Problem Base and Case Study Methodology in Medical Education

Objectives: EBM (Evidence-Based Medicine) and Case Study is a relatively new concept in medicine, and medical education, but one that is rapidly gaining acceptance as an important approach in assisting medical students, residents, and practicing physicians in their clinical decisionmaking. Problem Base and Case Study learning in Medical Education has become a widespread and effective method of using the medical literature. It has four basic steps: the development of a clinical question, the literature search for the appropriate medical literature to address the clinical question, critical appraisal of the acquired paper, and application of the results of the research paper to the patient at hand. Goals: Analysis of effectiveness of teaching methodology Methods: Observational Study Results: The use of PB(EBM) and CS should allow patient care that is the most effective, the most cost-effective, and the safest. The skills to master in use the EBM approach include that of question formulation, literature searching, critical appraisal of articles, and application of evidence. The resources needed include computers and Internet for access to full articles, a printer, and functional use of the English language. Moreover, this is a lifelong endeavor, so practice and mentorship are useful. The PB and CS component in the Tbilisi State Medical University has the aim of assisting students in learning objectives. Training in the PB and CS learning method will be provided at the beginning of the Module. Problem base and Case Study learning in education has become a widespread and effective method of literature use. It has four basic steps: the development of a clinical question, the Literature search for the appropriate medical literature to address the clinical question, critical appraisal of the acquired paper, and application of the results of the research paper to the patient at hand. Conclusion: By the end of this course you should have demonstrated your capacity to: recognize, compare, and contrast the general "ways of thinking" of science (biology) and of philosophy (ethics). Approach bioethical problems, break them into smaller component parts (analysis), and discuss those analyses through oral and written communication, both individually and in groups. Approach bioethical problems and propose solutions to them that transcend the disciplines of biology and philosophy, solidly rooted in their respective ways-of-knowing. Acquire and separate factual knowledge from opinion in the areas of science and philosophy. Demonstrate good critical thinking (that is, clear, logical (coherent and relevant), broad, deep, and discriminating) in bioethics through speaking and writing. Outcomes of PBL and CS are the problem-solving skills, self-directed learning skills, ability to find and use appropriate resources, critical thinking, measurable knowledge base, performance ability, social and ethical skills, self-sufficiency and self-motivation, leadership skills, ability to work on a team, communication skills, proactive thinking, congruence with workplace skills

Wine, Beer, Snuff, Medicine, and Loss of Diversity - Ethnobotanical travels in the Georgian Caucasus

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Plant and fungal use in Tusheti, Khevsureti, and Pshavi, Sakartvelo (Republic of Georgia), Caucasus

In this study, we documented traditional plant use in Tusheti, Khevsureti, and Pshavi and hypothesized that (i) plant use knowledge in general would be higher in isolated high elevation communities, and that (ii) use of home gardens would be much more restricted to lower elevation settings. Fieldwork was conducted in Khevsureti, Pshavi, and Tusheti. Interviews using semi-structured questionnaires were conducted with 74 participants. In the present study, we encountered 317 plant species belonging to 203 genera of 80 families being used in the research region. Of these, 197 species were exclusively wild-harvested, 73 were grown in homegardens, and 47 were both grown in gardens and sourced in the wild. The ordinations in plant-space and in use-space were significantly fit by elevation of informant community, and community itself. Age and gender did not significantly fit the distribution of informants across either plant-space or use-space, respectively. Number of use-reports was highest across all communities in the food and medicinal use-categories, and informant consensus. Species with especially high use-diversity (UD) tended to be woody species although. Species with high use-value (UV) were mostly managed/domesticated species from home orchards, gardens, or farms. Plant species, and uses, found in our study, showed clear relations to the wider Eurasian cultural complex. The species number found was, however, far higher than in any published study from either the region or the wiser Mediterranean and Eurasia. The maintenance of home gardens in Georgia serves as socio-ecological memory. While the great variety of plant species used in the Georgian Caucasus might provide a reservoir for food security climate change is starting to affect both natural floristic diversity and gardens both in the Caucasus as well as continent wide

Ethnobotany of Samtskhe-Javakheti, Sakartvelo (Republic of Georgia), Caucasus

7-24Samtskhe-Javakheti was formed in the 1990s in southern Georgia from the historical provinces of Meskheti, Javakheti and Tori. The majority of the inhabitants are ethnically Armenian, with a Georgian minority. We documented traditional plant use in Samtskhe-Javakheti, and hypothesized that (1) plant use knowledge in general would be higher in isolated high elevation communities, and that (2) use of home gardens would be much more restricted to lower elevations. Fieldwork was conducted July–August 2013, July–August 2014, and September–October 2015, using semi-structured questionnaires. We encountered 261 plant species belonging to 161 genera of 70 families being used in the region. Of these, 160 species were exclusively wild-collected, 81 grown in homegardens, and 20 were both grown in gardens and collected wild. Most species and uses were widely used across the region, with some particular species in the low lying villages, that allowed a wider variety of species to be grown and gathered. The elevation of informant community significantly fit the ordination in plant-space and use-space. In addition, community significantly fit the ordination for both plant-space and use-space. Informant age significantly fit the plant-space ordination only, while informant gender was not significant in either space

Plants in the spa – the medicinal plant market of Borjomi, Sakartvelo (Republic of Georgia), Caucasus

25-34As part of a larger ethnobotanical inventory of Skartvelo (Republic of Georgia) we studied the medicinal plant market in Borjomi Spa since 2013. All of the venders in Borjomi featured the same set of medicinal plant mixtures, and essentially no plants were sold separately. Overall, the same 17 distinct mixtures were sold by all venders. Plants, according to the venders, were collected by them in the wider surroundings of Borjomi, and all mixtures were prepared at home. Although the preparations of medicinal plant mixtures in Borjomi seemed very controlled and standardized, the separation of all mixtures into their respective ingredients revealed that most mixtures either contained contaminants, and/or lacked ingredients claimed to be included. This study underlines that in many cases natural remedies sold in markets can be problematic, and that great care should be taken before using any medicine, whether allopathic or complimentary. Linguistic explanations for all plant names and indications are given

Unequal brothers – Plant and fungal use in Guria and Racha, Sakartvelo (Republic of Georgia), Caucasus

7-33Guria and Racha are historical provinces of Republic of Georgia, located on the South-facing macro-slope of the western part of the Greater Caucasus (Racha) and East of the Lesser Caucasus towards the Black Sea (Guria).In this study we documented traditional plant use in Guria and Racha, and hypothesized that (1) plant use knowledge in general would be higher in isolated high elevation communities, and that (2) use of home gardens would be much more restricted to lower elevation settings. Fieldwork was conducted in Lechkhumi in July–August 2014, and in Guria and Racha in July-August 2016. Interviews using semi-structured questionnaires were conducted with 32 participants (10 women and 22 men), with oral prior informed consent. We encountered 338 plant species belonging to 252 genera of 101 vascular plant families, 4 undetermined species, and 20 fungal species and 15 undetermined fungi, belonging to at least 16 genera of 16 families being used in the research region. Of these 223 species were exclusively wild-collected, 110 were grown in home gardens, and 56 were both grown in gardens and collected in the wild. Plants and their uses mostly overlapped among the areas within the region, with a slightly wider divergence in uses than in plants. The environmental fit analysis showed that a large degree of this variation was explained by differences among participant communities. The elevation of the participant community significantly fit the ordination in plant-space and explained a large degree of the variation in plant species reported but not in use-space. Gender was not significant in plant-space or use-space

Additional file 1: of A comparative ethnobotany of Khevsureti, Samtskhe-Javakheti, Tusheti, Svaneti, and Racha-Lechkhumi, Republic of Georgia (Sakartvelo), Caucasus

Plants used in Georgia. (FOREST = includes all non garden areas; GARDEN = area where species are cultivated; Arm. = Armenian; Khev. = Khevsurian; Russ. = Russian; Svan. = Svanetian; Phsh. = Pshavian). (DOCX 153 kb