Distance Education in Medicine - Module 4: How To Make An DE Lesson in Medicine Using A Nonprint Medium

H O W T O M A K E A
D I S T A N C E E D U C A T I O N L E S S O N
I N M E D I C I N E
U S I N G A N O N P R I N T M E D I U M
(An Off-Campus Study)
Reynaldo O. Joson, MD, MHA, MHPEd
1995
FOREWORD
Dear Learner,
Mabuhay!
Welcome to a learning experience in becoming a health

professional.
This program has been especially designed with you, the

learner, and the principles of effective teaching and learning in
mind.
As you go through this learning program, please bear in mind

the following:
1. I am treating you as an adult learner which
1.1 Assumes you have learning aspirations and

expectations and, therefore, are motivated;
1.2 Gives you the privilege to use other learning

strategies in achieving the objectives in this
program;
1.3 Welcomes you to go beyond the learning package

as you so desire; and
1.4 Expects discipline, honesty, and maturity in

fulfilling your learning activities.
2. We shall define learning as a positive observable

change (for the better or improvement) in human
behavior, disposition, attitude, performance, or
capability which persists over a period of time.
3. Active learning strategies and activities will be

utilized as much as possible.
4. The program will contain learning materials which I

think will be relevant to your being an effective,
efficient, and humane health professional.
5. The ultimate goal of the learning program is to

produce health professionals who will contribute to
the health development in the Philippines.
6. When I made the program, I tried my best to
facilitate your learning. Bear in mind, however, I
am not infallible. Thus, analyze carefully
everything in this program. Don't hesitate to offer
disagreements and constructive criticisms for my own
learning and for the improvement of the program.
Best wishes for a fruitful learning with the help of this

program.
Reynaldo O. Joson, MD, MHPEd

1995
GUIDELINES IN STUDYING THE PROGRAM
Dear Learner,
Mabuhay!
Welcome to an experience in self-instruction.
The program consists of a printed material and a videotape.
This program has been designed so that you learn on your

own. You can learn at your own pace - as fast as you can or as
slow as you wish. You can choose to study anywhere and anytime.
For effective learning, however, please follow the following

guidelines in studying the program (start with the printed
material then the videotape):
1. You should diligently and chronologically go through

each part. Each part has an important role.
- The Introduction gives you an orientation,

perspective, and tells you the importance of the
subject matter.
- The Prerequisites tells you what you must

possess before you go into the program proper.
- The Objectives tells you what you are expected

to achieve after you have finished the program.
- The Text, of course, is the learning material

proper.
- Within the text are Activities where you will be

actively involved in the learning process.
- The Recapitulation helps you put together

all that you have learned earlier in the text.
- The Summative Evaluation tells you what you

should undertake, for me, your faculty
facilitator, to be able to assess you for
certifying purpose.
- The Student's Assessment of Self-Study Program

will give me a feedback on my efforts to
facilitate your learning.
- The List of Papers to Submit will provide you
with a checklist on what to submit to me.
- The Recommended Follow-up suggests what other

learning activities you should undertake.
2. Look at the videotape only after you are through

with the printed material.
- The Videotape gives you a sample of a self-

instructional material in a nonprint medium. It
is for you to critique and to learn from.
3. You must follow all the specific instructions to the

letter.
4. You must complete and submit all the assigned tasks

on the specified date.
5. You need to have the following materials when you

accomplish the activities of the program:
- Ballpen or pencil
- Papers
- A video player
The estimated study time for the program excluding the

summative evaluation activity is 1 to 2 hours.
Best wishes!

1995
Table of Contents
Introduction ........................................... 1
Prerequisites .......................................... 1
Learning Objectives .................................... 2
I. Basic Steps in Constructing a Nonprint

Self-instructional Material ........................... 2
II. Checklists and Questionnaires for

Critiquing and Developmental Testing of a
Nonprint Self-instructional Material .................. 4
III. Writing a Script of a Self-instructional Material

in the Nonprint Medium ................................ 12
A. The Script .......................................... 13
1. Lay-outing of Word and Picture Slides Based

on the Script .................................... 19
2. Transforming the Script into a Nonprint

Self-instructional Material ..................... 27
Recapitulation ......................................... 28
Summative Evaluation ................................... 29
Student's Assessment of Self-Study Program ............. 30
List of Things to Submit ............................... 31
Recommended Follow-up .................................. 32
Attachment:
A Videotape containing a self-instructional program

HOW TO MAKE A DISTANCE EDUCATION LESSON IN MEDICINE
USING A NONPRINT MEDIUM
Introduction
Conducting a distance education (DE) program in medicine

will invariably necessitate construction of self-instructional
materials (SIM).
The SIMs may either be in the print or nonprint medium.
The SIMs in the nonprint medium are usually in the form of

audiotapes, videotapes, and computer programs.
A decision on what medium to use for a particular SIM is

dependent primarily on the answer to the question -
Which medium will best (in terms of effectiveness and

efficiency) facilitate the students' learning of the
subject matter of the SIM?
Other factors that may affect the decision on what medium to

use are:
1. Availability of equipment in the student's area for

him to be able to use the nonprint SIM. Are
audiovideotape players and computers available?
2. Cost of production of the nonprint SIM
3. Competency or know-how of the medical educator
In this self-study program, you will learn the basic

steps on how to make a nonprint SIM in medicine for DE use.
Using the guidelines that I will give you and using your
creativeness, ingenuity, and resourcefulness, you will learn
how to make a nonprint SIM in medicine.
Prerequisites
Before you embark on this self-study program, you must have
1. Understood fully the concept of distance education

in medicine.
2. Designed a distance education program in medicine.
3. Written a distance education lesson in medicine in

the print medium.
1
If you do not possess these three prerequisites, I suggest
you first go through the following self-study programs written by
yours truly:
1. Distance Education in Medicine
2. How to Design a Distance Education Program in

Medicine
3. How to Write a Distance Education Lesson in Medicine
Specific Learning Objectives
When you finish this program, you must be able to:
1. Make a distance education lesson in medicine using any

nonprint medium.
2. Critique a distance education lesson in medicine in the

nonprint medium.
I. Basic Steps in Constructing a Nonprint Self-instructional

Material
1. Think of a lesson in medicine which you are a content expert

of and which you think is best to use a nonprint medium for
its SIM.
2. Think of audiotapes, videotapes, and computer devices. If

you are a computer wizard, go ahead and choose a project that
will come out with a computer programmed SIM. If you are not
familiar with computer programming like me, I suggest you
consider audiotapes and videotapes. Between the two, I
prefer videotapes, either VHS or Betamax.
3. With your intended learners in mind, formulate the learning

objectives of your planned nonprint SIM. The objectives
should be very specific and can be completed in one hour.
2
_________________________________________________________________
Now, please fill up the form below. After you are through,
proceed to Step No. 4.
TITLE OF SIM:
TYPE OF NONPRINT MEDIUM TO USE:
INTENDED LEARNERS:
SPECIFIC LEARNING OBJECTIVES:
-----------------------------------------------------------------
4. Write a script of your planned SIM,
4.1 with distinct and well-organized parts such as

introduction, learning objectives, body, and summary.
4.2 with adequate and appropriate information, learning

objectives, and self-assessment exercises that can be
finished in one hour.
4.3 in an informal and interactive way.
5. Revise and finalize your script.
6. Using your resourcefulness, procure the necessary equipment

and materials needed to transform your script into a nonprint
SIM.
7. Using your resourcefulness, ingenuity, and creativity,

transform your script into a nonprint SIM.
3
8. Have your nonprint SIM critiqued by your peers and revise as
necessary.
9. Have your nonprint SIM undergo a developmental testing using

both face-to-face tryouts and field trials. Then revise as
necessary.
-----------------------------------------------------------------
Hold it for a while.
Don't implement Steps 4 to 9 yet.
Take a look first at the checklists and questionnaires for

critiquing and developmental testing of a nonprint SIM. They
will give you more guidelines on how to make a nonprint SIM.
-----------------------------------------------------------------
II. Checklists and Questionnaires for Critiquing and

Developmental Testing of Nonprint Self-instructional
Materials
The checklists and questionnaries for critiquing and

developmental testing of nonprint SIMs are essentially the same
as those used for SIMs in print.
For nonprint SIMs, however, be they audiotapes, videotapes,

and computer programs, CLARITY in production is a criterion to
include in the evaluation.
In the next few pages, you will see the checklists and
questionnaires for critiquing and developmental testing of
nonprint SIMs. Go over them and keep the criteria in mind when
you make your nonprint SIM.
4
CHECKLIST FOR FACE-TO-FACE TRYOUT OF A NONPRINT SIM
Name of Learner:
Self-instructional Material:
Time started: _______ Time Finished: _______ Total time: _______
Observations: Possible Reasons given

reasons by learner
1. Seem to be bored?
2. Seem to have undue difficulty?
3. Others:
Note: Beside your personal observation, it is recommended that

you also ask the learner to fill up a questionnaire.
5
QUESTIONNAIRE FOR FIELD TRIAL AND FACE-TO-FACE TRYOUT
OF A NONPRINT SIM
Name of Learner:
INSTRUCTIONS: Please assess the self-instructional material by

answering the items below as comprehensively and as
accurately as possible. Use the back page or
additional papers if necessary.
1. How long did it take you to finish the SIM?
__ 1 hr __ 2 hr __ 3 hr __ 4 hr __ 5 hr Others ________
2. How difficult was the instruction?
__ very difficult __ fairly difficult/easy __ very easy
Where/what was it very difficult or very easy?
3. Were there any parts, concepts, or words that you found

particularly difficult or not well explained? If there were,
please give details.
4. Was the SIM well structured and well programmed?
5. The "Introduction" in the SIM
Did it adequately and appropriately orient you?
Did it adequately and appropriately motivate you?
6. The "Learning Objectives" in the SIM
Were they clear (specific, observable, measurable)?
Were they "must know" objectives?
Were they too heavy?

6
7. Did you achieve the learning objectives after going through
the SIM?
How confident are you of your achievement of the learning

objectives?
8. The "Content" in the SIM
Was it adequate based on the stated learning objectives?
Was it appropriate based on the stated learning objectives?
Was it clear?
Was it well structured?
9. The "Active Learning Activities" in the SIM
Were they adequate?
Were they appropriate and effective?
10. The "Self-assessment Exercises" in the SIM
Were they adequate?
11. The "Feedback" or "Responses" in the SIM
Were they adequate?
12. The "Summary" or "Review" in the SIM
Was it brief and concise?
Was it appropriate and effective (helpful)?
7
13. The "Instruction" in the SIM
Were the directions clear or confusing?
Was the pacing too slow or too fast?
How was the vocabulary in the SIM?
How was the grammar in the SIM?
How was the sentence and paragraph construction?
Was there a clear expression of ideas?
Was there a smooth and proper flow of thought?
What was your general impression of the SIM's appearance?

Was it friendly or cold? Was it formal or informal?
Was it interactive or not?
14. Was the production of the SIM clear in all aspects?
15. What did you particularly like about this SIM?
16. What did you particularly dislike about this SIM?
17. Any suggestions on what might have helped you in this

instruction? Give suggestions to improve the SIM.
8
CHECKLIST OR QUESTIONNAIRE FOR CRITIQUING A NONPRINT SIM
Name of Critique:
INSTRUCTIONS: Please assess the self-instructional material by

answering the items below as comprehensively and as
accurately as possible. Use the back page or
additional papers if necessary.
1. How long did it take you to finish the SIM? How long do you
think it will take a learner to finish the SIM?
__ 1 hr __ 2 hr __ 3 hr __ 4 hr __ 5 hr Others ________
2. How difficult was the instruction?
__ very difficult __ fairly difficult/easy __ very easy
Where/what was it very difficult or very easy?
3. Were there any parts, concepts, or words that you found

4. Was the SIM well structured and well programmed?
5. The "Introduction" in the SIM
Did it adequately and appropriately orient you?
Did it adequately and appropriately motivate you?
6. The "Learning Objectives" in the SIM
Were they clear (specific, observable, measurable)?
Were they "must know" objectives?
Were they too heavy?
9
7. Did you achieve the learning objectives after going through
the SIM? What are the chances that a learner can achieve the
learning objectives fairly easily after going through the
SIM?
8. The "Content" in the SIM
Was it adequate based on the stated learning objectives?
Was it appropriate based on the stated learning objectives?
Was it clear?
Was it well structured?
9. The "Active Learning Activities" in the SIM
Were they adequate?
10. The "Self-assessment Exercises" in the SIM
Were they adequate?
11. The "Feedback" or "Responses" in the SIM
Were they adequate?
12. The "Summary" or "Review" in the SIM
Was it brief and concise?
Was it appropriate and effective (helpful)?
10
13. The "Instruction" in the SIM
Were the directions clear or confusing?
Was the pacing too slow or too fast?
How was the vocabulary in the SIM?
How was the grammar in the SIM?
How was the sentence and paragraph construction?
Was there a clear expression of ideas?
Was there a smooth and proper flow of thought?
What was your general impression of the SIM's appearance?

Was it friendly or cold? Was it formal or informal?
Was it interactive or not?
14. Was the production of the SIM clear in all aspects?
15. What did you particularly like about this SIM?
16. What did you particularly dislike about this SIM?
17. Any suggestions on what might have helped you in this

instruction? Give suggestions to improve the SIM.
11
III. Writing a Script of a Self-instructional Material in a
Nonprint Medium
Below is a script which I made for a nonprint SIM in

medicine.
Go through it and learn something from it. You can use it

as a pattern when you make the script of your planned nonprint
SIM.
TITLE OF SIM:
Intraoperative Gross Examination of the Thyroid Gland
TYPE OF NONPRINT MEDIUM TO USE:
Videotape
Specifics:
An instruction using word and picture slides.
The whole instruction is recorded via a
videocamera using either Betamax or
VHS tapes.
DURATION OF THE VIDEOTAPE:
Not more than one hour
INTENDED LEARNERS:
Surgical trainees
SPECIFIC LEARNING OBJECTIVE:
At the end of the program, the surgical trainee must be

able to make an intraoperative diagnosis of a thyroid
disorder based on gross examination and clinical findings.
12
III-A. The Script
INTRAOPERATIVE GROSS EXAMINATION OF THE THYROID GLAND
Reynaldo O. Joson, M.D.
INTRODUCTION
The lack of pathologists in many areas in the Philippines

has always been considered one of the major problems affecting
proper surgical management. During surgery for thyroid diseases,
surgeons in these areas of the country always wish they have a
pathologist around when they need to have a frozen-section study.
The presence of a pathologist will certainly be a big help

to the surgeons in the intraoperative diagnosis of a thyroid
nodule and subsequently, in deciding on the extent of
thyroidectomy. Unfortunately, there is still a lack of
pathologists in many areas of the country. Until the time that
this problem will be solved, the surgeons will have to play the
role of a pathologist.
The surgeons may not have to do frozen-section study of the

thyroid nodules because of lack of proper equipment. However,
they can do a gross examination of the thyroid gland and nodules,
which is very easy to do, as you shall see later on, and which
requires no sophisticated equipment. What is needed is just a
pair of eyes or an eye to look at the gross appearance of the
thyroid gland and nodules, fingers to palpate, and a knowledge of
the gross pathology of this particular organ.
In this self-study program, you will learn how to do an

intraoperative gross examination of the thyroid gland.
LEARNING OBJECTIVE
When you finish this program, you must be able to make an

intraoperative diagnosis of the thyroid disorder just based on
the gross examination and clinical findings.
BODY
There are at least eight thyroid disorders which you can

readily suspect just based on the intraoperative gross
examination of the thyroid gland and the clinical findings.
These eight thyroid disorders are:
13
1. Diffuse hyperplastic goiter
2. Chronic thyroiditis
3. Colloid cyst
4. Colloid adenomatous nodule
5. Multiple colloid adenomatous goiter
6. Papillary carcinoma
7. Follicular adenoma-carcinoma
8. Anaplastic carcinoma
These eight thyroid disorders comprise 99% of all the

thyroid disorders which you will encounter in practice in the
Philippines. Imagine the "expert" feeling you will get if you
know how to recognize these eight thyroid disorders just based on
gross examination on operation and clinical clues.
I shall now tell you the intraoperative gross

characteristics and the clinical clues that you can use to
suspect each of the eight thyroid disorders.
The gland is almost symmetrically and uniformly enlarged

with smooth surface and without discrete nodule. On cut section,
the parenchyma is uniformly red-brown with beefy appearance.
Preoperative clinical findings of hyperthyroidism contribute to a
diagnosis of diffuse hyperplastic or toxic goiter.
The gland is also almost symmetrically and uniformly

enlarged with no discrete nodule. However, in contrast to
diffuse hyperplastic goiter, the surface of a gland with chronic
thyroiditis is not smooth but diffusely lobulated or nodular.
The consistency of the gland is firm and rubbery. On cut
section, the parenchyma is firm and pale brown.
3. Colloid cyst
A discrete cystic nodule of any size is present. A tense

colloid cyst may feel hard on palpation. On cutting, yellow,
brown, or black colloid fluid is obtained. After all the colloid
fluid content is evacuated, what is left is merely a capsule with
no solid element making up the nodule. The capsule may be thin
or thick depending on the duration of the disorder.
14
A discrete soft nodule of any size is present. On cutting,

the nodule is made up of colloid fluid, gelatinous granular
tissues, and soft adenomatous tissues.
More than one discrete nodules are present in either one or

two of the major lobes of the thyroid gland. The nodules are
generally soft. Calcified nodules may be present which feel
hard. On cutting, there is a variegated surface consisting of
combinations of colloid cysts and colloid adenomatous nodules,
gelatinous and cartilaginous substances, calcifications, and at
times, blood clots.
Nodules of papillary carcinoma are usually discrete. They

can be of any size. They are usually white in color. Majority
are hard; some are soft. Hard papillary carcinomas usually
present as uniformly hard white solid nodules which are gritty on
cutting. Soft papillary carcinomas usually present as soft
nodules which on section have a furry cut surface due to myriads
of tiny papillae.
Nodules of follicular adenoma-carcinoma are discrete. They

can be of any size. They are usually soft in consistency. On
cut section, the nodule is uniformly soft solid with a pale
reddish-brown surface and without cystic areas exuding colloid
fluid. In patients with a thyroid nodule with a concomitant
distant mass suspicious for metastasis, if the above gross
findings are seen, a diagnosis of follicular carcinoma is made.
Likewise, in such patients, even if the gross appearance of the
thyroid pathology is that of multiple colloid adenomatous goiter,
a diagnosis of follicular carcinoma is also made.
A diagnosis of anaplastic carcinoma is made in an elderly

patient with a huge fixed mass causing dyspnea and dysphagia. On
section, the mass has an ill-defined capsule with a fleshy dirty
white cut surface.
15
Now let's have a drill or exercise. I will show you
several intraoperative pictures of the thyroid gland. Based on
the gross characteristics that you will notice on the pictures
and with some intraoperative and clinical clues that I will give,
make a diagnosis.
There will be a total of eight cases in this drill. For

each case, I will give you not more than one minute to decide on
the diagnosis and to jot it down on a piece of paper.
After one minute has passed for each case, I will give you
the diagnosis which is considered the correct answer. Place a
(/) mark on your answer if it is the same as the correct answer.
If not, place an (x) mark. Are you ready?
Case 1: Picture
Other intraoperative clues
Clinical clues
What is your diagnosis?

One-minute lapse
The correct answer.
Case 2: Picture
Clinical clues

One-minute lapse
The correct answer.
Case 3 to Case 8:
Same Format: Picture
Clinical clues

One-minute lapse
The correct answer.
How did you fare in this drill?
If you got all correct, congratulations! You must be a fast

learner.
If you didn't get all correct, don't feel bad. You will have
another chance to improve your mark.
16
We will have another drill or exercise for improvement as
well as for mastery.
Before we go to the second drill, decide whether you want to

rewind the tape to review the tips that I gave and the first
drill or exercise. I will give you two minutes to decide.
Okay. We will have another drill or exercise for improvement

as well as for mastery.
I will give 10 cases this time. The pictures will be

different from those you have seen before.
Same instructions:
Based on the gross characteristics that you will see on the

pictures and with some intraoperative and clinical clues that I
will give, make a diagnosis.
You will be given not more than one minute to jot down your
diagnosis on a piece of paper.
When I give the correct answer, check your answer.
Are you ready?
Case 1: Picture
Clinical clues

One-minute lapse
The correct answer.
Case 2: Picture
Clinical clues

One-minute lapse
The correct answer.
Case 3 to Case 10:

Same Format: Picture
Clinical clues

One-minute lapse
The correct answer.
17
So, how did you fare in this second drill?
If you got all correct, I should say that you already know
how to make an intraoperative diagnosis of the thyroid disorder
just based on gross examination findings and clinical clues.
Isn't that great?
If you didn't get all correct, don't feel bad. Just think
that it took me several years to become competent in
intraoperative gross diagnosis of thyroid disorders. You just
need to rewind this tape and go through it again.
SUMMARY
To summarize, I have given you tips on how to make an

intraoperative diagnosis of a thyroid disorder just based on
gross examination findings and clinical clues. After the two
drills that you undertook, I am confident that you now know how
to make an intraoperative diagnosis of a thyroid disorder just
based on gross examination findings and clinical clues.
I hope you apply what you learn from this self-study program
in the next and subsequent thyroidectomy patients that you will
have. Make an intraoperative diagnosis based on the gross
findings and clinical clues and then compare it with the
postoperative histopathologic report that you will get from a
pathologist. Remember it is only through constant application and
willingness to learn that you will achieve a 99% accuracy in your
intraoperative gross diagnosis of thyroid disorders.
18
III-A-1. Lay-outing Word and Picture Slides Based on the Script
*Word slide -
INTRAOPERATIVE GROSS EXAMINATION
OF THE
THYROID GLAND
Reynaldo O. Joson, M.D.
INTRODUCTION
*Word slide outlining the message of the following paragraph -
The lack of pathologists in many areas in the Philippines

has always been considered one of the major problems affecting
proper surgical management. During surgery for thyroid diseases,
surgeons in these areas of the country always wish they have a
pathologist around when they need to have a frozen-section study.
The presence of a pathologist will certainly be a big help

to the surgeons in the intraoperative diagnosis of a thyroid
nodule and subsequently, in deciding on the extent of
thyroidectomy. Unfortunately, there is still a lack of
pathologists in many areas of the country. Until the time that
this problem will be solved, the surgeons will have to play the
role of a pathologist.
The surgeons may not have to do frozen-section study of the

thyroid nodules because of lack of proper equipment. However,
they can do a gross examination of the thyroid gland and nodules,
which is very easy to do, as you shall see later on, and which
requires no sophisticated equipment. What is needed is just a
pair of eyes or an eye to look at the gross appearance of the
thyroid gland and nodules, fingers to palpate, and a knowledge of
the gross pathology of this particular organ.
In this self-study program, you will learn how to do an

intraoperative gross examination of the thyroid gland.
19
LEARNING OBJECTIVE
When you finish this program, you must be able to make an

intraoperative diagnosis of the thyroid disorder just based on
the gross examination and clinical findings.
BODY
*Word slide outlining the messages of the following paragraphs -

(Two slides are needed to avoid overcrowding.)
There are at least eight thyroid disorders which you can

readily suspect just based on the intraoperative gross
examination of the thyroid gland and the clinical findings.
These eight thyroid disorders are:

3. Colloid cyst
These eight thyroid disorders comprise 99% of all the

thyroid disorders which you will encounter in practice in the
Philippines. Imagine the "expert" feeling you will get if you
know how to recognize these eight thyroid disorders just based on
gross examination on operation and clinical clues.
I shall now tell you the intraoperative gross

characteristics and the clinical clues that you can use to
suspect each of the eight thyroid disorders.
*Picture slides of a diffuse hyperplastic goiter -
The gland is almost symmetrically and uniformly enlarged

with smooth surface and without discrete nodule. On cut section,
the parenchyma is uniformly red-brown with beefy appearance.
Preoperative clinical findings of hyperthyroidism contribute to a
diagnosis of diffuse hyperplastic or toxic goiter.
20
*Picture slides of a chronic thyroiditis -
The gland is also almost symmetrically and uniformly

enlarged with no discrete nodule. However, in contrast to
diffuse hyperplastic goiter, the surface of a gland with chronic
thyroiditis is not smooth but diffusely lobulated or nodular.
The consistency of the gland is firm and rubbery. On cut
section, the parenchyma is firm and pale brown.
*Picture slides of a colloid cyst -
3. Colloid cyst
A discrete cystic nodule of any size is present. A tense

colloid cyst may feel hard on palpation. On cutting, yellow,
brown, or black colloid fluid is obtained. After all the colloid
fluid content is evacuated, what is left is merely a capsule with
no solid element making up the nodule. The capsule may be thin
or thick depending on the duration of the disorder.
*Picture slides of a colloid adenomatous nodule -
A discrete soft nodule of any size is present. On cutting,

the nodule is made up of colloid fluid, gelatinous granular
tissues, and soft adenomatous tissues.
*Picture slides of a multiple colloid adenomatous goiter -
More than one discrete nodules are present in either one or

two of the major lobes of the thyroid gland. The nodules are
generally soft. Calcified nodules may be present which feel
hard. On cutting, there is a variegated surface consisting of
combinations of colloid cysts and colloid adenomatous nodules,
gelatinous and cartilaginous substances, calcifications, and at
times, blood clots.
21
*Picture slides of a papillary carcinma -
Nodules of papillary carcinoma are usually discrete. They

can be of any size. They are usually white in color. Majority
are hard; some are soft. Hard papillary carcinomas usually
present as uniformly hard white solid nodules which are gritty on
cutting. Soft papillary carcinomas usually present as soft
nodules which on section have a furry cut surface due to myriads
of tiny papillae.
*Picture slides of a follicular adenoma-carcinoma
Nodules of follicular adenoma-carcinoma are discrete. They

can be of any size. They are usually soft in consistency. On
cut section, the nodule is uniformly soft solid with a pale
reddish-brown surface and without cystic areas exuding colloid
fluid. In patients with a thyroid nodule with a concomitant
distant mass suspicious for metastasis, if the above gross
findings are seen, a diagnosis of follicular carcinoma is made.
Likewise, in such patients, even if the gross appearance of the
thyroid pathology is that of multiple colloid adenomatous goiter,
a diagnosis of follicular carcinoma is also made.
*Picture slides of an anaplastic carcinoma
A diagnosis of anaplastic carcinoma is made in an elderly

patient with a huge fixed mass causing dyspnea and dysphagia. On
section, the mass has an ill-defined capsule with a fleshy dirty
white cut surface.
Now let's have a drill or exercise. I will show you

several intraoperative pictures of the thyroid gland. Based on
the gross characteristics that you will notice on the pictures
and with some intraoperative and clinical clues that I will give,
make a diagnosis.
There will be a total of eight cases in this drill. For

each case, I will give you not more than one minute to decide on
the diagnosis and to jot it down on a piece of paper.
22
After one minute has passed for each case, I will give you
the diagnosis which is considered the correct answer. Place a
(/) mark on your answer if it is the same as the correct answer.
If not, place an (x) mark. Are you ready?
*Picture slide -
Case 1: Picture
Clinical clues
One-minute lapse
*Word slide containing the correct answer -
The correct answer.
*Picture slide -
Case 2: Picture
Clinical clues
One-minute lapse
The correct answer.
Case 3 to Case 8:
Same Format: Picture slides

Clinical clues
One-minute lapse
The correct answer.
23
How did you fare in this drill?
If you got all correct, congratulations! You must be a fast

learner.
If you didn't get all correct, don't feel bad. You will have
another chance to improve your mark.
We will have another drill or exercise for improvement as

well as for mastery.
Before we go to the second drill, decide whether you want to

rewind the tape to review the tips that I gave and the first
drill or exercise. I will give you two minutes to decide.
Two-minute lapse
Okay. We will have another drill or exercise for improvement

as well as for mastery.
I will give 10 cases this time. The pictures will be

different from those you have seen before.
Same instructions:
Based on the gross characteristics that you will see on the

pictures and with some intraoperative and clinical clues that I
will give, make a diagnosis.
You will be given not more than one minute to jot down your
diagnosis on a piece of paper.
When I give the correct answer, check your answer.
Are you ready?
24
*Picture slide -
Case 1: Picture
Clinical clues
One-minute lapse
The correct answer.
*Picture slide -
Case 2: Picture
Clinical clues
One-minute lapse
The correct answer.
Case 3 to Case 10:
Same Format: Picture slides

Clinical clues
One-minute lapse
The correct answer.
25
So, how did you fare in this second drill?
If you got all correct, I should say that you already know
how to make an intraoperative diagnosis of the thyroid disorder
just based on gross examination findings and clinical clues.
Isn't that great?
If you didn't get all correct, don't feel bad. Just think
that it took me several years to become competent in
intraoperative gross diagnosis of thyroid disorders. You just
need to rewind this tape and go through it again.
SUMMARY
To summarize, I have given you tips on how to make an

intraoperative diagnosis of a thyroid disorder just based on
gross examination findings and clinical clues. After the two
drills that you undertook, I am confident that you now know how
to make an intraoperative diagnosis of a thyroid disorder just
based on gross examination findings and clinical clues.
I hope you apply what you learn from this self-study program
in the next and subsequent thyroidectomy patients that you will
have. Make an intraoperative diagnosis based on the gross
findings and clinical clues and then compare it with the
postoperative histopathologic report that you will get from a
pathologist. Remember it is only through constant application and
willingness to learn that you will achieve a 99% accuracy in your
intraoperative gross diagnosis of thyroid disorders.
*"The End" Slide
26
III-A-2. Transforming the Script into a Nonprint SIM
1. Materials needed
1.1 The script
1.2 The word and picture slides
1.3 Slide projector with remote control and screen
1.4 Video 8 camera with a tripod with an operator
1.5 Loud speaker and microphone
1.6 A noise-free room for audiovideorecording
2. Mechanics
2.1 Using the script, the slides, and the
projector, I will deliver the instruction
facing a videocamera.
2.2 The videotape that contains my instruction
will be the end product, a self-
instructional material in the nonprint
medium.
27
Recapitulation
Up to this part of the self-study program, I have given you

basic guidelines in making a distance education lesson using a
nonprint medium. I hope you have recognized and appreciated the
guidelines that are contained in the:
1. Basic steps in constructing a nonprint SIM;
2. Checklists and questionnaires in critiquing and

developmental testing of nonprint SIMs; and
3. Sample of a script of a nonprint SIM.
This self-study program will not be complete if you don't

critique and make a distance education lesson in medicine in the
nonprint medium.
So, why don't you now get hold of the videotape that
contains a self-instructional program, view it, and critique it
using a checklist that I have given you in the program.
After you are through with your critiquing, write a script

of your planned nonprint SIM, transform it into a real nonprint
SIM, and then have it undergo a developmental testing using face-
to-face trials by three potential students.
Come back later to the last few pages of this self-study

program in print to do the following:
1. Fill up the Student's Assessment of the Self-Study

Program.
2. Check the things that you have to submit to me.
3. Read "Recommended Follow-up".
Now, view the videotape.
28
Summative Evaluation
As part of the summative evaluation activities for this

program, please submit the following:
1. Critique of a nonprint SIM (the videotape)
2. Script of your planned nonprint SIM
3. A nonprint SIM made by you using any type of

nonprint medium and subjecting it to face-to-face
trial by at least 3 potential students
29
STUDENT'S ASSESSMENT OF THE SELF-STUDY PROGRAM
Name ___________________________________________ Date ___________
PROGRAM: ________________________________________________________
AUTHOR: _________________________________________________________
INSTRUCTIONS: Please assess the program through the following

statements. Use the key below:
KEY : 5 = Strongly Agree

4 = Agree
3 = Uncertain
2 = Disagree
1 = Strongly disagree
1. The objectives were clear. 5 4 3 2 1
2. The objectives were "must knows." 5 4 3 2 1
3. The objectives were too heavy. 5 4 3 2 1
4. The content was appropriate based on 5 4 3 2 1

the stated objectives.
5. The content was adequate based on 5 4 3 2 1
the stated objectives.
6. The content was clear. 5 4 3 2 1
7. The content was presented in logical 5 4 3 2 1

sequence.
8. The learning activities were 5 4 3 2 1
appropriate based on the objectives.
9. The learning activities were 5 4 3 2 1
effective in facilitating learning.
10. The summative assessment was appropriate. 5 4 3 2 1
INSTRUCTIONS: Please answer seriously. Use back page if needed.
Were there any parts, concepts, or words that you found

Any suggestions on what might have helped you in this instruction?

Any suggestions to improve the self-study program?
30
LIST OF THINGS TO SUBMIT
Script of your SIM in the nonprint medium
Critique of my SIM in the nonprint medium
Your SIM in the nonprint medium
Developmental testing results of our SIM in the nonprint

medium
Student's Assessment of Self-study Program
Deadline for submission: ___________________________________
NOTE: You can only proceed to the next self-study program

after you have submitted all of the above and have
satisfactorily passed the summative evaluation.
Remedials may be given if you don't pass the
summative evaluation.
31
Recommended Follow-up
After you have made one distance education lesson in the

nonprint medium, I recommend you make more. To do so will not
only promote mastery but willl also give you satisfaction and
other benefits associated with developing distance education
instructional materials in medicine.
Now that you have completed the four modules in distance

education in medicine, namely:
1. Distance Education in Medicine
2. How to Design a Distance Education Program in

Medicine
3. How to Write a Distance Education Lesson in Medicine
4. How to Make a Distance Education Lesson in Medicine

in the Nonprint Medium
I should say CONGRATULATIONS! You have attained proficiency

in distance education in medicine.
The next thing which I recommend you to do is to complete

the development of self-instructional materials for the distance
education program which you have designed in Module 2. After you
have developed the whole program, implement it. When you see the
fruits of our labor, I bet you will get the utmost satisfaction
of being a medical educator.
32

Distance Education in Medicine - Module 4: How To Make An DE Lesson in Medicine Using A Nonprint Medium

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H O W T O M A K E A

(An Off-Campus Study)

Reynaldo O. Joson, MD, MHA, MHPEd

Welcome to a learning experience in becoming a health

This program has been especially designed with you, the

As you go through this learning program, please bear in mind

1. I am treating you as an adult learner which

1.1 Assumes you have learning aspirations and

1.2 Gives you the privilege to use other learning

1.3 Welcomes you to go beyond the learning package

1.4 Expects discipline, honesty, and maturity in

2. We shall define learning as a positive observable

3. Active learning strategies and activities will be

4. The program will contain learning materials which I

5. The ultimate goal of the learning program is to

Best wishes for a fruitful learning with the help of this

Reynaldo O. Joson, MD, MHPEd

Welcome to an experience in self-instruction.

The program consists of a printed material and a videotape.

This program has been designed so that you learn on your

For effective learning, however, please follow the following

1. You should diligently and chronologically go through

- The Introduction gives you an orientation,

- The Prerequisites tells you what you must

- The Objectives tells you what you are expected

- The Text, of course, is the learning material

- Within the text are Activities where you will be

- The Recapitulation helps you put together

- The Summative Evaluation tells you what you

- The Student's Assessment of Self-Study Program

- The Recommended Follow-up suggests what other

2. Look at the videotape only after you are through

- The Videotape gives you a sample of a self-

3. You must follow all the specific instructions to the

4. You must complete and submit all the assigned tasks

5. You need to have the following materials when you

The estimated study time for the program excluding the

Reynaldo O. Joson, MD, MHA, MHPEd

Learning Objectives .................................... 2

I. Basic Steps in Constructing a Nonprint

II. Checklists and Questionnaires for

III. Writing a Script of a Self-instructional Material

A. The Script .......................................... 13

1. Lay-outing of Word and Picture Slides Based

2. Transforming the Script into a Nonprint

Summative Evaluation ................................... 29

Student's Assessment of Self-Study Program ............. 30

List of Things to Submit ............................... 31

Recommended Follow-up .................................. 32

A Videotape containing a self-instructional program

Conducting a distance education (DE) program in medicine

The SIMs may either be in the print or nonprint medium.

The SIMs in the nonprint medium are usually in the form of

A decision on what medium to use for a particular SIM is

Which medium will best (in terms of effectiveness and

Other factors that may affect the decision on what medium to

1. Availability of equipment in the student's area for

2. Cost of production of the nonprint SIM

3. Competency or know-how of the medical educator

In this self-study program, you will learn the basic

Before you embark on this self-study program, you must have

1. Understood fully the concept of distance education

2. Designed a distance education program in medicine.

Time started: ___ Time Finished: _ Total time: _____

very difficult fairly difficult/easy __ very easy