Why Comrade PhysioProf Loves Teaching Medical Physiology

Nov 09 2008 Published by under Mentoring

Comrade PhysioProf--while mostly focused on prosecuting his research program and mentoring the trainees in his lab--also spends a substantial amount of time teaching physiology to medical students. During the academic year, I lead a 1.5 hour tutorial session every week in which a break-out group of the first-year students and I discuss the physiological principles presented in that week's lectures. I fucking love this shit!

I consider my task two-fold. First, medical students--not suprisingly--are motivated by the desire to treat patients. They frequently view the basic sciences as an irrelevant obstacle to be overcome, so that they can barely pass their basic science boards and get to the clinics. I strive to demonstrate to them that a deep knowledge of human physiology will enable them to be better clinicians. What's my sales pitch?
Well, medical students learn--if they don't already know--that practicing medicine is 99% pattern recognition as soon as they set foot in the medical school bookstore and see the racks and racks of pocket cards and pocket guides that are all organized around identifying defining combinations of characteristics of particular pathological states and then reading off the relevant diagnosis, prognosis, and intervention. Deep knowledge of physiology doesn't help physicians recognize patterns.
But if physicians become solely pattern recognition machines, then they become helpless in the face of unrecognizable patterns. And this is where deep knowledge of all the basic sciences is important. And for internal medicine, physiology is paramount. I passionately advocate to my students that really getting down and dirty with physiology is the only way to handle their clinical cases that don't match the patterns they have learned, or that are on their pocket cards/guides. Through the application of physiological principles, novel presentations can be understood, and reasonable interventions proposed.
And all the evidence suggests that my Comrade PhysioProf's sales pitch is effective, as both student feedback and top-down administrative feedback is that Comrade PhysioProf is very effective at motivating his students to work their asses off at the medical physiology curriculum.
OK. So the first aspect of my task, just dealt with, is to motivate first-year medical students to give a shit about physiology. What's the second? Well, they gotta actually learn the shit!
Physiology, by definition, is a quantitative discipline in which the mathematical relationships between interacting biological variables are examined, both empirically and theoretically.
We have students who are all intellectually brilliant, but with a very wide range of disciplinary backgrounds, ranging from applied mathematics majors to history majors. As you can imagine, these students have greatly different abilities to deal easily and intuitively with complicated mathematical formulae.
Some of my fellow senior faculty respond to this diversity with dismay, and even disdain for the our admissions process, and rue the days when medical students were all hard science majors with extensive quantitative backgrounds. These faculty refuse to let go of their equations as the primary means for conveying physiological principles.
Comrade PhysioProf prefers to take a much more intuitive and teleological approach to conveying physiological principles to medical students. I explain to them that the vast majority of the mathematical formalisms of physiology are more or less complicated versions of Ohm's law. And I ask them to imagine how they would design a system to perform the task at hand: keep cardiac output constant, keep the membrane potential constant, maintain body fluid and solute homeostasis, etc.
Without getting too technical, for our non-physiologist readers, my overriding pedagogical principle is that I am much more interested in inculcating in my students an intuitive grasp of the relationships between physiological variables than I am in exact mathematical formulae. I want them to feel in their guts the reason why when extracellular potassium increases, the membrane potential becomes more depolarized. I am less concerned with their ability to write out the Nernst equation.
I derive a huge amount of pleasure seeing the transitions of my students' faces from "HUH!?" to "AAAHH!!" And I hope that my pedagogical efforts eventually lead to some sick patient who might have otherwise died surviving, because one of my students was excited and educated by my tutorials.

26 responses so far

  • Arlenna says:

    This is how we teach Organic Chemistry to our pre-Pharmacy students, and it sure works! They still find it incredibly difficult and need to put all their best effort into surviving the course, but they actually LEARN, like REALLY learn, things they need to know in the process. I love it.

  • llewelly says:

    wait a minute. Comrade PhysioProf wrote something positive? Is he off his meds? Did he get new meds? Better meds? Whatever it is, keep it up.

  • Oh wow - I LOVED taking classes from profs like you...way more into the intuitive grasp of relationships than solve mathematical equations. Keep up the good work.

  • I think often a physiologist is someone who thought they wanted to be a doctor, realized they were an engineer, and realize how to marry their two passions. At least such was the case for me.
    I think we do students a great disservice if we allow them to leave a physiology curriculum without teaching them to draw a block diagram or to write a mass balance. So many basic physiologial principles (the Frank-Starling Principle, renal filtration, the alveolar gas equation, Ficks Law) are easily understandable if you begin with a block equation and a mass balance.
    But you keep on rockin' the med phys, brother physiologist. Your enthusiasm for teaching is admirable.

  • In an earlier life, I was a mathematics teacher and used much the same sort of approach as you've indicated. Providing the students with tools that will enable them to see how and why things work is much more effective in both the short and long term, regardless of the subject area. Seeing the sudden look of comprehension on the students' faces is what teaching is all about for me. Now if only I could remember some of those mathematical principles myself ...

  • Sven DiMilo says:

    Right on, man. I've taught physiology to undergrads--premeds and nonmajors alike--for 12 years now, and I long ago gave up making 'em know much math. Some simple proportionalities, plus graphs of the relationships among variables are much more to the point, I think. And clear explanations of what the equations mean in words. By the way, seen this excellent tool for visualizing the Nernst and Goldman equations?

  • PalMD says:

    physiology and pathophys always felt like "real" classes. It felt more relevant, even, than gross anatomy. Learning how things worked seemed a basic step to learning how things stopped working.

  • S. Rivlin says:

    More often than not, it is a dysfunction or a disorder that teaches us about the function or the order. There is still much unknown in neurophysiology and a big chunks of new knowledge originates from studying neuropathophysiology. Thus, much new knowledge about cerebral energy metabolism and homeostasis has been glean in the past 20 years from the study of cerebral ischemia.

  • Eugenie says:

    I really, really want to take a physiology class. It would be freaking awesome if CPP taught it too. But I'll have to settle with what my school offers....
    I'm more or less a stats/math freak, ex-biophysics major with an academic masochist mindset.... I want to know how things work, damnit.

  • DDeden says:

    wowzer. yeah, pattern recognition and meta-pattern recognition are both critical to the How, but you gotta go holistic to find the Why, which was my dig/dive/discovery...
    and Greg's quote 'don't be a chimp', frosting on the cupcake!

  • Becca says:

    "an intuitive grasp of the relationships between physiological variables [rather] than... exact mathematical formulae."
    Yes! Although, for me at least, an intuitive grasp of the relationships between physical variables was what I needed to get exact mathematical formulae.
    I think teaching calculus without teaching physics is unnecessarily cruel.

  • DSKS says:

    "I am less concerned with their ability to write out the Nernst equation."
    Agreed. Although, this is quite a cool and intuitive little Flash program on that subject, if you haven't already seen it.

  • DSKS says:

    Sorry, didn't scan the comments thoroughly. DiMilo beat me to it.

  • dajokr says:

    I just returned from several days of a workshop for academic administrators where one session was led by an early advocate of the teaching portfolio to document one's educational service. This post is a superb example of a compelling teaching philosophy with which to lead off such a portfolio.

  • I just returned from several days of a workshop for academic administrators where one session was led by an early advocate of the teaching portfolio to document one's educational service. This post is a superb example of a compelling teaching philosophy with which to lead off such a portfolio.

    Yeah, that would be nice if medical schools gave a flying fuck about the "teaching philosophy" of basic science faculty in making promotion/tenure decisions.

  • Unfortunately, the typical criteria for successful "teaching" is centered around how much information the students can regurgitate at the end of the semester. There's a truckload of shithouse "teachers" out there who only teach because they have to for tenure requirements and the like, despite the fact that they have little/no teaching skill or experience and often no interest in facilitating student learning. Motivated students, such as those typically found in medical schools, overcome this ridiculous situation by rote-learning out of a book which comes back to CPP's original point about the importance of learning the how, what and why of physiology.

  • meep says:

    Most of my physiology profs in grad school were not good teachers. Clearly, they understood the material (and DID enjoy giving lectures), but most of the class barely understood anything.

  • Meep, please share with us what was ineffective about their teaching? That would be very valuable information for those of us who are always seeking to further improve our own.

  • Beth says:

    Mmmm this is exactly how I came to enjoy physiology so much, and exactly the type of lessons I thrived on. The best lecturers I had covered the maths behind the physiology, but the main emphasis was on how systems work together as a whole. Everything always centered around homeostasis and how it is achieved. Once I understood the practicality of it, the maths came easily. Love it!!!

  • CPP, you are awesome. I suspect that I would have classified you as one of the profs that I'd have an "academic crush" on.
    Isis, when you throw around terms like "Fick's Law", you make my heart go pitter patter.

  • Dr. Isis says:

    CPP, you are awesome. I suspect that I would have classified you as one of the profs that I'd have an "academic crush" on.
    Isis, when you throw around terms like "Fick's Law", you make my heart go pitter patter.

    I think the hotness of PP's teaching post and CE's worship is too much for this humble goddess to handle. You both are simply lovely...except that CE is more lovely.

  • meep says:

    CPP, these things I thought were ineffective: No handouts containing notes, handouts of powerpoint slides with figures from textbooks we didn't have, and the assigned readings were almost exclusively on the lecturer's system of interest. This last issue is ok except that it gave a very narrow view. The grades were based on an essay (paper) and two multiple choice exams: the midterm and final. The grading of the paper was subjective, IMHO. Keep in mind that this class was geared towards grad students, not medical students. Your lectures are probably tailored for a different type of audience.

  • Lamar says:

    as long as they can sign their name on my Vicodin script at the end of the day, I'm happy.

  • dajokr says:

    Yeah, that would be nice if medical schools gave a flying fuck about the "teaching philosophy" of basic science faculty in making promotion/tenure decisions.

    Most of the folks at my workshop were at SLACs or other predominantly teaching institutions where instructional prowess is a major determinant in promotion and tenure decisions. Hence, I have even greater admiration for someone like you who cares so deeply out of personal pride and professional dedication.

  • S. Rivlin says:

    Not taking away from the importance of a good, dedicated and enthusiastic teacher, I think that we are allowing the American student to get away from her responsibility to study and comprehend the material.
    I started my career as a high school teacher and later in college before coming to the US. I find the American college or medical student to be lazy, spoiled and unwilling to invest time and effort in comprehending the material. For her, the main goal is the grade and the diploma. I had taught medical students, graduate students and residents. Especially where residents were concerned, I frequently found myself amazed at the lack of basic understanding of physiological, biochemical and pharmacological principles.
    Over the past two decades, as the number of Chinese students flocking to American universities has grew into the hundreds of thousands, we have had the opportunity to compare the difference between theirs and American students' drive, discipline and hard work. Considering the language deficit Chinese students suffer from, it is even more telling about the American student's laziness, lack of drive and unwillingness to work hard to achieve her goals.

  • matt says:

    PhysioProf's tutorials sound very cool. I can't help wondering, though, if teleological explanations mightn't encourage creationist tendencies in these medics. It's all too easy to conceptualise physiological processes in terms of "design" and elide the amazing stochastic messiness that drives them -- and that, inter alia, provides natural selection with so much scope for adaptation.

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