The four-box approach for problem-based learning

Initial evaluationProcedural strategies
  •  Physical examination, complementary tests and  functional status assessment

  •  Indications, contraindications and expected results

  •  Patient's significant comorbidities

  •  Operator and team experience and expertise

  •  Patient's support system (also includes family)

  •  Risk–benefits analysis and therapeutic alternatives

  •  Patient preferences and expectations (also includes  family)

  •  Respect for persons (informed consent)

Procedural techniques and resultsLong-term management plan
  •  Anaesthesia and other perioperative care

  •  Outcome assessment

  •  Techniques and instrumentation

  •  Follow-up tests, visits and procedures

  •  Anatomical dangers and other risks

  •  Referrals to medical, surgical or palliative/  end-of-life subspeciality care

  •  Results and procedure-related complications

  •  Quality improvement and team evaluation of  clinical encounter