A BALANCED APPROACH FOR FACILITATED, STEP LADDER LEARNING OF HUMAN PHYSIOLOGY

Pak J Physiol 2009;5(1)
A BALANCED APPROACH FOR FACILITATED, STEP LADDER
LEARNING OF HUMAN PHYSIOLOGY
Tariq Mahmood Alam
Department of Physiology, Wah Medical College, Wah Cantt: Pakistan
Background: In Pakistan, the 1st Year and 2nd Year examinations are held separately, bifurcating
each relevant subject in 2 almost water-tight compartments. The guiding principles by regulatory
bodies explicitly spelt out that Repetitive teaching of the same contents by different disciplines
must be avoided, and the university faculty is free to decide the order in which to teach a subjectآ.
Except few colleges taking marginal advantage of the above guidelines, most are still on board the
same old boats. Currently, in 1st Year: General & Cell Physiology, Blood, Nerve & Muscle
Physiology, GIT, CVS and Respiration; while in the 2nd Year, Body Fluids & Kidney, Nervous
System, Special Senses, Endocrinology and Reproduction are covered. Disadvantages: 1)
Maximum load of curriculum is shifted to 1st Year when the foliage students are already disturbed
by numerous adverse factors. 2) The topics of Biological Membrane, Liver Functions, their tests &
Jaundice in 1st Year and the Endocrinology and Acid/Base Balance in 2nd Year are being taught by
Physiology & Biochemistry, generating duplication. A balanced approach is suggested to cover
General & Cell Physiology, Blood, Nerve & Muscle Physiology, Respiration, Body Fluids &
Kidney in 1st Year, while GIT, CVS, Nervous System, Special Senses, and Reproduction in the 2nd
Year. Relevance will guide division of duplicated topics amongst Physiology and Biochemistry,
avoiding unnecessary repetition. Advantages: 1) All prevailing disadvantages are eradicated. 2)
All practicals in 2nd Year will be the clinical methods, facilitating clinical clerkship in 3rd year.
INTRODUCTION
2. Eliminate the repetitive teaching of the same
contents by different disciplines.
For the Medical Education in Pakistan, HEC and
3. Emphasize what the student must know, and
PM&DC are the regulatory bodies under the
yet ensure that the student is not over
constitutional
ordinance.
Their
directives
are
burdened.
mandatory to be followed by the medical institutions.
The HEC and PM&DC selects the
Paradox in the document on curriculum:
medical subject specialists as component of
Certain topics with similar contents are being taught
NCRC every three years to revise the booklet on
by Physiology as well as Biochemistry, generating
curriculum prescribed for MBBS. As the previous
the prohibited duplicity.
one was published in 2005; the revised booklet is
First Year:
in offing.
Biological Membrane, Liver Functions, Liver
In Pakistan, the subjects on Basic Medical
Function
Tests,
Iron
metabolism,
Fate
of
Sciences are bisected under the directive of
Haemoglobin and Jaundice
regulatory bodies and examined after 1st Year and
Second Year:
2nd Year respectively.
Endocrinology and Acid/Base Balance
MATERIALS AND METHODS
Duplication adds up unnecessary burden on
the students, and even muddling and confusion due to
The existing Curriculum of MBBS (Revised-2005)
the possible difference of opinion by 2 different
prepared by Pakistan Medical & Dental Council
teachers.
and Higher Education Commission, Islamabad1
In addition, the students being examined by
was critically analysed for application of the
2 disciplines for almost the same contents is
guiding
principles.
The
Physiology
and
unjustified.
Biochemistry syllabi prescribed for the first 2
years of MBBS were compared for any anomaly.
How to Customize Endocrinology
Physiology and Biochemistry constituted one subject.
The remedial measures which may be helpful to
As the knowledge started swelling, the mitosis
improve the relevant contents in the booklet
resulted into bifurcation of these into separate
awaited will be suggested.
disciplines at the undergraduate level.
RESULTS
Currently,
instead
of
the
respective
hormones, the headings relevant to all hormones have
The Guiding Principles by HEC (2002 & 2005):
1. Avoid the duplication of the contents which
been divided, as reflected in the Table-1.
extend into more than one discipline.
http://www.pps.org.pk/PJP/5-1/Tariq.pdf
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Pak J Physiol 2009;5(1)
Table-1: Curriculum for Endocrinology in
(11th Edition).2 In this book, the chapters on
Biochemistry and Physiology for MBBS 2nd Year
Endocrinology span from pp. 905 to 992. In this
S.#
BIOCHEMISTRY
PHYSIOLOGY
section the material exclusively relevant to
1
General Principles (GP)–
Physiology is displayed in Table-2.
Classification

2 Chemistry

The Endocrinology in chapters 74 to 79 (pp
3
Biosynthesis
905 to 994) constitute 90 pages. In this section the
4 Secretion

5 Regulation (of secretion)
Feedback Control (GP)
exclusive Physiology part is only 6 pages, i.e., less
Control of secretion
than 7%, where in, except for a total 1 page on
6
Transport
Growth, rest all is covered when other important
7 Mechanism of Action
Mechanism of Action (GP)
8 Effects on Carbohydrates,
Actions
systems of the body are taught.
Lipids, Proteins, Minerals
To remove these weaknesses, duplication
and Water Metabolism
and injustice; clear cut delineation is not impossible.
9
Metabolism (of hormones)
10 Disorders of various
Diseases in Endocrine System
Endocrinology
is
not
irrelevant
to
endocrine glands.
Physiology. Requirement is to assess the content-
In this table, the aspects of endocrines
relevance of individual hormones; to Physiology or
marked for Physiology at S. # 1, 3, 6 and 9 are
Biochemistry?
relevant to Biochemistry. The 5, 7, 8 and 10 being on
Keeping in view the logical sequencing of
both the sides, are duplicated. S. # 2 and 4 are already
the topics in Biochemistry, metabolism and then the
ascribed to Biochemistry.
endocrines as regulators of metabolism constitute a
The text book on Physiology being followed
nice and coherent package for the undergraduate
in most of the medical colleges in the country is the
students.
Text Book of Medical Physiology by Guyton & Hall
Table-2: The text on Endocrinology exclusively relevant to Physiology in the Text Book of Medical Physiology
by Guyton & Hall (11th Edition): Chapter 74–79
S.#
Hormone
Page#
Relevance
Pages
Remarks
1
Growth Hormone
923
Cartilage & Bone Growth
0.50

Hormones of Thyroid Gland
936—
Growth
0.25
*Discussed in the Physiology
2
*937—
*Cardio vascular
*1.00
of CVS
Adrenocortical Hormones
948–9…..
Renal effects
1.50
Discussed in the Physiology
3
953–4…..
Haematological effects
2.00
of Kidney and Blood
4
Insulin
967
Growth
0.25

Table-3: Suggested Curriculum for Endocrinology with Content-Relevance to Biochemistry and Physiology
Biochemistry
Physiology
Classification of Hormones.

General principles of secretion, regulation and the mechanism of action.

All aspects about the hormones of:
All aspects about:

Hypothalamus (Except ADH and Oxytocin)
The Physiology of Growth

Anterior Pituitary (Except Prolactin and Gonadotropins)

(pp. 923, 936, 967)

Thyroid
ADH

Parathyroid
Oxytocin

Pancreas
Prolactin

Adrenal Cortex
Gonadotropins
Biosynthesis, Transport,
Placental Hormones (Except the sex steroids)
Metabolic Actions and Metabolism of:
Non-metabolic Actions, Regulation and Disorders of:

Mineralocorticoids

Mineralocorticoids

Catecholamines
Catecholamines

Sex steroids
Sex steroids


It will be appreciated that the entire time
the directive of regulatory bodies and examined after
currently
ascribed
to
endocrinology
(in
First Year and Second Year respectively.
Physiology) will now be spared because the
The flexibility to modify the grouping and
responsibility portrayed for physiology in this
making the universities independent to change
grouping is already covered in other topics, like
grouping will probably fail the objective of
regulation of body fluids, reproductive and renal
uniformity at its own end.
physiology and ANS.
Facility of migrations dictates that all the
Grouping of the Topics for the First and Second
universities must adopt a uniform division of the
Year of MBBS
curriculum and also the sequencing of the topics to be
As it has been already mentioned that in Pakistan, the
taught in all the academic years, more importantly
subjects of Basic Medical Sciences are bisected under
during the first 2 years due to bisection.
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Pak J Physiol 2009;5(1)
The Pakistan Medical and Dental Council
Table-4: Current grouping of the body systems in
recognised medical colleges in Pakistan:
first 2 years of MBBS
Public Sector: 23+
1st Year MBBS
Private Sector: 30+ (With few more in the pipeline)
Topic
Lectures
Practical
General & Cell Physiology
10
2
Hence accepting the ground realities, we
Blood
30
32
will have to predetermine important principles, and
Nerve & Muscle
20
6
then go ahead for the grouping without defying
GIT
16

those principles.
CVS
45
20
1. Extend relatively more facilitation during 1st
Respiration
30
8
Year, to
Total
151
68
2nd Year MBBS
a. Help the foliage students tide over their
Topic
Lectures
Practical
latency
of
adjustment
in
a
unique
Body Fluids & Kidney
30

social/academic environment.
Nervous System
45
12
b. Absorb the late inductions.
Special Senses
16
14
c. Impact morale boasting on the 2nd Year
Endocrinology
30

consequent upon the naturally encouraging
Reproduction
15
2
Total
136
28
results from the lighter 1st Year.
d. Time consumption in
It becomes quite obvious at the very first
i) Delayed admission process
glance that we could not evolve the curriculum
ii) Further inductions in the next 1 or 2
commensurate with our specifications. The students
months
in their First Year have to bear approximately 35%
iii) During a lecture, grooming the students
more burden than the Second Year.
for etiquettes, ethics peculiar to a medical
Here, most of the knowledge gained during
institution.
the first year is more relevant to the commonly
iv) Adjustments in the newer environments
occurring diseases, which gets rusted during the
v) Language barrier especially for the
second year and becomes almost unavailable for
students hailing from the rural areas.
application during the clinical years.
vi) Registering a tremendous number of
[This fact is now being realized by few institutions.
unfamiliar medical terminologies.
One remedy being adopted is admirable to shift the
vii) Certain very basic concepts need more
GIT to the Second Year. But the other one is terrible.
time devotion and repetitions due to their
To reduce the practical load of 1st Year, the practicals
global application, like, the Genesis &
on Nerve and Muscle are shifted to Second Year with
maintenance
of
RMP,
the
Nernst
the plea that being the excitable tissue, these match
Equation, electrical events in the excitable
with the CNS. While performing the practicals on
tissues, muscular mechanics, etc.
Nerve and Muscle, the primary objective is to exhibit
 Relatively lesser time remains available for
the mechanical properties of the skeletal muscles
overall academic activities.
learnt during the theory of the Nerve & Muscle
2) The body systems demanding intra-topic and
physiology. Hence this divorce is not legitimate.]
the inter-topic integrations over a wider range
Table-5: Proposed grouping of the body systems
should be grouped in 2nd year.
in first 2 years of MBBS
3) The practicals should remain proportionately
1st Year MBBS
equal for both the years, keeping them
Topic
Lectures
Practical
integrated with their related topics in theory.
General & Cell Physiology
10
2
4) The practicals based on the clinical methods
Membrane Physiology
5

should be adjusted in second year, facilitating
Nerve & Muscle
20
6
the students’ clinical clerkship.
Blood
30
32
5) The grouping should generate minimum
Respiration
30
8
Body Fluids & Kidney
30

objections and yet achieve the maximum
TOTAL
125
48
objectives.
2nd Year MBBS
Keeping in view the approach of
Topic
Lectures
Practical
principles, let us have a look on currently in vogue
GIT (Motility)
12

division of the body systems for the first 2 years of
CVS
45
20
MBBS. The figures in the tables indicate the
Nervous System
45
12
number of hours.
Special Senses
16
14
Reproduction
15
2
TOTAL
133
48
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Pak J Physiol 2009;5(1)
In this system of grouping the glimpses out
problems inherent in teaching the same topics by
of the chapter 16 about the capillary dynamics and
two disciplines.
the Starling Equilibrium for capillary exchange will
4. In the second year, those systems (including GIT
need to be taught before starting the Body Fluids and
by the Biochemistry) will be taught which are
Renal Physiology.
involved in the diseases of common occurrence.
It will facilitate the students to effectively apply
CONCLUSIONS
their acquired knowledge and skills, being fresh,
1. During the 1st Year MBBS, facilitation is
to learn preclinical and the clinical subjects.
extended with more time available for repeated
5. The practical work in second year will be
discussions/presentations, and thus the students
altogether clinically oriented, helping the
are enabled to provide encouraging results, in
students to learn the clinical methods at an early
spite of their undeniable initial difficulties. It will
stage. It will facilitate their clinical clerkship in
provide them a morale boasting effect.
3rd year MBBS.
2. During the 2nd Year MBBS, when the academic
pressure is gradually mounted, the students can
REFERENCES
easily absorb the added pressure, having been
1.
Pakistan Medical & Dental Council & Higher Education
adjusted and conversant with the medical
Commission, Islamabad. Curriculum of MBBS, Revised
2005.
terminologies.
2.
Guyton AC, Hall JE. Endocrinology and Reproduction. In:
3. The duplication amongst the Physiology and
Guyton & Hall Text Book of Medical Physiology. 11th ed.
Biochemistry is removed. It will eradicate all the
Philadelphia: WB Saunders Company. pp 905–1041.
Address for Correspondence:
Prof. Tariq Mahmood Alam, Department of Physiology, Wah Medical College, Wah Cantt: Pakistan.
Email: physiocurriculum@hotmail.com
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