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

Apr 19, 2011
R.J. Naftalin


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.