus. I vlvs h cuus ac w m ssals dscls gazd a cmm slv xl cmm ssus wh h bs ssbl aca h a. I s dsgd m h acv aca ach dscl a ca. 2 P R Th ssals hs acc s a xmly busy wh w us am mgs. ally, h am s abl cllaba ad mak am dcss a as dd bass. Hwv, h P ms wh h hysca, xssg ccs sh has abu a w sd. Th sd mad dcss abu sval as whu csulg h P, wh dsags wh may h las ac. As wll, h P had mad aagms h gsd dca vd sm duca a dabc a. Th sd, hwv, ld h a ha hs was a y. Th a aas cusd by h mxd mssags. Hw culd ach ssal db wh h las abu wha had ad mdl aa cmmuca? Wha wuld b yu hughs abu hs sua? IFORMATIO CTIO Wha culd hav b d v hs sua m ccug? IP: TH OAL 1. Th gal IP s la gh d wk gh h bs ss as, h amls ad h cmmus. 3 T achv hs gal, halh ssals mus dvl ssal kwldg, auds ad sklls a h -lcsu ad acc lvls.4 2

3 Wkg Tgh: Issal duca ad Cllaba amg Halh Pssals May gazas a dvd mg IP ad halh ssal cllaba, bh h acadmc ad clcal acc sgs. Adx 1 a lsg aal ad aal avs. IP: TH MOL Th Halh Caada mdl IP cs h -lash bw la ucms ad cllabav acc by cusg las as hy as m acadmc clcal vms, ad clcas as hy wk gh ad wh las. Th mdl s basd h ms ha h sh ssal acc qus chags halh ssal valus, scalza, ad wklac gazaal sucus. I ams m culual chag ad dvl sv l mdls wh h clcal lag ss. 4 scg sxually-asmd dsas11 adul mmuza12 acud hs13 dcasd am css h maagm lw-bh-wgh as14 valua ad maagm gac as15 acu ca abusd wm h mgcy m16 mvd a sasac wh h ca17 dcasg h a clcal s18 b ca mal halh19 P R : Rsach h cacy h halh ca sgs s gg. F h La 3. Alhugh h s gg dba abu h mal mg duc ssal duca, sach shws ha las h aly sags h ducaal gams a ady ad wllg ak a ssal duca.20 Iducg IP a hs m may acla h dvlm sv auds ad bhavus wads h halh ssals.7 Las wh xc IP a m awa h mac ssal wkg ca dlvy ha hs whu hs xc21 ad a m cllaba ad ssal aachs.17 Th auhcy h lag xc s ma.22 Las, h, d s h lk bw h lag ad uu acc. T vw h mdl, g : hh/cc-g.d (accssd Mach 2010) asd Amu, Oadasa, I (2004). I Oadasa al. (ds). Idsclay duca Cllabav Pa Cd Pacc. Oawa: Halh Caada. Issal Cmcy Famwk Th Caada Issal Halh Cllabav (CIHC) has dvld a amwk ulg h cmcs ha a ssal cllabav acc. mas clud h llwg: l claca; am ucg; ssal clc slu; am ucg; cllabav ladsh; a/cl/amly/cmmuy-cd ca; ssal cmmuca. F h Pssal 4. IP sags cas cllaba ad cmmuca amg am mmbs.23 Pssals vlvd hs kd cllaba xc mvd jb sasac ad casd sl cdc.8 Rsc shw d ls ad scvs abls ssals b abu gas h kwldg ad ask quss. 24 Th gaza, as a whl, bs m ssals wkg gh a m cv ad c ma.8 Th ull dcum s avalabl a: h:// ls/cihc_ipcmcs_fb1210.d (accssd Mach 2010) TH FIT F h Pa 2. Culy, s ssbl daw m ccluss abu h lg-m cvss IP mvg a ca.5;6 Hwv, cllabav acc vs hav b ud mv a ucms7-10 h llwg aas: 3

4 Wkg Tgh: Issal duca ad Cllaba amg Halh Pssals HOW TO PROMOT ITRPROFIOAL COLLAORATIO valg sys ad uwllg s ca halh ssals as h s cac.8 Cllaba Yu Ow Pacc 9. I s ma addss u ssus bw d halh sss, ad cmm gals ad bak dw lg-sadg w bls ad sucus.25 a. I s ssal hl ad cuag las udsad, cgz ad sc h sc acc/l h am mmbs ad claly acula h w ls ad ssbls hs.7 Pvdg us las m ad wk wh dvdual am mmbs a -- bass s ky.26 Fmal mal us w am mmbs shadw hs ca hl s a udsadg h am mmbs ls. Tam-basd cas dscusss a als hlul. b. duca as abu hw ach am mmb wll cbu h ca.25;29 5. T ach ad mdl cllabav acc a la, s ssal assss ad lc yu w ad yu am s cllabav bhavu. A wll-ucg cllabav am s chaaczd by:25;26 sud ladsh muual sc scv sghs ad dcs clay abu am mmbs ls ad ssbls cla ad gula cmmuca aa gazaal sucus (.g., gula mgs) quabl dcs-makg cv clc slu a cus a ds a lg cllcv accuably ad ssbly wk a gad ash. P R 10. Claca ls s scally ma h s a al vla bw d vds ad las gadg cmcs ad sc acc.26 Ths vla ca sul l blug du cus as wh s acc budas bg ad d. 28 m am mmbs may l hy a bg udulzd, a h h d h scum, l hy a dg vyhg. Clc ad buu ca sul.28 val sags ca hl avd hs dculs ad cas cm wh h vlag ls: a. Pvd all am mmbs, cludg las, wh cla l dscs avd dulca ad acla aa dlga.30 b. Cduc a gula vw su vy s cmabl wh h scv ls ad l hy a bg usd a mal way.26 Lads ad Ms 6. g ladsh s sumal mg IP ad cllabav acc. I a ssal cllabav acc, acs wll cllabavly dm wh wll vd gu ladsh ay gv sua.27 A cv lad ca:25;26 su a gd mx sklls ad dvsy wh h gu cuag am mmbs dvl h sklls ad al sablsh cmm gals dvl am csss cludg l clay ad am su s cla asks Cmmuca 7. Wh clcal sgs, s ma mdl cllabav acc las.8 Tachs lay a ky l cag a vm ha sus h gals IP ad acg as l mdls las.7 Ogg cachg ad mg ca hl las dvl ad maa h amwk xs Mmbs a ssal am mus wk dvl a cmm laguag ad a cmm ccual amwk basd cmm valus whch wll ascd hs ach scc ss. 28 I s ma allca ugh m am mmbs sha ma, dvl sal lashs ad addss am ssus. Fuhm, shag sac ad wkg hyscal xmy ducs ssal aly ad aavsc bhavus. 30 c Pacc 8. chd auds msccs abu sc acc ca ma ssal cllaba.25;28 Las may bg ssal ad culual bls ad auds ha ca ac h wllgss cllaba wh h halh ssals. Pas may als b acd by 12. Fmal cmmuca bw am mmbs ad las ca b aclad by am mgs. Rgulaly schduld mgs a ma, 4

5 Wkg Tgh: Issal duca ad Cllaba amg Halh Pssals aculaly wh sm am mmbs wk a a-m bass d lcas.26 a. Mgs ca b clcal (cas vw), ducaal, admsav lag au. Thy ca b a hlul um sa m d dscls gah, dscuss ad wk am buldg.26 b. Las ca us hs us la m abu scv scs acc/ls, ad bsv s-had hw h am cllabas cas maagm.26 TH OTTOM LI Rlc ssal cllabav bhavu yu acc. Clay ad s sc ls/sc acc all am mmbs. Idy sags ach ad mdl cllabav ca las. Us clc as a lag uy. P R 13. I add mal clcal sgs, mal sgs (.g., ag luch, ca lg, scal g-ghs) ca vd asy, m-c us acs ad las sha xcs ad cllabav aachs.7;26 cuma ad duca 14. Th dvlm halh ca cls acc mauals, wh d a cllgal ash, ca acla succssul ssal cllaba.30 su las a awa ay cls ad, b y, vlv hm h dvlm such cls. 15. duca am wk ad cllcv dcsmakg s hlul mg ssal cllaba.30 Clc Rslu 16. Whl a ca amu clc s xcd ad halhy dug h am dvlm has, may als sgal msudsadgs abu ls scs acc ad, lss, sal dculs. Issal clc slu has b dd as a c cmcy ssal cllaba.27 I s ma dy cmm suas ha a lkly lad dsagm acual clc bw sa mmbs ad addss hm as s as ssbl, dally wh a clc-slu mchasm alady lac.26 sablshg a sa vm whch xss dvs s s ky.27 Th aa hadlg clcs bw am mmbs ca b a ma lag uy las. Adx 2 Hw T Us A Clc As A Lag Tl may b hlul. 5

6 Wkg Tgh: Issal duca ad Cllaba amg Halh Pssals Hw culd ach ssal db wh h las abu wha had ad mdl aa cmmuca? CA COMMTARI CA 1: Pmay Ca Tam Physca, sd, us ac (P), dca I wuld b hlul ackwldg ha h la saw wha had ad ha h ss m bh as was aa. Th la culd b cuagd lc h sua by askg: Why d yu hk had? Hw wuld yu hav hadld? Thkg abu h w ms asg m hs sua (.g., a, axy) wuld b sucv. Adx 2. Wha wuld b yu hughs abu hs sua? Ths sua s a cmm xc. Th sd has much la m h ssals ms gg chc dsas maagm (I P 3). I wuld b ma dm h P has addssd h ssus wh h sd dcly. P R I wuld b ma ha h ssals a hgh abu h w vlvm h cd, cgzg h huma scv ad ha bad days ha m m m. Th algy ad -sablshm h lash was a sv ucm bg h la s a. Wha culd hav b d v hs sua m ccug? Pvv sags culd clud: lcg whh yu w am mmbs a cllabag a cv ma (I P 5) vdg a h sd abu am uc, sc acc, awass hs ls (I P 9). gagg h la a wkg l wh h P (I P 9a) mdllg cllabav bhavu wh h P a clcal sg (I P 7) sug h sd hugh ladsh ad msh (I P 6) schdulg gula m am buldg (I s 11-13) dvlg a ssal cl gud cllaba (I P 14) dscussg ad clayg maagm wh h a (I P 9b) Wha w h sucual ssus ha ld hs sua ccug? y dcsucg wha had ad why (.g., why a mds avalabl, u dug wa-u sss), wuld b ssbl dy wha culd b d avd hs sua m ccug aga. h sysm ad sal bas ad aclas cllaba shuld b csdd. Cas 2: Hsal Ou-a Clc Tam Physcas, mdcal suds, uss, scal wks, hamacss, dcas, ccuaal hass Wha a sm h ssbl acs ha culd b lucg h ssal bhavus dmsad hs ac? Whl agu ad sss lay ma ls hs sua, s ma csd h ssus. Clay ls sms b a ma asc, ad h cmmuca wh h am may als b qusd. Th vbal ac may lc a w gad, clc v ladsh, has sal ssus. 6

7 Wkg Tgh: Issal duca ad Cllaba amg Halh Pssals Auhs: sclsus cmg ss: dclad Paca lm, Kv Wdwad, Ivy Oadasa, Ally Walsh ad Lyda Cas. Paca lm, Ph c, Pgam I ssal Pacc, duca ad Rsach (PIPR) Haml, Oa Pa Hall was h c-lad h ICPCP Iavs jc Adx 1. h s a udg mmb h Isu Halh ccs duca (IH) ad a mmb CHIC mmb. h has cvd gas m Halh Caada, Halh Fc Oa, CIHR, ad Uvsy Oawa Idsclay Iavs ud sach ssal duca acc. Kv Wdwad, M, FRCPC Ial Mdc ad Icus sass Haml, Oa P R Rvws: Pa Hall, M, CCFP, FCFP, Md Pallav Ca Physca Oawa, Oa Whl vy ca has b ak cmlg h ma cad hs mdul, h Pgam ca guaa s alcably scc clcal suas wh dvdual as. Physcas ad hs shuld xcs h w dd judgm ccg a ca ad am, basd h scal ccumsacs ach cas. Ivy Oadasa, M, CCFP, MHc, FCFP Famly Physca T, Oa Mdcal d: Ally Walsh, M, CCFP, FCFP Famly Physca Haml, Oa Mdcal W: Lyda Cas, Hs A T, Oa Rsach: Wdy Ladb, R, c Haml, Oa Ay usg h ma ds s a h w sk ad lass ad ags dmy Th Fuda Mdcal Pacc duca ad h Pacc asd mall u Lag Pgam m ay ad all juy damag asg m such us. Th dvlm hs mdul was mad ssbl wh udg su m h Pgam Issal Pacc, duca ad Rsach (PIPR), McMas Uvsy, Haml, Oa ad a ga m Halh Fc Oa. Th Fuda s mdul am wuld lk ackwldg, wh haks, h Pacc asd mall us aclad by Paca lm (Haml, Oa), Kal bb (Haml, Oa) ad Ally Walsh (Haml, Oa) wh l-sd hs ducaal mdul. P-, Pgam Faculy vlm, McMas Uvsy 7

8 Wkg Tgh: Issal duca ad Cllaba amg Halh Pssals Rc Ls (1) C h Advacm Issal duca. g IP h:// Accssd Mach (14) Rgwsk J, Hba J, Plsk P, ak L, dg J, dwads W al. cmc mlcas aal sv ca u cllabav qualy mvm. Pdacs 2001; 107: (2) Hb CP. Chagg h culu: ssal duca cllabav a-cd acc Caada. J I Ca 2005; 19 ul 1:1-4. PM: (15) alvd I, M, Fays P, Kaasa, lvld O. Rducd maly ag aculy sck, al ad ld as gac valua ad maagm u. A scv admzd al. Jual h Amca ac cy 2002; 50: (3) Y. Lag gh ach gh: ssal duca ad aculy dvlm. J I Ca 2005; 19 ul 1: PM: (16) Cambll J, Cb J, McLughl, awa, ah, lass al. A valua a sysm-chag ag mdl mv mgcy dam ss bad wm. Acadmc mgcy Mdc 2001; 8: P R (4) Halh Caada. Isu Issal Halh ccs duca h:// Accssd Mach (5) Rvs, Zwas M, ldma J, a H, Fh, Hammck M al. Issal duca: cs ssal acc ad halh ca ucms. Ccha aabas ys Rv 2008;(1):C PM: (17) Cua VR, Mugd J, Law RMT, Macald. Iluc a ssal HIV/AI duca gam l c, auds ad amwk sklls udgadua halh sccs suds. duca Halh: Chag Lag & Pacc 2005; 18(1): (6) Zwas M, ldma J, Rvs. Issal cllaba: cs acc-basd vs ssal acc ad halhca ucms. Ccha aabas ys Rv 2009;(3):C PM: (18) My JC, m R, Jay, Was RL, alsbuy M, uks KA al. duc ad mac mvm h mgcy dam hugh mal amwk ag: valua suls h MdTams jc. Halh Rs 2002; 37: (7) Oadasa I, Rvs. Ky lms ssal duca. Pa 1: h la, h duca ad h lag cx. J I Ca 2005; 19 ul 1: PM: (19) Yug A, Chma M, Fqu L, Kgh L, Vgl H, Mll A al. Us a csum-ld v mv vd cmcs. Psycha v 2005; 56(8): PM: (8) Amu, Oadasa I. Issaly as h ld ssal acc ad ssal duca: a mgg cc. J I Ca 2005; 19 ul 1:8-20. PM: (20) Hd, ma I, C, ll, Hl R, Judd P al. Issal cs halh ca suds. J Issal Ca 2003; 17: Zwas M, Rvs, P L. cvss -lcsu ssal duca ad s-lcsu cllabav vs. J I Ca 2005; 19 ul 1: PM: (21) Pllad K, Rckaby C, Ms M. valuag sud lag a ssal cuculum: Th lvac -qualyg ssal duca uu ssal acc. R h Hgh duca Acadmy Halh cc ad Pacc ubjc C Ld. (10) Rvs, Fh P, McC P, Py. I achs yu wha xc h uu... IP lag a ag wad mdcal, usg, ccua hay ad hyshay suds. Md duc 2002; 36: (22) Hammck M, Fh, Kl I, Rvs, a H. A bs vdc sysmac vw ssal duca: M ud. 9. Md Tach 2007; 29(8): PM: (11) ha MA, Tbb KP, Pall RH, Wbblsma CJ, uhaus JM, T AC al. c a clcal acc mvm v Chlamydal scg amg adlsc gls. JAMA 2002; 288(22): PM: (23) Vaza, Hays R, ha MF, Cwa M. c mudsclay v cmmuca ad cllaba amg hyscas ad uss. Amca Jual Ccal Ca 2005; 14(1): (12) wada A, Rashd A, Jhs M, wy M. Clus admzd al a ducaal uach vs mv luza ad umcccal mmuza as may ca. sh Jual al Pacc 2002; 52: (24) Kas-Ov, McCals P, Klly, MacVca R. Th Paccbasd mall u Lag gamm: xcs las mul-ssal gus. J I Ca 2009; 23(3): PM: (13) agl, Tasy C, Kklad JL, Oglv-Has J, sky A, chlls al. Idsclay a ca ldly l wh h acu: a admzd clld al. CMAJ 2002; 167(1): PM: (25) Oadasa I, ak R, ak K, sc C, Amu, Js L. al. Tamwk halhca: Pmg cv amwk halhca Caada. Plcy syhss ad cmmdas Oawa, O, Caada Halh vcs Rsach Fuda. (9) 8

9 Wkg Tgh: Issal duca ad Cllaba amg Halh Pssals (26) Msy Halh ad Lg-Tm Ca. Famly halh am. ud cllabav am acc h:// gv..ca/asma/h/h_guds.hml Accssd Mach (27) Caada Issal Halh Cllabav. A aal Issal Cmcy Famwk h://www. chc.ca/ls/cihc_ipcmcs_fb1210.d Accssd Mach (28) Hall P. Issal amwk: ssal culus as bas. J I Ca 2005; 19 ul 1: PM: P R (29) Hwad M, Agawal, Hls L. Pa sasac wh accss w ssal acadmc amly mdc clcs. Fam Pac PM: (30) a Ma-Rdguz L, aulu M, Amu, Fada-Vdla M. Th dmas succssul cllaba: a vw hcal ad mcal suds. J I Ca 2005; 19 ul 1: PM:

10 Adx 1. Issal Halh duca Iavs CAAA Caada Issal Halh Cllabav (CIHC) h:// Halh Caada: Issal duca Cllabav Pa-Cd Pacc (ICPCP) h:// /dx-g.h Isu Issal Halh ccs duca h:// Issal duca ad Rsach amg h Halh Psss, Mmal Uvsy h:// Issal duca a g w Cllg h:// Issal duca Cllabav Ps-cd Pacc hugh h Humas jc (Pash bw Uvsy Oawa ad CO Halh vc) h:// Issal duca ac Ca Pgam a h Uvsy Maba h://umaba.ca/uach/gc Issal duca Pgam a h h Oa chl Mdc h:// Oc Issal Halh duca ad Rsach, Uvsy Ws Oa h:// Pgam Issal Pacc, duca ad Rsach (PIPR), McMas Uvsy h://hs.mcmas.ca//dx.hm Qu s Uvsy Oc Issal duca ad Pacc h://mds.qusu.ca/ amlss Ca: A Issal duca Pjc Ivav Tam-asd Tas Ca alhus Uvsy h://samlssca.dal.ca/ Uvsy sh Clumba Issal Cug duca h:// Uvsy T Oc Issal duca h://.u.ca/ P R ITRATIOAL C h Advacm Issal duca (CAIP) h:// WHO Pgamm Issal duca ad Cllabav Pacc h:// All wbss accssd May P-, Pgam Faculy vlm, McMas Uvsy 10

11 APPIX 2. Rslvg Clc a Lag ua scb h sua Wha, why Avd aul, gul, humla malzg aa h l m h sua Ask ach la/ac hs/h c h blm Cml a squc vs I acg as h mda, yu c (a hs m) ds ma a md ha msudsadgs ad clcs a vabl gu lag P R Clay dss back h ml claca scuss caus & c su ha all a usg acv lsg sklls (sam, lc, claca) Talk abu hw vy l A ma s as valdas vy s lgs K md h mac buldg sv gg lashs Fd shad Iss xl vy s dd ss* ah ha ss (ulma gals, ah ha hw g h) Idy ss ha a hld cmm. Mak a Pla asd shad ss, ga a vay s Mak dcss basd bjcv sadads Ica a cllabav aach wh wuld b ma cllabas? Add h ml wha ss a w gg ak? m masus succss ad add ml Imlm ad valua Imlm las valua ucms accdg ml Hghlgh gss ad s agm Idy wha has b lad m hs sua CLOUR *Iss a dd as ds, dss, ccs ad as. ucs: 1) Clc Rslu Wksh. Wha s clc slu. Iduc. Caach. Avalabl a: hml#; 2) Mashall P, Rbs R. Clc Rslu Halhca: A Ovvw. Iac 2003; 16 (1/2). Avalabl a: ds/clc_slu_vvw.d; 3) g Ys. Fsh R, Uy W. Pgu ks, w Yk 1981 (Cha 1 avalabl a ls/ty-ch1.d); 3) alma C, O a A, Kdd MR. Clc maagm: a m dcs ag. Psgad Md J 2006; 82(963):9-12. All wbss accssd Mach P-, Pgam Faculy vlm, McMas Uvsy 11

12 Tyg I Ou Rl-layg dug h P sss I achg, jus as clcal wk, s ma g byd dscuss w das aachs. Iga wks bs by yg hgs u. Ty alyg h ccs ssal cllaba hugh sm l-layg acvs dug h sss. TH OAL Th gal a l-layg acvy s allw acas h chac has d aachs a achg sua, ad la m h xc ad skll hs hugh bsva ad dscuss. P R T UP vd u small gus h u l. dg h sz h gu (ad h m), m ha l-lay ca ak lac smulausly. O aca aks h l h c ad ah h l la. Th h aca(s) ac as bsvs. Pacas ca chs a ssal sua wh las ha hy w vlvd, chs m h cass h mdul, cludg hs h cas bak (s h llwg ag). I s bs h s layg h la mags hmslvs as a la wh whm hy hav wkd sally (.., assum ha la s chaacscs ad sa). F h us h l-lay, dals ca b lshd u ald as qud (.g., ddg h ds h gu, h la ca b gammd ay d chaacscs sss). Th cs lay hmslvs, bu acc xm wh w ways gvg dback. Idally, h c ad la acas kw ly h w dvdual sc ul a h l lay s cmld. Th c ad h la shuld dm h lac ad mg h dback sss b bgg h l lay. cd hw lg h l lay shuld g b sg dscuss usually lg ha v mus. Th bsv(s) shuld h b ad cmm h ma whch h c hadld h sua usg h cls cv dback. Th h dscuss all acas. I sm suas, a a m u ad dscuss, d acas may assum h c ad/ la l ad lay h sua usg a d aach. P-, Pgam Faculy vlm, McMas Uvsy 12

13 CA AK : Ths cass s suas m a vay sgs ad may b usd addal gu dscuss ad/ l lays. Cas 3: Hsal: Adg hysca, sd, us, hyshas ducaal Issus: Clc maagm, hw sd a s sua Th hysca s havg a dbg sss wh a sd. Th sd s ha sh add a am mg wh a sk a ad h daugh aag cmmuy su u dschag. Th us wh was ladg h mg mad a cmm ha h hysca dd valu hyshay ad ccuaal hay ad d ha sh wuld su ha h svcs wuld b aagd. Th sd was usu hw sd dug h mg. Hw culd h hysca us hs uy hl h sd dal wh hs sua? P R Cas 4: Pmay halh ca am: us, usg sud, hamacs, amly hyscas ducaal Objcvs: lack cmmuca ad a ucla udsadg ls I s h day b a hlday lg wkd a lag amly mdc c. Th us wh us h --ca acagula clc alzs ha h s a maj qum blm, ad ha all as mus b -sd ad gv w sucs h Cumad dsag. h, h usg sud ad h hamacs a h c bg lacg calls 35 as. I h mam, alzg ha h s ll m g hs sg d ha day, h us sds a lcc mssag all h hyscas ad sds h clc mg hm ha hy wll d mmdaly b sucd hw us h qum d h sg, as h sds ad hyscas call v h wkd may hav d h sg hs as wh ca b accmmdad ha day. val hyscas mssag back say ha -call s vy busy ad hs culd vwhlm h svcs. Why mgh sm h hyscas sd wh cc whl hs d? Hw ls culd h ssals a hs c hav hadld h sua a ducv ucm? Wha mac culd hs hav h usg sud? Cas 5: ugcal Tam: ug, sd, las, hyshas ducaal Issus: Clc slu, udsadg scs acc/ls am mmbs ug a clcal csh, h sug s akg las hugh a mdcal wad. Whl uds, h hysca vhas a dscuss bw a hyshas ad w sds. Th hyshas has ccs abu a acula a whch h mdcal am had b lag dschag. Wh h s dscuss hs ccs wh h sds, sds culy, Lk, I m h dc, yu jb s jus d wha I m llg yu; g h a ady dschag. Th scd sd aas ccu. Hw wuld yu addss hs clc wh yu suds, kwg hy had jus wssd aa bhavu? Wha sags culd yu suds basm d dal wh hs y sua h w acc? P-, Pgam Faculy vlm, McMas Uvsy 13

14 Rlcs ad Plas Hw hs sss wll luc wha I d h uu 1. Ky ak-hm mssag(s) m: 2. P R As a sul hs sss, I am: ly lag chag my aach achg las abu wkg cllabavly h uu. Plas scc xamls ad dy ay al bas makg h chag(s): Csdg a chag my aach achg las abu wkg cllabavly. Plas scc xamls: cuagd cu sm wha I alady d wh achg las abu wkg cllabavly my acc vm. I la cu d m h llwg: P-, Pgam Faculy vlm, McMas Uvsy 14