Abraham Flexner 1910

1
??????? ?? ????? ??????? ????? ?? ?????

• ???? ???? ????? ????
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• ??????? ?????
• ??????? ???? ????? ?????

2

• ??????? ?? ????
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• ??????? ?? ?????

3
Abraham Flexner1910

• ????????? ??? ?? ???? ?? ???? ????? ????? ???? ??
  ??? ?? ???? ?? ???????? ???? ???? ?????? ?????.
• ?? ??? 1910?? ??? 155 ??????? ????? ?? ?????? ?
  ?????? ???? 16 ??????? ??? ????? ?? ??????.

4

• ?????? ??? ??? ????? ?? ???????
• ????? ???? ????? ????? ?? ??????? ? ?????????
• ????? ?? ????? ?? ??? ????
• ???? ????? ???? ?????????
• ???? ????? ?????????
• 1904 160
• 1920 85
• 1935 66

5
Volume 75, September 2000, Supplement 9
6
??????

• ??????? ? ?????? ?????????
• ???? ?????
• ????? ??????
• ???? ?? ?????
• ???? ??????? ?????????
• ???????? ???????
• ??????? ???????
• ??????? ?? ???????? ? ????????
• ??????? ???????
• ????? ??????

A Guide to the 130 Reports in This
Snapshot Supplement to Academic Medicine 200075
(9)
7

• ???? ??? ?? ??????? ???? ?? ????? ????? ?? ????
  ??? ? ?????? ??????? ????? ???? ?? ???.
• ?? ???? ??????? ?? ???? ??? ?? "??????? ?? ????
  ??? ???."?? ??? ?????? ????? ? ????? ????? ?????
  ???? ?????

A Guide to the 130 Reports in This
Snapshot Supplement to Academic Medicine 200075
(9)
8
(No Transcript)
9
?????? ? ??????
10
??????? ???????

• ??????? ?????? ????
• ??? ?? ???? ??? ????
• ???? ?? ???? ?????
• ??????? ?? ????????
• ??? ?????? ?? ??? ????
• ????? ??? ???????? ???????
• ????? ?? ????? ??????
• ??????? ?? ????? ????????? ???
• ?????? ??? ?? ?????
• ???? ?? ????? ?? ????? ?? ?????
• ?????? ????? ?? ?????

A Guide to the 130 Reports in This
Snapshot Supplement to Academic Medicine 200075
(9)
11
????? ?? ? ?????????? ??? ??????? ?? ????? ?????
(2000-1980)

• the GPEP Report and the ACMETRI Report from the
  Association of American Medical Colleges (AAMC)
• reports from the Josiah Macy, Jr. Foundation such
  as The New Biology and Medical Education
• Adapting Clinical Medical Education to the Needs
  of Today and Tomorrow,
• the American Medical Associations Future
  Directions for Medical Education,
• publications issued by the Hastings Center,
• by a group of medical educators in Canada,
• by the General Medical Council of Great Britain8
  represent only a few of these.

A Guide to the 130 Reports in This
Snapshot Supplement to Academic Medicine 200075
(9)
12
??????? ????? ?????

• ????? ??? ???? ? ?????? ?????? ?? ??? ??????
  ??????? (???????)
• ????? ???? ??? ???????????????
• ?????? ??? ?? ????? ?? ???? ???? ????? ???????
  ???? ???
• ???? ?? ????????? ???????? ???? ?????? ? ????????
  ??????
• ????? ? ????? ?????? ???? ??????? ??????

• ??????? ?????? ????
• ??? ?? ???? ??? ????
• ???? ?? ???? ?????
• ??????? ?? ????????
• ??? ?????? ?? ??? ????
• ????? ??? ???????? ???????

• ????? ?? ????? ??????
• ??????? ?? ????? ????????? ???
• ?????? ??? ?? ?????
• ???? ?? ????? ?? ????? ?? ?????
• ?????? ????? ?? ?????

GREEN. Applying adult learning principles to
medical education in the United States Medical
Teacher, Vol. 26, No. 1, 2004, pp. 7985
13
?????? ????????-??????-????????

• ?? ??? 1999 ?????? ?? ????
• 45 ??????? ?? 50 ?? ???? ?????? ????. (??????
  15? ???????? 10 ? ???????? 24)
• ??? ??? ??????????? ??? ?? ?? ?? ??? ????? ???.
• 82/2 ??????? ?? ?? 7 ??? ????? ?? ????????? ???
  ???? ????? ???? ?????
• (13 ??????? ?? ??????? 8 ??????? ?? ????????
  ? 16 ??????? ?? ????????).

Elliott M.K. Are we going in the right direction?
A survey of the undergraduate medical education
in Canada, Australia and United Kingdom from a
general practice perspective. Medical Teacher
1999 21(1) 53
14
?????? ????????-??????-????????

• ????? ????? ????? ?? ??????? ???? ?? ???????
  ????? ???? ?????? ????? ???

Elliott M.K. Are we going in the right direction?
A survey of the undergraduate medical education
in Canada, Australia and United Kingdom from a
general practice perspective. Medical Teacher
1999 21(1) 53
15
?????? ????????-??????-????????
Elliott M.K. Are we going in the right direction?
A survey of the undergraduate medical education
in Canada, Australia and United Kingdom from a
general practice perspective. Medical Teacher
1999 21(1) 53
16
?????
17
????? ?? ?????

• ????????? ??? ????? ????? ?? ?? ???? ??? ?????
  ?????
• ????????? ???? ?? ?? ?? ??? ???? ?? ??? ?? ??
  ???? ???????? ????????? ? ??????? ?? ?? ????
  ??????? ????? ?? ?????? ?? ????? ????.
• ?? ????? ?? 131 ??????? ???? ???? ??????? 46 ??
  ??? ????? ????? ????? ?????.

Jippes M, Majoor G.D. Influence of national
culture on the adoption of integrated and
problem-based curricula in Europe. MEDICAL
EDUCATION 2008 42 279285
18
????? ?? ?????
Jippes M, Majoor G.D. Influence of national
culture on the adoption of integrated and
problem-based curricula in Europe. MEDICAL
EDUCATION 2008 42 279285
19
?????? ???? ????

• ????? 16 ??????? ????? ?? 6 ???? ???? ???? ?????
• ????????? ??? ??? ????????? ????? ????????? ?
  ????? ?? ???????? ??? ?? ????? ???? ?? ? ?????
  ????? ???? ?????.
• ??? ?????? ???? ??????? ? ?? ????? ????? ??
  ????????? ???.

Likic R, Dusek T, Horvat D. Analysis and
prospects for curricular reform of medical
schools in Southeast Europe. Medical Education
2005 39 833840
20
???????

• ???? ??????? ?? ??? 1990 ???????????? ???? ?????
  ??????? ?? ???????????? ?????????? ????? ?? ?????
  ?? ????? ??? ????? ???
• ?????? ??????
• ????? ????? ???? ? ??????
• ????? ??????? ???? ?????? ?? ???????
• ????? ????? ??? ????? ? ??????
• ???? ?? ????? ? ...

• BOMBI JA. Teaching in Spanish medical schools.
  Medical Teacher, Vol. 25, No. 4, July 2003, pp.
  428432

21
???????

• 2000 ??????? ?? 12 ??????? ?? 27 ???????
• ???? ??? ??????????? ??? ?? ??????? ?? ?? ??? ???
  ?????? ? ?????? ????? ?? ???? ? ?????? ????? ??
  ???????? ?????
• ?? ??? ??? ?????? ????? ????? 66 ???? ?? 5
  ??????? ????? ??
• ?? ??? ??? ?????? ?? 12 ??????? ????? ???? ?????.
  

• BOMBI JA. Teaching in Spanish medical schools.
  Medical Teacher, Vol. 25, No. 4, July 2003, pp.
  428432

22
??????

• ???? ?? ??? ??? ???? ??? ?????????? ?? ??????
  ??????? ?????? ????? ???? ???.
• ?? ??? ???? ??? ???? ?? ???? ?????? ???????????
  ?????? ? ?????????? ????? ???.
• ?? ?????? ??? ??? ?????? ???? ????? ?? ??? ??
  ???.

Segouin C. Medical education in France . Medical
Education 2007 41 295301
23
??????

• ?? ??? 1990 ??????????? ????? ??????? ????? ????
  ???? ??? ?? ??????
• ????? ????
• ?? ?? ?? ??? ??? ???? ??????? ???
• ?? ?? ??? ????? ?????? ?? ?????? ?? ???? ? ????
  ?? ??? ???????
• ???? ??????? ?? ?????? ?? ???? PBL
• ??????? ???? ??????? ??????-??????? ?? ????? ??
  ??????? ???? ????? ????? ? ???? ????.

24
??????

• ??????
• ?????? ????? ?????????
• ??? ?????? ????? ???????
• ????? ?????? ?? ??? ????? ????? ??????
• ???????? ??? ????? ?? ????

25
????????
26
University Otago

• ?? ??? 80 ??? ???? ????????? ???? ?? ?? ???? ????
  ???? ???.
• ?? ??? 1997 ????? ????? ?? ?? ????????? ???
  ?????? ?? ???? ?????? ????? ???. ???? ???? ??
  ????? ??? ?? ??? ?? ? ?? ??? ??? ????? ?? ?????
  ?? ??? ?? ????? ?? ????? ????? ? ????? ?? ??????
  ????? ????? ?? Case ? ??? ?? ???? ???? ???? ??.
• ?? ??? ????? ????? ????? ? ?????? ???? ??????? ?
  ????????? ?? ????? ???? ??????? ????? ???.

Tavanaiepour D, Schwartz Pl, Loten EG. Faculty
opinions about a revised pre-clinical curriculum.
MEDICAL EDUCATION 200236299-302
27
University of New South Wales

• ??? 2004
• ????????? ????? ?? ?????? ?? ??? ???? ???? ?
  ?????? ????? ?????? ?? ???.
• ????? ?? ???? ??? ??? ???? ????? ????? (life
  cycle) ????? ???
• Society and Health
• Beginnings Growth and Development
• Health Maintenance
• Ageing and Endings

McNEIL HP, HUGHES CS, TOOHEY SM, DOWTON SB An
innovative outcomes based medical education
program built on adult learning principles.
Medical Teacher 2006 28(6)527534
28
(No Transcript)
29
????
30
????? ????? ?? ????

• ????? ?? ???? ?? ??? ???? ????? ???? ????? ???
  ????? ?? ??????????? ???? ?? ??? ?? ????? ?? ????
  ????? ???? ? ???????? ????? ? ?????? ???

Tai Pong Lam, Yu Ying Bess Lam. Medical Education
Reform The Asian Experience. Acad Med 2009
8413131317.
31
????? ???????? ??? ???? ????? ??? ????? ? ??????
??????? ????????

• ?????? ???? ?? ??????? ? ???? ????? ????? ????
• ??? ????? ???? ????? ?? ????? ????? ???? PBL
  ????? ?? ??? (??????? ???)
• ???????? ????? ???? ???? ???? ???? ????? ??????
  ????????? ? ?? ??? ????? ?????? ????? ???? ????
  ?????
• ????? ???? ?? ??????
• ?? ??? ????? ????? ???? ???? ???? ? ???????
• ???? ????? ?? ?????? ??????? ?? ???.

Tai Pong Lam, Yu Ying Bess Lam. Medical Education
Reform The Asian Experience. Acad Med 2009
8413131317.
32
????? ??????????????? ???????? ?????? ????
?????? ????? ???????? ??? ?????? ????????
???????? ??????

• ????? ?? ???? ??? ??? ???????
• ?? ???? ?????????? ??? ?? ???????? ????? ????
  ?????? ????? ???
• ?????? ??????? ???????? ?? ??????? ????? ?? ?
  ????? ??? ?? ??????
• ????? ???? ???? ???? ????? ????????? ????? ??
  ?????? ??? ?????? PBL ?? ????? ???? ?? ???

Tai Pong Lam, Yu Ying Bess Lam. Medical Education
Reform The Asian Experience. Acad Med 2009
8413131317.
33
????? ?????

• ??? ?????
• ??? 2005
• ????
• ?? ??????? ????? ????? ?? ???? ?? ?? ????? ???
  ???? ???? ??
• ???????
• ??????? ?????? ????? 1983
• ????????? 5 ????

Tai Pong Lam, Yu Ying Bess Lam. Medical Education
Reform The Asian Experience. Acad Med 2009
8413131317.
34

• Year 1
• MODULE 1 Introductory Module Cell and Systems
  (6 W)
• MODULE 2 Blood and Inflammation (7 W)
• MODULE 3 Nutrition and Metabolism (7 W)
• MODULE 4 Respiration and Circulation (8 W)
• MODULE 5 Renal (4 W)
• MODULE 6 Multisystem-I (4 W)
• Year 2
• MODULE 7 Musculoskeletal system (6 W)
• MODULE 8 Neurosciences (10 W)
• MODULE 9 Endocrine Reproduction (8 W)
• MODULE 10 Immunity and Infectious Diseases (7 W)
• MODULE 11 Neoplasia Multisystem-II (4 W)

35
????? ???? ??????????? ????? ????? ?????? ??????
???????? ???????? ??????? ???????? ??????

• ??? ??? ?????? ? ?????? ????? ?? ??? ??????? ??
  ?????? ????? ?????
• ????? ?? 50 ???? ??????? ?? ?? ??? ?????? PBL
  ??????? ??? ???
• ?????? ??? ??????? ?????? ????? ?? ????? ? ?????
  ?? ???? ??????? ????? ???? ???? ???? ????? ???.

Tai Pong Lam, Yu Ying Bess Lam. Medical Education
Reform The Asian Experience. Acad Med 2009
8413131317.
36
?????

• ??????? ?? ????????? ???? ?????????? ????? ?? ???
  1990
• ??????? ??????
• ?? ??? ?? ??? 1988 ??????? ????? ????? ?????? ??
  ???? ???? ? ????? ???? ?? ???? ???? ??.
• ??? ???? ?? ??? 1998 ?? ???? ???? ????? ????? ?
  ????? ???? ?? ??? ???? ??? ? ?????? ???? ???
  ?????
• ??????? ???????
• ????????? PBL? ????? ?? ????? ? ????? ?????

Sim Si Mui. Teaching of pharmacology in
Universiti Malaya and the other medical schools
in Malaysia a historical perspective. Acta
pharmacologica Sinica 2004 25
37
????? ????? ? ????

• ????? ????? ?? ??????? ? ????? ????

Tai Pong Lam, Yu Ying Bess Lam. Medical Education
Reform The Asian Experience. Acad Med 2009
8413131317.
38
?????

• The Arabian Gulf University
• ????? 1982 ? ?? ???? ????? ?? ???? PBL
• ??????? ???? ?? ??? 2002
• ?????? ????
• ??????? ????? ?????
• ????? ?? ?????
• PBL
• ????? ????? ? ???? ??? ???????
• ???? ????? ??? ?????

Hamdy H, Anderson MB. The Arabian Gulf
University, College of Medicine and Medical
Sciences A Successful Model of a Multinational
Medical School. Acad Med 2006 8110851090.
39

• ??????

40
School of Medicine, University of Pretoria, Africa

• 1997
• ????? ?????
• ????? ?? ?????
• ?? ????
• 17 ???? ????? ??? ????? ????? ? ?? ?????? ????
  ??? ??????
• 9 ?? ????

DU PREEZ R, PICKWORTH G, ROOYEN M. Teaching
professionalism a South African perspective.
Medical Teacher 2007 29 284291
41
Nelson R. MandelaSchool of Medicine, Durban,
Africa

• ?? ??? 2001
• PBL

MCLEANS M. Staining problem-based learning
reform advice in hindsight! Medical Teacher
200426 (8) 726728
42
Top Universities
43
Academic Ranking of World Universities in
Clinical Medicine and Pharmacy - 2009
44
Times Higher Education-QS Rankings 2009-life
sciences and biomedicine
45
Stanford School of Medicine UCLA school of
Medicine UCSF School of Medicine Yale school of
Medicine
46

• Preclinical phases
• Different types of revision
• Structure
• Vertical horizontal integration
• Integration in different types and degrees

47
Stanford School of Medicine

• http//med.stanford.edu/

48
Year 1 2-Block 1 Foundations of Medicine I
II

• organized by organ system
• integrate histology, physiology, pathology,
  microbiology, and pharmacology.
• Organ system units cover
• normal structure and function
• response to disease (including infection),
• treatment (therapeutics).

49
Year One - Block 1 Foundations of Medicine I
50
Year One - Block 1 Foundations of Medicine II
51
Year 1 2-Block 2 Human Health Disease

• organized by organ system
• integrate histology, physiology, pathology,
  microbiology, and pharmacology.
• Organ system units cover
• normal structure and function
• response to disease (including infection),
• treatment (therapeutics).

52
Block 3 Practice of Medicine Year 1 2

• to reinforce basic science concepts.
• large group lectures
• small group (8-12 learners) discussions,
• smaller groups (2-3 learners)
• one-on-one instruction.
• clinical problem-based cases,
• multistation exercises,
• standardized patients,
• videotaping,
• computer-based instruction.

53
Block 4-Year 3, 4, (5)Clinical Clerkships

• Clinical correlations in clerkships provide
  review of basic sciences.

54
UCLA School of Medicine
http//dgsom.healthsciences.ucla.edu
55
Changing Medical Curriculum

• 3rd Year- Core Clerkships (2000)
• Revisions being planned 2007
• 4th Year- The Colleges (2001)
• 1st 2nd Years - Integrated, interdisciplinary
  Human Biology Disease curriculum (2003)

56
Medical Neurosciences 1
Cardiovascular, Renal Respiratory Medicine 2
Medical Neurosciences 2
Musculoskeletal Medicine
Gastrointestinal, Endocrine Reproductive
Medicine 1
Gastrointestinal, Endocrine Reproductive
Medicine 1
Foundations of Medicine 2infectious diseases
cancer
Cardiovascular, Renal Respiratory Medicine 1
Summer Breakoptional STTP research program
Foundations of Medicine 1molecular, cell
biology, development, immunology, general path
57
(No Transcript)
58

• Cardiovascular, Renal Respiratory I
• 8 weeks
• Anatomy,
• histopathology,
• physiology,
• biochemistry,
• genetics,
• imaging,
• selected pathophysiologic mechanisms

• Foundation of Medicine
• 8 Weeks
• Pathologic processes
• Genetics
• molecular and cellular biology,
• basic immunology,
• critical appraisal.

Phase 1 -year 1
59

• Foundation of Medicine II
• 8 weeks
• Basic pharmacology
• microbes,
• host defense and immunity
• immune disorders
• clinical trials epidemiology
• infectious diseases,
• including classification of pathogens
  therapeutics
• cancer, including classification,
• causes therapeutics of other blood disorders.

• Block 9 Cardiovascular, Renal Respiratory
  Medicine II
• 8 weeks
• Pathology pathophysiology of these systems
• including hypertension,
• developmental disorders
• therapeutics - pharmaceuticals and other
  treatments
• clinical trials epidemiology
• prevention common infectious agents.

Phase 1 -year 2
60
UCSF School of Medicine

• http//medschool.ucsf.edu/index.aspx

61
MD program

• two integrated phases
• Pre-clerkship the first and second years
• Clerkship the third and forth years

62
pre-clerkship

• 8 block courses
• organized around a range of themes and systems
• each about 8 weeks
• The first year
• Prologue
• Major Organ Systems
• Metabolism and Nutrition
• Brain, Mind, and Behavior.
• The second year
• Infection, Inflammation, and Immunity
• Cancer Bench to Bedside
• Life Cycle
• Epilogue.
• Foundations of Patient Care
• A longitudinal course

63
First-Year Blocks

• 1-Prologue
• all linked together as a foundation for patient
  care
• Anatomy
• Biochemistry
• Pharmacology
• Histopathology
• Genetics
• social and behavioral sciences
• 50 days

64
First-Year Blocks

• 2-Major Organ Systems
• an integrated approach
• Cardiovascular
• Pulmonary
• renal systems
• 3 months

65
First-Year Blocks

• 3-Metabolism Nutrition (M N)
• gastrointestinal system
• endocrinology,
• metabolic issues,
• additional emphasis on prevention of disorders in
  these areas and on counseling for nutritional
  health.
• 2 months

66
First-Year Blocks

• 4-Brain, Mind Behavior (BMB)
• neuroscience,
• neurology,
• psychiatry.
• 2 months

67
Second-Year Blocks

• 1-Infection, Inflammation Immunity (I-3)
• microbiology,
• Immunology
• infectious disease
• public and international health issues.
• 2 months

68
First Second-Year

• Foundations of Patient Care (FPC)
• A longitudinal course,
• clinical skills,
• professional development
• clinical reasoning.
• ethics,
• doctor-patient interaction
• a 3-day immersion in the hospital setting for
  first in-patient experience.

69
Clerkship Third year

• Intersessions
• 4 week-long breaks between some of the clerkship
  blocks.
• students return to the classroom to engage in
  discussions
• ethics,
• evidence-based medicine,
• health policy.
• also re-visit basic science topics to refresh
  their knowledge.

70
Yale School of Medicine
http//info.med.yale.edu/ysm/
71
2 phases- 4 years
72
(No Transcript)
73
(No Transcript)
74
??????? ????????? ??? ????? ?? ?????
75

• ??????? ???? ????? ???? ?????
• ??????? ???? ????? ??????
• ??????? ???? ????? ?????
• ??????? ???? ????? ???
• ??????? ???? ????? ??????
• ??????? ???? ????? ????????
• ??????? ???? ????? ??????
• .......

76
??????? ???? ????? ???? ?????
77

• ??? ?? ???? ????
• ?????????????
• ??? ?? clerkship
• ??? ?? internship
• ????? ???? ? ?????
• ????? ???????
• ??????? ??????

78
??? ??
Information Technology
Study Skills
General Units
Introduction to Basic Medical Sciences III
Introduction to Basic Medical Sciences II
Introduction to Basic Medical Sciences I
???? ????????? ????? ???? ??????? ???? ?????
???? ?????- ???? ???? ??????
79
??? ??
Musculoskeletal Organ System
General Units
Elective Courses
Public Health
Psychology
Integument Organ System
Cardiovascular Organ System
???? ????????? ????? ???? ??????? ???? ?????
???? ?????- ???? ???? ??????
80
??? ??
Endocrine Organ System
General Units
Elective Courses
Evidence Based Medicine I
Parasitology
Respiratory Organ System
Nervous Organ System
???? ????????? ????? ???? ??????? ???? ?????
???? ?????- ???? ???? ??????
81
??? ????
Community Exposure I
Early Patient Contact I
Visual Organ System
General Units
Elective Courses
Virology
Clinical Genetics
Auditory Organ System
Renal Organ System
???? ????????? ????? ???? ??????? ???? ?????
???? ?????- ???? ???? ??????
82
??? ???
Gastrointestinal Organ System
General Units
Early Patient Contact II
Community Exposure I
Microbiology
Nutrition
Hematology Organ System
Reproductive Organ System
???? ????????? ????? ???? ??????? ???? ?????
???? ?????- ???? ???? ??????
83
??????? ???????????? ???? ????? ?????
84
??????? ???? ?????????????
85
???? ????? ?? ??????
86
??????? ????? ??????? ???? ????? ???? ????? ???
87
??????? ????? ???

• ????? ??? ????? ???? ?? ???? ????
• ????? ??? ?????? ????? ?? ???? ?????? ?????? ????
  ????
• ????? ??? ICM (????? ???? ?????????????-?????????
  ??-????????)
• ??????? ???? ??? ???????? ? skill lab
• ????? ? ????? ????? ????? ????? ????? ?????? ?
  ????????? ?? ???? ????????
• ????? ? ????? ??????????? ?????? ?????? ????????
  
• ????? ???? ?????? ??????? (??????? ?? ???????)
  ??? ????????

88
????? ???? ???? ???? ????

• ????? ?? ?? 1386
• ???? ?? ??? ??? ??? 88-1387
• ?? ?? ????? ????? ?? ????? ???? ???????? ????
  ?????? ???? ????? ? ????????? ????? ??????.

89
?????? ????? ???? ?? ???? ????
90
?????? ??? ??????

• ?? ??? ???? ?? ???? ?? ????? ????? ?? ?? ?? ???
  ???? ?? Early clinical exposure ?????? ???? ??.
• ???? ?? ???? Early clinical exposure ?? ??? ?????
  ??

91
??????? ???? ????? ??????
92

• ????? 4 ??? ???????? ?????????? ???? ????? ? ????
  ????? ?? ???? ????? ?????
• 8 ????
• ?????? ( ????? ???????)
• ????? ????
• ????? ???? ??? ? ???
• ????? ???
• ????? ???? ? ????? ?????? ??????
• ????? ?????
• ????? ?? ? ???? ? ?????
• ????? ??? ? ???

93

• ?????? ????? ?? ???? ????
• ????? ????? ??????
• ????? ???? ????? ???? ????
• ????? ???? ??????
• ??????? ?? ?? ??? ??? ?????? ? ?? ??? ???? ????
• ??? ?? ???? ?????? ? ?????? ?????? ??? ???????
  ???? ?? ??? ????? ?? ???? ?? ??? ????? ???

94
??????? ???? ????? ????????
95
(No Transcript)
96
(No Transcript)
97
??? ???
?????? ???? ???? ?????
1 ???? 2 ???? ???????
4 ????
8 ????

???? ?????
1 ???? 2 ???? ?????????
6 ????
12 ???? ?????? ??? ? ???? ? ???? ??? ????
????? 3 ????
6 ???? ???????
5 ???? 10
???? ???? ?????
2 ???? 4 ???? ?????????
15????
30 ???? ?????? ?????? ???? ?????
2 ???? 4
???? ???????
2 ???? 4 ???? ?????? ?????
???? ????? 2????
4 ???? ???????
5/7 ???? 15
????


???? ????? 4
???? 8 ???? ?????????
6 ????
12????
98
(No Transcript)