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Center High School
Informational Meeting for Parents
          and Students
Center High School

Project Lead the Way
    Bio-Medical
         and
    Engineering
      Programs
INTRODUCTION
  PLTW + CHS
Introductions
• Mr. Mike Jordan, Principal CHS
  Overview of PLTW and CHS goals
• Mr. Curtis Hunter, Bio-medical Teacher
  Instructional methods of PLTW
• Mr. Matt Tozzi, Bio-medical Teacher
  Overview of Biomedical Program
• Mr. Ben Klatt, Engineering Tech Teacher
  Overview of Engineering Program
  ARC Articulation
What is PLTW?
• Project Lead The Way (PLTW) is a not-for-profit
  organization partnering with public schools,
  organizations in the private sectors, and higher
  education institutions to increase the number and
  quality of engineers, technologists, and
  biomedical professionals graduating from our
  educational system.

• PLTW offers both a pre-engineering and
  biomedical sciences sequence of course work for
  high school students. 

• PLTW courses utilize project and problem-based
  learning that teaches students how to apply what
  they are learning to real-life situations.
Why PLTW?
When asked which skills new college
 graduates needed to improve most—

 More than half of the college recruiters
 responding to the question named
 some combination of critical thinking,
 problem solving skills and the ability to
 think independently.
8
Standards-Based

National Science Education Standards
Principles and Standards of School Mathematics
National Health Care Cluster Foundation
Standards
Standards for English Language Arts
Standards for Technological Literacy
National Content Standards for Engineering and
Engineering Technology
Curriculum Attributes

Rigorous and Relevant
Aligned with National Standards
Project and Problem-based
Integrate biology, chemistry, and
physics
Integrate science, mathematics,
English language arts, and social
studies
                                    10
PLTW Biomedical and Engineering
          Programs

Address impending critical shortage of
qualified science and health professionals.


Prepare students for rigorous post-secondary
education at two and four-year colleges or
universities.
Mat Tozzi                                     11
Attributes of Graduates
            Expectations
Think creatively and critically.
Able to problem-solve.
Communicate effectively.
Have professional conduct.
Able to work in teams.
Understand how scientific research is
conducted, applied, and funded.
                                        12
Biomedical Careers
               --- some examples ---

Doctor             Research Scientist
Nurse              Health Information
                   Manager
Dentist
                   Medical Technologist
Veterinarian
                   Radiologist
Pharmacist
                   Medical Technical
Paramedic
                   Writer
Dietician
                   Physicians’ Assistant
Surgeon
                   Biomedical Engineer
                   13
PLTW Biomedical Sciences Program
Address impending critical shortage of
qualified science and health professionals.


Prepare students for rigorous post-secondary
education at two and four-year colleges or
universities.


                                              14
Course #1: (PBS) Principles
            of the Biomedical Sciences

Student work involves the study of human
medicine, research processes and an introduction
to bio-informatics.


Students investigate the human body systems and
various health conditions including: heart disease,
diabetes, sickle-cell disease, hypercholesterolemia,
and infectious diseases.


                                                       15
Principles of the
Biomedical Sciences


Human Body Systems


Medical Interventions
Examples of Student Work
• Activities: build skills and knowledge
• Projects: build team work and allow
  students to practice the skills and
  knowledge with a real-world task
• Problems: build problem-solving skills,
  team work, encourage creativity, and
  allow students to apply skills and
  knowledge

                                            18
Principles of the Biomedical Sciences
                 (PBS)
               Course #1
Key Biological Concepts:

Cellular basis of life
Homeostasis
Metabolism
Inheritance of traits
Defense against disease

                                      20
Examples of Student Activities
            from Unit 2: Heart Attack
Build a simple pump
Measure factors that affect pump efficiency
Dissect a sheep heart
Use LabVIEW software and Vernier probes to
measure EKG, heart rate, and blood pressure



                                              21
LabVIEW Front Panel




                      22
Examples of Student Activities
           Unit 4: Sickle Cell Disease
Make a chromosome spread
Isolate DNA from plant cells
Analyze karyotypes
Build models of DNA and proteins
Read a genetic map
Use computer simulation software to
build a designer protein
                                      23
24
3-D Model of a
Blood Protein




                 25
Student examples from PBS
        (1st course)
Course #2: (HBS)
              Human Body Systems
• Engage students in the study of basic
  human physiology, especially in
  relationship to human health.


• Students will use LabVIEW® software to
  design and build systems to monitor body
  functions.

                                          27
HBS Activity (Course #2)




Example from HBS curriculum
HBS Activity




Example from Unit 1 in the HBS curriculum
Course #3: (MI)
   Medical Interventions

Student projects will investigate
various medical interventions that
extend and improve quality of life
including: gene therapy,
pharmacology, surgery, prosthetics,
rehabilitation, and supportive care.



                                   31
Medical Interventions Topics:
MI Activity –
                 Laparoscopic Surgery




Example from Unit 4 in the MI curriculum
Engineering
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PLTW Parent Night Presentation

  • 1. Center High School Informational Meeting for Parents and Students
  • 2. Center High School Project Lead the Way Bio-Medical and Engineering Programs
  • 4. Introductions • Mr. Mike Jordan, Principal CHS Overview of PLTW and CHS goals • Mr. Curtis Hunter, Bio-medical Teacher Instructional methods of PLTW • Mr. Matt Tozzi, Bio-medical Teacher Overview of Biomedical Program • Mr. Ben Klatt, Engineering Tech Teacher Overview of Engineering Program ARC Articulation
  • 5. What is PLTW? • Project Lead The Way (PLTW) is a not-for-profit organization partnering with public schools, organizations in the private sectors, and higher education institutions to increase the number and quality of engineers, technologists, and biomedical professionals graduating from our educational system. • PLTW offers both a pre-engineering and biomedical sciences sequence of course work for high school students.  • PLTW courses utilize project and problem-based learning that teaches students how to apply what they are learning to real-life situations.
  • 6. Why PLTW? When asked which skills new college graduates needed to improve most— More than half of the college recruiters responding to the question named some combination of critical thinking, problem solving skills and the ability to think independently.
  • 7.
  • 8. 8
  • 9. Standards-Based National Science Education Standards Principles and Standards of School Mathematics National Health Care Cluster Foundation Standards Standards for English Language Arts Standards for Technological Literacy National Content Standards for Engineering and Engineering Technology
  • 10. Curriculum Attributes Rigorous and Relevant Aligned with National Standards Project and Problem-based Integrate biology, chemistry, and physics Integrate science, mathematics, English language arts, and social studies 10
  • 11. PLTW Biomedical and Engineering Programs Address impending critical shortage of qualified science and health professionals. Prepare students for rigorous post-secondary education at two and four-year colleges or universities. Mat Tozzi 11
  • 12. Attributes of Graduates Expectations Think creatively and critically. Able to problem-solve. Communicate effectively. Have professional conduct. Able to work in teams. Understand how scientific research is conducted, applied, and funded. 12
  • 13. Biomedical Careers --- some examples --- Doctor Research Scientist Nurse Health Information Manager Dentist Medical Technologist Veterinarian Radiologist Pharmacist Medical Technical Paramedic Writer Dietician Physicians’ Assistant Surgeon Biomedical Engineer 13
  • 14. PLTW Biomedical Sciences Program Address impending critical shortage of qualified science and health professionals. Prepare students for rigorous post-secondary education at two and four-year colleges or universities. 14
  • 15. Course #1: (PBS) Principles of the Biomedical Sciences Student work involves the study of human medicine, research processes and an introduction to bio-informatics. Students investigate the human body systems and various health conditions including: heart disease, diabetes, sickle-cell disease, hypercholesterolemia, and infectious diseases. 15
  • 16. Principles of the Biomedical Sciences Human Body Systems Medical Interventions
  • 17.
  • 18. Examples of Student Work • Activities: build skills and knowledge • Projects: build team work and allow students to practice the skills and knowledge with a real-world task • Problems: build problem-solving skills, team work, encourage creativity, and allow students to apply skills and knowledge 18
  • 19. Principles of the Biomedical Sciences (PBS) Course #1
  • 20. Key Biological Concepts: Cellular basis of life Homeostasis Metabolism Inheritance of traits Defense against disease 20
  • 21. Examples of Student Activities from Unit 2: Heart Attack Build a simple pump Measure factors that affect pump efficiency Dissect a sheep heart Use LabVIEW software and Vernier probes to measure EKG, heart rate, and blood pressure 21
  • 23. Examples of Student Activities Unit 4: Sickle Cell Disease Make a chromosome spread Isolate DNA from plant cells Analyze karyotypes Build models of DNA and proteins Read a genetic map Use computer simulation software to build a designer protein 23
  • 24. 24
  • 25. 3-D Model of a Blood Protein 25
  • 26. Student examples from PBS (1st course)
  • 27. Course #2: (HBS) Human Body Systems • Engage students in the study of basic human physiology, especially in relationship to human health. • Students will use LabVIEW® software to design and build systems to monitor body functions. 27
  • 28.
  • 29. HBS Activity (Course #2) Example from HBS curriculum
  • 30. HBS Activity Example from Unit 1 in the HBS curriculum
  • 31. Course #3: (MI) Medical Interventions Student projects will investigate various medical interventions that extend and improve quality of life including: gene therapy, pharmacology, surgery, prosthetics, rehabilitation, and supportive care. 31
  • 32.
  • 34. MI Activity – Laparoscopic Surgery Example from Unit 4 in the MI curriculum
  • 36.
  • 37. Questions?? Make sure to leave your information at under the banner!!

Notas del editor

  1. First, one must define “system”: A system is an interconnected set of elements that is coherently organized in a way that achieves something (Donella Meadows—”Thinking in Systems”). PLTW teaches students to understand systems, build systems, and evaluate systems in order to find solutions and solve problems. The PLTW system is comprised of three elements: curricula, professional development, and partnerships. These elements are coherently organized and interconnected to produce rigorous and relevant learning for students and for teachers. But further than that, in order for us to build the STEM workforce that our country demands, we must use this PLTW system achieve this “something”, which is to not only help students understand systems and how to use them to solve problems, but also to give them the tools, skills and attributes that will help them understand how the innovative work must be done. The essential understanding of how a multi-layered team must work together to solve problems, the skill of project management is illustrated by a great story from your own Washington Schools: A success story....Amos. He is a very intelligent, capable young man who is in the Special Education program due to his writing ability (which is very low).  As a result of his disability, Amos is very reserved (shy and quiet) and doesn't bring a lot of attention to himself.  His self-esteem and self-confidence was very low.  As a sophomore he took IED and blossomed as a student, leader, and as a individual person.  As IED is highly computerized (Autodesk Inventor) his writing disability no longer inhibited his learning.  Needless to say he excelled in the course.  Not only did he finish his work to near perfection, he also became the student that all of his peers sought for help with their own work.  For the first time in his education career Amos became the kid that knew it all.  As the final project approached, students were placed in groups and each group selected a lead for their group.  Without hesitation, Amos' group selected him as their leader (which in itself is profound...where a group of sophomores selected the student who they have known historically to struggle, but recognize the fact that Amos had a deep rooted understanding of the program and what needed to be done).  Amos became the leader of his group and guided them through a 6-week process of developing a new product.  During this time, Amos grew as a person as he had the opportunity to be a leader, make decisions, hold his peers accountable, all while learning how to delegate tasks (namely the parts of the project that dealt with writing...he was able to assign those tasks to different groups members).  Amos' experience in IED is what education should be for all students, especially those on IEP's (Special Education). 
  2. The curriculum includes: Alignment to the National Standards in: science, healthcare, mathematics, English language arts, ISTE educational technology, and ITEA technology literacy. Teacher notes Answer Keys Scoring Rubrics Student activities Glossary Detailed lesson plans that include: introduction, concepts, performance objectives, standards addressed in lesson, key terms with definitions, assessment suggestions, essential questions, day-by-day plan for implementation, additional resources
  3. The attributes of this curriculum will be the same as for the engineering curriculum. The student work will be rigorous in order to prepare students for college or other post-secondary training. The work will also be relevant to the biomedical sciences and the various careers within the field. Students will be doing the same types of activities and work as someone with a career in biomedical science might be doing. The curriculum follows the Project Lead The Way format for Activities, Projects, and Problems. Each course within the program integrates the primary fields of science instead of treating each field in isolation, in addition to integrating language arts, history, and mathematics. The integration of multiple disciplines better emulates the real world of job expectations, e.g. scientists and physicians must be able to communicate effectively in writing and to use mathematics to analyze results of experiments or determine proper dosages.
  4. The biomedical sciences comprise one of the largest industries in the United States, employing more than 15 million people working in a wide range of occupations. Over 10% of the national employment is in the healthcare industry. By the year 2014, over 3.6 million new healthcare jobs are expected to be created. Eight of the twenty occupations projected to have the greatest job growth over the next ten years are in healthcare. (U.S. Dept. of Labor, Bureau of Labor Statistics, 2006)
  5. The attributes of the graduates of the Biomedical Sciences Program are listed. These are the same attributes as graduates of the Engineering program and emphasize skills most often cited by employers as the most needed or desired attributes of new employees.
  6. Examples of some of the fields students in the Biomedical Sciences Program may want to pursue. This list is far from all inclusive. One common theme about all the careers is the need for two or more years of post-secondary education and training. In some cases, many more than two years of post-secondary education is required. Most people commonly think of healthcare in terms of hospitals, doctors, nurses, and dentists, but the biomedical sciences are much more varied and extensive. In addition to people who provide direct care and diagnostic services, the field includes those who do biomedical engineering, research disease and human physiology, study nutritional science, are involved in a variety of supporting professions such as, facilities design and management, environmental health and safety, health information management and analysis, industrial hygiene, and those who determine public policy affecting health care delivery, finance, regulation, and community services. Pharmaceutical manufacturing is the fastest growing manufacturing industry in the U.S. and requires workers to research, develop, manufacture, and supply medicines and other biomedical therapies derived from biotechnology. The United States is the world’s leading developer and producer of modern medicines, and pharmaceuticals are an important American export.
  7. The biomedical sciences comprise one of the largest industries in the United States, employing more than 15 million people working in a wide range of occupations. Over 10% of the national employment is in the healthcare industry. By the year 2014, over 3.6 million new healthcare jobs are expected to be created. Eight of the twenty occupations projected to have the greatest job growth over the next ten years are in healthcare. (U.S. Dept. of Labor, Bureau of Labor Statistics, 2006)
  8. The first course, Principles of the Biomedical Sciences, lays the foundation for the subsequent courses. It is also the engagement course designed to introduce students to the broad field of biomedical science. There are no pre-requisite courses for this first course, and students do not need to have had a high school biology course. The biology concepts necessary for success in the course are embedded within the curriculum. Students can take this course in 9 th grade, or depending on how the school implements the program they may take it in the later grades. Even 12 th graders can take the course if they decide late in high school that they are interested in the biomedical sciences. Students taking any of the other courses in the Project Lead The Way Biomedical Sciences Program, must take this course prior to, or concurrent to, their enrollment in those courses. In this course students investigate the major biological concepts by studying various disease conditions. For example, students learn about the importance of homeostasis, feedback mechanisms, and metabolism by investigating diabetes; they learn about genetics and DNA by investigating sickle-cell disease. In this course students use Vernier probes and the LabVIEW software to take various heart measurements, including EKG, blood pressure, and heart rate. They perform DNA gel electrophoresis, Gram stain bacteria, and prepare and present a grant proposal.
  9. The Biomedical Sciences Program is a sequence of four courses. Each course builds on the skills and knowledge students gained in the preceding courses. This is unlike the Engineering Program that uses a Foundation and Specialization format and does not require students to take the foundation courses in any particular sequence. Although the program is designed to be a sequence with students taking one course each year of high school, students can take two consecutive courses simultaneously in their later years in high school. For example a student could begin the program as junior and take both the Principles of the Biomedical Sciences and the Human Body Systems courses; then as a senior take both Medical Interventions and Biomedical Innovation.
  10. The topics covered in the Principles of the Biomedical Sciences course include: Literary research skills Human Body Systems Basic chemistry Structure and function of DNA Bioinformatics Protein structure Causes of infectious diseases Grant proposals
  11. The Biomedical Sciences Curriculum uses the same framework and follows the same Activities, Projects, and Problem model to enhance student learning as the Engineering curriculum.
  12. These are the key biological concepts investigated by students in the first course. Each of these concepts is represented in the National Science Standards. Cellular basis of life: all living things are made of individual cells that work together to provide the materials and processes necessary to sustain life. All living things begin as a single cell, i.e. the fertilized egg cell that becomes a human, and death also occurs at the cellular level, i.e. a heart attack is the death of heart muscle cells. Homeostasis is the ability of living things to maintain a consistent environment, i.e. humans maintain an internal body temperature of about 98 degrees Fahrenheit. Metabolism is the conversion of one form of energy into another; i.e. humans convert the chemical energy in molecules of food into a form of energy, called ATP, that can be used by cells to maintain life processes. Inheritance of traits is the passing of genetic information from one generation to the next. The molecule responsible is called Deoxyribonucleic acid, DNA. Defense against disease is the ability to fight off infections.
  13. Examples of student work completed in the second unit of the Principles of the Biomedical Sciences course are listed. The students first learn about pumps and build a simple pump using two flasks, rubber tubing, and a balloon. By applying weights and measuring the time it takes to move a specified volume of water the students can explore factors that affect the efficiency of a pump, including the diameter of the tubing. In this unit students are introduced to the LabVIEW software that will be used throughout the Biomedical Sciences courses. The students use the pre-designed programs to measure EKG, heart rate, and blood pressure. They then look at the “back side” of the program to see how the commands for the program were assembled. By having them learn about the actual programming, the students have to think about the experiment in terms of what is being measured, how often measurements need to be taken, how the data is to be presented, and whether mathematical formulas have to be applied to the data (i.e. calculating a mean, setting a threshold, calculating a difference from a baseline, etc.).
  14. This is a picture of the front panel of the LabVIEW program for determining blood pressure. This is a simple user interface that allows students to easily collect data by simply pressing the “Collect” button. Values are then plotted on the graphs. After the data collection is stopped the blood pressure readings are displayed in the appropriate colored boxes on the left.
  15. Examples of student work from the fourth unit in the Principles of the Biomedical Sciences course are listed. Student use the human cell line called HeLa, the first human cell line which has been cultured continuously since the 1950’s, to prepare chromosome spreads. A chromosome spread is made by breaking apart the cells and allowing the chromosomes to literally fall or spread out from the cell. The chromosomes are stained and viewed under a microscope. Students also do a simple extraction of DNA from various fruit cells, including raspberries and bananas. The students use an interactive simulation of human chromosomes to prepare karyotypes of clinical cases. A karyotype is an organized arrangement of the 46 human chromosomes and it allows for the diagnosis of medical conditions caused by an abnormal number of chromosomes, i.e. Down’s syndrome is caused by the additional copy of chromosome #21 (3 copies instead of 2). To learn about modern genetics and genetic analysis the students build 3-D models of both DNA and protein, and use computer simulation software to explore how these molecules change. They analyze a human genetic sequence and see the direct relationship between the sequence of nucleotides in a gene (DNA) and the structure of the protein encoded by the gene. The final project in the unit is for the students to use computer simulation software to design a protein that has specific characteristics and can perform a specified function. In this course the students also perform gel electrophoresis, analyze DNA fragments, and learn about the PCR (polymerase chain reaction) in order to experience and practice how modern genetic techniques are used to diagnose disease.
  16. Screen shot of the Internet-based interactive karyotyping activity. Students need to examine the images of the human chromosomes and correctly align them according to size and shape in order to diagnose the genetic condition of 3 different patients. The patients represented each have a genetic disease or defect that the students then explore.
  17. Students work in teams and read maps of the protein structure to create a 3-D model of the beta-globin protein. Beta-globin is one of the components in hemoglobin, the protein in red blood cells that carries oxygen. Sickle cell disease is caused by a change in a single amino acid (out of over 200) in beta-globin. Students use 2-D maps and 3-D interactive computer images to create their models.
  18. Students investigate the human body systems and various health conditions including heart disease, diabetes, sickle-cell disease, hypercholesterolemia, and infectious diseases. They determine the factors that led to the death of a fictional person, and investigate lifestyle choices and medical treatments that might have prolonged the person’s life. The activities and projects introduce students to human physiology, medicine, research processes and bioinformatics. Key biological concepts including homeostasis, metabolism, inheritance of traits, and defense against disease are embedded in the curriculum. Engineering principles including the design process, feedback loops, and the relationship of structure to function are also incorporated. This course is designed to provide an overview of all the courses in the Biomedical Sciences program and lay the scientific foundation for subsequent courses. PLTW™ Curriculum Overview 03/14/12 May 2008 Project Lead The Way, Inc. Copyright 2008
  19. The second course, Human Body Systems, builds on the concepts students learned in the first course and goes much more in-depth into the mechanisms that keep the body, a living machine, functioning. Students will learn how to use LabVIEW to write programs that allow them to collect data from the experiments they design. The focus will be on how the human body is a system that requires the coordinated actions of multiple interrelated systems, each responsible for various actions. For example, the respiratory, circulatory, digestive, and muscular systems are all coordinated to provide energy to the body from food. If a breakdown occurs in any of the systems, then the cells in the body will not have sufficient energy to survive.
  20. Students examine the interactions of body systems as they explore identity, communication, power, movement, protection, and homeostasis. Students design experiments, investigate the structures and functions of the human body, and use data acquisition software to monitor body functions such as muscle movement, reflex and voluntary action, and respiration. Exploring science in action, students build organs and tissues on a skeletal manikin, work through interesting real world cases and often play the role of biomedical professionals to solve medical mysteries. The Human Body Systems course covers some of the same concepts and principles as in a traditional anatomy and physiology course. Unlike traditional anatomy and physiology this course takes a functional approach. Instead of looking at each of the body systems in isolation, the focus is on how the individual systems work together to support the human body system. For example instead of looking individually at the respiratory system, the cardiovasculuar system, and the digestive system, this course focuses on the need for power or energy for the human body to survive. These three systems have to work together to harvest energy from food and distribute it throughout the body. Students examine the contributions and interdependencies of the body systems needed to support life, and learn about the consequences, disease or illness, when one or multiple systems do not function properly.
  21. PLTW™ Curriculum Overview April, 2007 Project Lead The Way, Inc. Copyright 2007 This example shows the Maniken™ from Anatomy in Clay® that is used throughout the Human Body Systems course for students to build body systems and parts using clay. Each pair of students works on a single manikin for the entire course adding human systems as they study them in the curriculum. As you can see in the picture of the maniken on the slide the different regions of the brain are shown in different colors of clay. No two manikins will look alike, yet all will have similar features.
  22. PLTW™ Curriculum Overview April, 2007 Project Lead The Way, Inc. Copyright 2007 In Human Body Systems students take measurements of bones to determine if a bone is from a man or a woman and to determine that person’s ethnicity.
  23. The third course, Medical Interventions, will allow students to investigate the wide variety of preventive and treatment actions available to prolong and improve the quality of life. Possible topics include stem cell research, cochlear implants, insulin pumps, joint and organ replacements, heart pacers, and internal defibrillators. Students will be expected to use LabVIEW to create programs that automate tasks or take specific body measurements and then trigger an intervention. For example, students may program a prosthetic arm made from legos or fishertechnics components that can pick up objects and place them in a container, or design a program that could measure blood glucose levels and supply insulin as needed.
  24. Students investigate the variety of interventions involved in the prevention, diagnosis and treatment of disease as they follow the lives of a fictitious family. The course is a “How-To” manual for maintaining overall health and homeostasis in the body as students explore: how to prevent and fight infection; how to screen and evaluate the code in human DNA; how to prevent, diagnose and treat cancer; and how to prevail when the organs of the body begin to fail. Through these scenarios, students are exposed to the wide range of interventions related to immunology, surgery, genetics, pharmacology, medical devices, and diagnostics. Each family case scenario introduces multiple types of interventions and reinforces concepts learned in the previous two courses, as well as presenting new content. Interventions may range from simple diagnostic tests to treatment of complex diseases and disorders. These interventions are showcased across the generations of the family and provide a look at the past, present and future of biomedical science. Lifestyle choices and preventive measures are emphasized throughout the course as well as the important roles scientific thinking and engineering design play in the development of interventions of the future.
  25. Some of the topics covered in Medical Interventions are: Molecular biology and genetic engineering Design process for pharmaceuticals and medical devices Medical imaging, including x-rays, CT scans, and MRI scans Disease detection and prevention Rehabilitation after disease or injury Medical interventions of the future
  26. PLTW™ Curriculum Overview April, 2007 Project Lead The Way, Inc. Copyright 2007 The students build and use a mock laparoscopic surgery trainer box. They try to complete multiple tasks using long handled grabbers while watching what they are doing on a video monitor. Inside the box webcams transmit images to the video monitor. The tasks are very easy when a student can do it with his or her hands; it is much more difficult when remote tools are used. The activity simulates the actions of a surgeon doing laparoscopic surgery.