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Opinion: The decline of physiology

Medical schools in the UK are teaching physiology courses primarily focused on clinical applications with much curtailed practical laboratory training to the detriment of medical education

By | April 19, 2011

A vivisection of a Common Sand FrogIMAGE: WIKIMEDIA COMMONS, MUHAMMAD MAHD KARIM

Physiology has been taught in British medical schools for a century and a half, but since about 1990, physiology teaching for medical students has been cut by more than fifty percent (see table). During this time, medical student numbers have doubled. Currently 8,000 new students enroll in UK medical schools each year. This bloating in numbers has outgrown the capacity of staff and space available to teach and accommodate them appropriately. Consequently, practical physiology training has been virtually eliminated.

Physiology studies the relationships between living states at all levels of biological organization, from molecules to organ systems. It is the key to understanding organ function and dysfunction. A good understanding of the subject is necessary for the proper training of the next generation of doctors under the UK's General Medical Council guidelines.

Some view physiology as an old-fashioned and mechanical approach to science -- rooted in a philosophy antagonistic to the statistical methodologies adopted by clinical science, such as epidemiology and human population genetics. But in fact this view is baseless; physiology has long since rejected its historical distrust of statistical evidence and enthusiastically embraces new methods, particularly molecular genetics, that shed light on biological processes.

Others take issue with the experiments performed in traditional physiology courses as a result of largely successful propaganda campaigns by anti-vivisectionists. Human and animal experimentation were first introduced into medical physiology teaching in Breslaw (Wroclaw) University 1842 by Jan Purkinje because it was believed that this form of active learning experience was better imprinted than any acquired by passive textual learning. Practical experimentation stresses the need for precision in preparation, observation, recording, collation, analysis and interpreting data, all of which are vital to the needs of all clinicians and scientists. Although animal experimentation is currently viewed with disfavour by a large section of the general public, government officials, and even some medical students, students lacking any such experience are relegated to being passive followers of conventional wisdom, wholly reliant on secondhand opinions for their own. Inadequate grounding in basic practical skills in biological experimentation will lead to wasted time, money and in some cases life in the laboratory or clinic.

*PBL plenary lectures on physiological topics Thanks to Glasgow University Registry and Steve Franey for retrieving this information and for useful discussions with CAR Boyd, O Hutter and Michael Lucas.

Besides rising student numbers, several other factors have contributed to physiology's lamentable decline. Problem Based Learning (PBL), imported from North America was widely adopted in various guises throughout the UK medical schools during the 1990s. It avowedly aims to encourage self-directed learning and to erase the artificial barriers between the -ologies by promoting an integrated or "holistic" approach to medicine. It was also seen as a means of shifting the increased teaching load away from active researchers to non-specialist "facilitating" staff. But its adoption has meant a comprehensive loss of autonomy of the biological scientists who have participated in this venture. Clinicians now take a leading role in pre-clinical teaching, largely displacing pre-clinical scientists who are more in touch with basic physiological processes. Scientific content taught in the context of clinical problems omits much basic science, which is regarded as inessential digression from the clinical problems upon which the course is centred.

PBL is much more appropriately suited to medical teaching in North America, where every medical student has studied biological sciences at college level prior to entering medical school. Undergraduate British medical students only rarely have equivalent experience, so realistically can only be expected to integrate knowledge and solve problems once they have acquired a firm understanding of basic sciences.

Another factor contributing to the decline of physiology courses has been the loss of physiology departments as a result of their merging with schools of biological, life, health, or medical sciences. Only one or two discrete academic physiology departments remain in the United Kingdom. Resource allocation within the preclinical schools, formerly controlled by academics working at the pre-clinical faculty or departmental level, is now centralized and controlled by senior administrators and clinicians. The financial and man power resources are redirected towards the more highly prioritized needs of the medical school rather than to science departments.

Although the "old fashioned approach" of incorporating extensive laboratory courses in physiology into medical and medical science courses is costly in time, labor and space, their omission may prove to be even more costly. Eventually British graduates will lose out to their competitors trained in Continental Europe, where universities mostly still devote serious attention to teaching practical skills to medical and science undergraduates.

R.J. Naftalin is Emeritus Professor of Physiology, King's College London and a F1000 Member since 2006. He was trained in medicine at Glasgow University and in biochemistry London University.

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Comments

Avatar of: David Low

Anonymous

June 14, 2011

Professor Naftalin has rightly argued for the significance of the basic sciences, particularly Physiology, in the education of young physicians and I applaud this central thesis in his essay. The view of PBL as expressed here however is incomplete and somewhat misleading, at least as it is utilized in north American medical schools. One of the principal benefits and specific aims of the PBL method is to help students to bridge the gap between basic science and challenges they will face in the real world of the medical clinic. Properly designed PBL courses do this very well. I have facilitated PBL groups for many years in an American medical school. The program always included many faculty from the basic sciences who usually outnumbered the participating clinicians. M. David Low, MD, PhD.

Avatar of:

Posts: 0

June 14, 2011

Professor Naftalin has rightly argued for the significance of the basic sciences, particularly Physiology, in the education of young physicians and I applaud this central thesis in his essay. The view of PBL as expressed here however is incomplete and somewhat misleading, at least as it is utilized in north American medical schools. One of the principal benefits and specific aims of the PBL method is to help students to bridge the gap between basic science and challenges they will face in the real world of the medical clinic. Properly designed PBL courses do this very well. I have facilitated PBL groups for many years in an American medical school. The program always included many faculty from the basic sciences who usually outnumbered the participating clinicians. M. David Low, MD, PhD.

Avatar of:

Posts: 0

June 14, 2011

Professor Naftalin has rightly argued for the significance of the basic sciences, particularly Physiology, in the education of young physicians and I applaud this central thesis in his essay. The view of PBL as expressed here however is incomplete and somewhat misleading, at least as it is utilized in north American medical schools. One of the principal benefits and specific aims of the PBL method is to help students to bridge the gap between basic science and challenges they will face in the real world of the medical clinic. Properly designed PBL courses do this very well. I have facilitated PBL groups for many years in an American medical school. The program always included many faculty from the basic sciences who usually outnumbered the participating clinicians. M. David Low, MD, PhD.

Avatar of:

Posts: 0

June 16, 2011

As stated "PBL is much more appropriately suited to medical teaching in North America, where every medical student has studied biological sciences at college level prior to entering medical school. Undergraduate British medical students only rarely have equivalent experience, so realistically can only be expected to integrate knowledge and solve problems once they have acquired a firm understanding of basic sciences". For fuller discussion on this topic see page 8-12 http://www.physoc.org/uploaded... 

Avatar of:

Posts: 0

June 16, 2011

As stated "PBL is much more appropriately suited to medical teaching in North America, where every medical student has studied biological sciences at college level prior to entering medical school. Undergraduate British medical students only rarely have equivalent experience, so realistically can only be expected to integrate knowledge and solve problems once they have acquired a firm understanding of basic sciences". For fuller discussion on this topic see page 8-12 http://www.physoc.org/uploaded... 

Avatar of: Richard Naftalin

Anonymous

June 16, 2011

As stated "PBL is much more appropriately suited to medical teaching in North America, where every medical student has studied biological sciences at college level prior to entering medical school. Undergraduate British medical students only rarely have equivalent experience, so realistically can only be expected to integrate knowledge and solve problems once they have acquired a firm understanding of basic sciences". For fuller discussion on this topic see page 8-12 http://www.physoc.org/uploaded... 

Avatar of: M. Bisby

Anonymous

June 24, 2011

Here in Canada it has not been a pedagogical shift that has caused the demise of the physiology lab. so much as successive departmental budget cuts, which have made it impossible to maintain and replace equipment and supplies, or provide salaries for the skilled technicians who prepared the lab. sessions.

I also agree that problem-based learning works well for medical students with some prior knowledge of anatomy and physiology. In fact, carefully-designed cases help the students to understand the importance of the basic concepts of physiology in managing clinical problems, in a way that old-style lectures did not.

Avatar of:

Posts: 0

June 24, 2011

Here in Canada it has not been a pedagogical shift that has caused the demise of the physiology lab. so much as successive departmental budget cuts, which have made it impossible to maintain and replace equipment and supplies, or provide salaries for the skilled technicians who prepared the lab. sessions.

I also agree that problem-based learning works well for medical students with some prior knowledge of anatomy and physiology. In fact, carefully-designed cases help the students to understand the importance of the basic concepts of physiology in managing clinical problems, in a way that old-style lectures did not.

Avatar of:

Posts: 0

June 24, 2011

Here in Canada it has not been a pedagogical shift that has caused the demise of the physiology lab. so much as successive departmental budget cuts, which have made it impossible to maintain and replace equipment and supplies, or provide salaries for the skilled technicians who prepared the lab. sessions.

I also agree that problem-based learning works well for medical students with some prior knowledge of anatomy and physiology. In fact, carefully-designed cases help the students to understand the importance of the basic concepts of physiology in managing clinical problems, in a way that old-style lectures did not.

Avatar of:

Posts: 0

September 12, 2011

I don't know that more dissected frogs is necessarily what undergrad courses need but a more "apprenticeship" type of approach would be helpful for all UK institutions. From my own recent experience as an undergrad and judging by what the undergrad/recentgrad students I've taught since have said I would make industrial years compulsory.

I also think universities should scrap the highschool-style lab sessions and replace them with one real lab based project a year. It would mean extra students every year for the labs which is more work and obviously a drawback... but a lot of that would be offset by having more able PhD students and having a much clearer picture of a prospective students abilities.

Avatar of:

Posts: 0

September 12, 2011

I don't know that more dissected frogs is necessarily what undergrad courses need but a more "apprenticeship" type of approach would be helpful for all UK institutions. From my own recent experience as an undergrad and judging by what the undergrad/recentgrad students I've taught since have said I would make industrial years compulsory.

I also think universities should scrap the highschool-style lab sessions and replace them with one real lab based project a year. It would mean extra students every year for the labs which is more work and obviously a drawback... but a lot of that would be offset by having more able PhD students and having a much clearer picture of a prospective students abilities.

Avatar of: Helen Troilo

Anonymous

September 12, 2011

I don't know that more dissected frogs is necessarily what undergrad courses need but a more "apprenticeship" type of approach would be helpful for all UK institutions. From my own recent experience as an undergrad and judging by what the undergrad/recentgrad students I've taught since have said I would make industrial years compulsory.

I also think universities should scrap the highschool-style lab sessions and replace them with one real lab based project a year. It would mean extra students every year for the labs which is more work and obviously a drawback... but a lot of that would be offset by having more able PhD students and having a much clearer picture of a prospective students abilities.

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