A Publication of The American Physiological Society Integrating the Life Sciences from Molecule to Organism THE Volume 45, Number 5 Physiologist October 2002 Thoughts on Teaching Physiology to Medical Students in 2002 John B. West Department of Medicine, University of California, San Diego Introduction sex practices, alternative and complementary medicine or It was a great pleasure and whatever, but a clear understanding of how the body works will a distinct honor to be select- always be the primary basis of a good medical education. This ed as the 2002 Arthur C. may sound like bringing coals to Newcastle for the readers of Guyton Teacher of the Year. The Physiologist, but it is essential to emphasize this funda- My admiration of Arthur mental truth at the very outset. Guyton knows no bounds, and it must be very satisfy- How Much Physiology Should We Teach in 2002? ing to him to have written a It may seem odd to raise this issue, but I believe that we have textbook of physiology that to recognize that the present day medical student cannot be has had such an enormous expected to learn as much physiology as was the case 25 years influence on thousands of ago. The reason is simply that so much essential new material medical students over many has entered the pre-clinical medical curriculum, that something years throughout the world has to give. Of course I am not suggesting that all the reduction (1). I still turn to his book should be in physiology. Rather it should be shared among all when there is a question on the pre-clinical courses. Naturally, reducing the content of a some area of physiology that core course is always difficult. In fact, in our medical school John B. West is unfamiliar to me, and am there is continual rarely disappointed. pressure from some Apparently it is the tradition for the recipient of this award courses to increase Inside this issue... to write a few remarks about the teaching of physiology. the amount of materi- Actually I am glad to have this opportunity because I am very al and expand their Council Meets in Bethesda involved in teaching physiology to medical students, and there courses because this p. 394 are few occasions where the issues can be discussed. Like most can bolster their case faculty members, I have never had any formal training in teach- for more resources. ing, and I can only offer as my credentials the facts that I have The question of Teachers Attend APS Workshop been director of the main physiology course for medical stu- how much physiology p. 402 dents at the University of California San Diego (UCSD) for 30- should be currently odd years, and that I have written several books designed to taught to medical stu- 2002 APS Committee Reports teach physiology to medical students. Moreover, some interest- dents confronted me p. 406 ing issues have arisen in the teaching of physiology to medical when I worked on a students over the past 10 or 15 years and I shall discuss five. new book, Pulmonary Experimental Biology 2003 Physiology and Patho- Preview Key Role of Physiology in the Medical Curriculum physiology: An In- p. 428 Never has an understanding of the principles of normal phys- tegrated, Case-Based iology been so important in medical education. As new drugs Approach (3). The are introduced, novel diagnostic and interventional techniques stimulus for this book Research Opponents Launch are developed, and a better understanding is obtained of how is that a number of Anti-Charity Campaign the genome alters function, it is more and more critical for the medical schools now p. 457 present-day medical student to understand the principles of teach pathophysiolo- both normal and abnormal physiology. This has to be clearly gy along with physiol- Siegman Named Chair of understood in spite of current changes and fashions in medical ogy in a combined Department of Physiology education. From time to time, legislators emphasize the impor- course. I am not con- p. 472 tance of teaching about aging, cardiopulmonary resuscitation, (continued on page 391) 389 Published bimonthly and distributed by THE The American Physiological Society 9650 Rockville Pike Bethesda, Maryland 20814-3991 PhysiologistVolume 45 Number 5 ISSN 0031-9376 October 2002 Barbara A. Horwitz President John E. Hall Past President Contents John A.Williams President-Elect Martin Frank Thoughts on Teaching Physiology Publications Editor and Executive Director to Medical Students in 2002 Tailoring Search Results in the Councillors John B. West 389 HighWire Library of the Sciences Kim E. Barrett, and Medicine: “Have it Douglas C. Eaton, Joseph R. Haywood, APS News Your Way” 455 Steven C. Hebert,Virginia M. Miller, Charles M. Tipton Horwitz Thanks APS Staff 394 Council Meets in Bethesda 394 Public Affairs Ex Officio Research Opponents Launch Dale J. Benos, Section News Anti-Charity Campaign 457 Mordecai P.Blaustein, Robert G. Carroll, Introducing Bruce Pitt 396 Congressional Appropriations 457 Curt Sigmund, Celia D. Sladek Introducing Matthew Grisham 398 House Agriculture Bill Would Halt USDA E-FOIA Disclosures 458 Publications Committee: Chairman:Dale Chapter News 2002 APS Mass Media Fellow 459 J. Benos; Members:Penelope A.Hansen, Second Meeting of the Gulf “Science in the Media;” Mark A. Knepper, Richard A. Murphy, Hershel Raff. Director of Publications: Coast Physiological Society 399 EB 2003 Symposium 460 Margaret Reich. Design and Copy Editor: Nebraska Physiological Society Symposium Summary on Web 461 Joelle R. Grossnickle. Holds Fifth Annual Meeting 400 FASEB Promotes Subscriptions: Distributed to members as Mentoring Tool 461 part of their membership. 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APS Membership Headquarters phone: 301-634-7164 Career Opportunities in Application 483 Fax: 301-634-7242 Email: [email protected] Physiology Symposium http://www.the-aps.org Report 449 Printed in the USA 390 The Physiologist Teaching Physiolog y Vol. 45, No. 5, 2002 (continued from page 389) cants admitted to medical schools us, it is so intuitive that if you block vinced that this is the best way to go nationally, and that there has been no part of the circulation of the lung the because there is a danger of glossing decline over the last few years. But the pulmonary vascular resistance has to over some of the principles of normal fact remains that students seem to increase, but some students apparent- physiology (see the section below on have more difficulty with concepts ly just cannot see this. This is a rela- case-based learning). However, a num- such as pressure, flow, resistance and tively trivial example, but many other ber of medical schools have taken this elasticity than used to be the case. conceptual difficulties arise when the route so it is a fait accompli for some Part of the reason for this is proba- present day student is introduced to students. In writing the new book, I bly that the teaching of physics at the notions of compliance, transmural carefully reviewed the content of my college level has been de-emphasized. pressure and surface tension. book Respiratory Physiology-The Friends tell me that this is the case all It would be interesting to see data Essentials (2), and concluded that over the world. Again, to some extent on the quantitative skills of incoming about 10 percent of the material in this may be the inevitable result of medical students as tested by simple that could be omitted without losing competing interests. Modern biology mathematical concepts. For example, the important principles. Some of the emphasizes the spectacular advances how many students know that y = mx material that was deleted was on pul- in molecular and cell biology of the + c is the equation of a straight line monary function tests because, in gen- last 15 years and perhaps it is where m is the slope and c is the y-axis eral, it is far more important to under- inevitable that physics and mathe- intercept? Some apparently do not, stand the principles of how the lung matics receive less attention. judging from the blank looks that works rather than how this is mea- The same trend can be seen in the greet a mention of this in a lecture. sured in pulmonary function laborato- hobbies that students have. While I Again, if a student is told that a tank ries. was growing up, I built radios from of water develops a hole near the bot- I hope I am not leaving the impres- scratch, and notions of voltage, cur- tom, how likely is he/she to see intu- sion that a watered-down course of rent and resistance were taken for itively that the rate of fall of the water physiology is acceptable.