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Course is divided into three themes: Theme A; The Cell: Theme B;. Man: Theme C ... integrated metabolism were included in a new comprehensive course on ...
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BIOCHEMICAL EDUCATION

April 1976 Vol. 4 No. 2

M. LANDON & R. J. MAYER AN EXPERIENCE: SIX YEARS OF TEACHING BIOCHEMISTRY IN A NEW MEDICAL SCHOOL The Medical School at the University of Nottingham was the first to be established in the United Kingdom this century. In seeking advice on medical education, the University appointed an advisory committee, under the chairmanship of Sir George Pickering, which reported in 19651 . The Medical School Advisory Report included comments on defects of traditional medical education and made clear recommendations regarding the organisation of the medical course. The guiding principles included (i) to shape the preclinical part of the course to conform in pattern and objectives with that of other science departments of the university and (if) to integrate and co-ordinate as far as possible preclinical and clinical departments and studies. The form recommended for the medical course was that it should consist of two periods: the first, of three years, devoted to the basic medical sciences and divided into a two-year general and a one-year honours course; the second, of two years, concerned with the clinical sciences. It was suggested that the honours degree course (Bachelor of Medical Sciences) would be for the majority of medical students, which would be similar to the situation in the science faculties in Nottingham at that time. Application of principle (i) gave the form of the Bachelor of Medical Science course which is divided into Basic Medical Sciences (Part I) and Special Medical Sciences (Part II), while the material presentation was guided by principle (if). In October 1970 the Medical School had its first intake of 48 students and this n u m b e r was increased to 96 in October 1975.

D e p a r t m e n t of B i o c h e m i s t r y U n i v e r s i t y H o s p i t a l a n d M e d i c a l School Clifton Boulevard Nottingham NG7 2UH England

biological oxidation and protein synthesis. As originally envisaged the practical work for the students involved mainly semi-automated methodology based on the philosophy that the underlying biological principles were more important than manual dexterity. This concept was emphasised by the association of a discussion group with each practical session. The continued success of the discussion groups is apparent, but the lack of emphasis regarding m a n u a l dexterity has trivialised the experimental component of the work in the eyes of some students. The discussion groups present to students the face-to-face contact with staff typical of the classical tutorial situation. The envisaged expansion of students, perhaps to an intake of 168, is being met by instituting alternative practical teaching situations including videotaped practical demonstrations coupled with data handling and review self-assessment sessions. The latter will substitute for the present tutorials. These and other changes of detail will we hope cope with the problems of teaching at increased student-staff ratios and meet the criticism of the present laboratory exercises. The examination system is that of intermittent assessment. However, the 72 units of examination (each unit approximates 45 minutes of examination) are not spread equally throughout the six terms. Indeed, we feel that the tendency to have an above average n u m b e r of units in term 3 and particularly in term 6 contrasts with the original aims of intermittent assessment. We also feel that there is a need for a reduction in the total n u m b e r of units.

Basic Medical Sciences (Part I) The teaching in the two years of the Basic Medical Sciences Course is divided into three themes: Theme A; The Cell: Theme B; Man: T h e m e C; The Community. The staff of the Biochemistry Department teach components of Themes A and B, and the staff contribution is shown in Table 1. We have contrasted the course for the 1970 student intake with that for the 1974 student intake. The detail of the teaching pattern has changed more than the table indicates and undoubtedly will continue to change in the future. The integrated nature of biochemis~.ry teaching is seen by the contributions to other courses as shown in Table 1. The original philosophy of the cell biochemistry course, the major course in terms of biochemical content, was that students should first learn about protein structure and enzymology. Subsequently, metabolism and its regulation were covered on the basis of the different functions of subcellular fractions. The course culminated in a short series of lectures on integrated metabolism. For the 1974 student intake the changes from this original pattern in teaching have involved limited transpositions of lectures. However, a major change has been that those elements of disordered metabolism that were formerly covered in the lectures on integrated metabolism were included in a new comprehensive course on disordered metabolism taught in collaboration with the Department of Pathology. The popularity of this course with students may presumably be attributed to a clearer appreciation of the role of abnormal biochemistry in the aetiology of disease processes. This successful change has prompted us to consider the potential for decreasing the time spent on teaching basic material and for using this time to develop the concept of 'whole-man biochemistry'. This could include changes in metabolism in response to the extremes in m a n ' s environment .e.g. temperature, oxygen tension, in self-induced stress such as exercise and in therapeutic starvation. In addition to lectures our teaching includes practical sessions with follow-up discussion groups (12 students per staff member). The practical laboratory sessions include studies on the properties of proteins and enzymes, glucose oxidation and gluconeogenesis,

Special Medical Sciences (Part II) The Medical School Advisory Committee Report 1 included the following comments in relation to the proposal that most medical students would take an honours degree in Medical Science. The Committee felt that his was the only way advantage could be taken of the great advances that had been made in the biological sciences in the last thirty years. They further commented 'The practice of medicine is becoming a scientific discipline, and every doctor should be a scientist. It is the function of the medical school to ensure that he is a good scientist. For this reason the Committee is most emphatic in its recommendation that every student should aim at studying some subject in depth.' Accordingly, at Nottingham every student presently has the opportunity to spend the third year in close relationship with the staff of one department. Students may freely choose, as far as is practicable, one of the courses available in the Departments of Biochemistry, Community Health, H u m a n Morphology, Pathology (including Microbiology) and Physiology and Pharmacology. Currently the Special Medical Sciences year in biochemistry is essentially the sole responsibility of the Department of Biochemistry. The present format of the course is shown in Table 2. The heavy emphasis on the project (Table 2) fulfils our commitment towards the study of some topic in depth. Whereas the projects were intially (1972) mainly on biochemical problems, subsequently clinically related projects have been offered to the students as a matter of policy e.g. topics related to cancer, microbial toxins, hyperlipidaemia, porphyria and hyperlactataemia. There is a large clinical content in the Part II course. Clinicians contribute to a n u m b e r of the teaching sessions in the course on biochemical aspects of clinical medicine and there is the two week course on chemical pathology in the first part of the year. Overall we feel that the time spent on clinical biochemistry (in the broadest sense) and basic biochemistry could be redivided in favour of more clinical biochemistry. The students appreciate the analysis of specific clinical problems by a scientific approach which is offered

BIOCHEMICAL EDUCATION

April 1976 Vol. 4 No. 2

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by the staff of the Biochemistry Department (e.g. migraine, hypolipidaemic drugs, neonatal hypoglycaemia, Parkinson's disease). Although we have not used intermittent assessment as the basis for examinations it can be seen with reference to Table 2 that the more traditional pattern of examinations is somewhat divided over the year. In the future we envisage this course to change little overall in relation to increased student numbers thus maintaining the very special nature of the training of medical students at Nottingham. In summary the Basic Medical Sciences Course consists of two years of intensive teaching and learning with a large degree of

integration of departmental contributions. The Special Medical Sciences Course, of one year, is less intensive in terms of teaching and permits the student to pace himself during his project work, where he can apply himself to an in-depth study of a restricted area of biochemistry. He will, in this time, learn the scientific method and live the frustrations and small successes of scientific research in relation to clinical medicine.

REFERENCE i Report of the Medical School Advisory Committee. University of Nottingham, 1965.

TABLE I . B i o c . e m i s t r y Department Teaching in Basic Hedlcal Sciences (Part I) 1970 intake Year 1 Year I I

1974 intake Year I

Year II

Cell Biochemistry Introduction Proteins Enzymology Carbohydrate metabolism L i p i d metabolism ~nino acid metabolism Protein catabolism Nucleic acid biochemistry Integrated metabolism Bioenergetics C i t r i c acid c y c l e / o x i d a t i v e phosphorylation Biochemical pharmacology * Totals Tutorials

9 9 7 5 ) )

+ + + +

3 (2) (4) (2) (2)

+ + + +

[I] [2] [2] [2]

7

3 15 + (1) + [ I ] 6

3 5 + (I) + [I]

II

28 + (3) + [3]

7

+ (0 9

+ [I]

" 5 + (I) + [1] •

4 + (2) + [2]

48 + (11) + [8] t

I 9 + (2) + [ I ] 9 + (4) + [2] 8 + (2) + [2] 9 3

44 + (9) + [6]

2

5

20 + (I) + [ I ] 2

Other courses Faculty i n t r o d u c t o r y course ( i n c l u d i n g measurement in medicine) Ceil s t r u c t u r e and f u n c t i o n Cell e x c i t a t i o n Respiratory system Locomotor system Disordered metabolism Metabolism and n u t r i t i o n A]imentary system Endocrine system Haemopoleticj lympl~-vascular systemf General and biochemical pharmacology Reproductive system

( ) [ ]

2 + (I) + ill 7 + (I) 2 + ( I ) + [1] 2 2

2 2 I

12 + ( I ) + [ I ] 2 7 JO ( I ) + [~]

2

Teaching in other courses

16 ÷ (3) + [2]

TOTAL

64 + (14) + [10]

p r a c t i c a l s , 3 hour sessions Discussion groups for p r a c t i c a l s ,

I + (1) 6 + (1) 2 + ( I ) + [1]

~ 1½-2 h sessions

13 41 + (3) + [3]

J8 + (3) + [1]

31 + (2) + [2]

62 + (12) + [7]

51 + (3) + [3]

Lectures in c e l l biochemistry, pharmacogenetics and biochemical pharmacology, Subsequently t h i s material is presented in general and biochemical pharmacology T u t o r i a l s are inserted at appropriate times in the course so t h a t blocks of course material (or relevant c l i n i c a l i m p l i c a t i o n s ) can be discussed,

TABLE 2. Biochemistry Department Teaching In Special Medical Sciences (Part I I t INTRODUCTION

PROJECT

COURSE MATERIAL

REVISION

ASSESSMENTS

(a) Laboratory 1 practice (b) Chemical | pathology l ACATION L i t e r a t u r e survey. Introduction essay f o r dissertation

(e) Biochemical aspects of c l i n i c a l n ~ d i c l n e (18) (b) Human genetics (6) * (c) E v o l u t i o n a r y b i o c h e m i s t r y (3)

L a b o r i t o r y ~ork for project

I i

I

I I I J

(e) (3) J (d) metabolismPhysl°l°gical(4) I n h e r i t e d d i s o rbiochemistry ders of

I

Revision tutorials In Cell Biochemistry'

( f ) Muscle biochemistry (3)

VACATION A= a b e .

I

W r i t i n g and

J

prelentation Of d i s e r t J I t l o n

I

I

i(g)

Inherited dlaorderl metabolism (4}

(h) Immunoblology (4)

The numbers o f lectures in each course are given .'in parentheses I - Assessment of i n t r o d u c t i o n to d i s s e r t a t i o n II, IV and V - Wrl t t e n assessments (3 x 3h)

of

I["'bo ll" I I I I - Assessments o f d i s s e r t a t i o n * Also 6 1½ h p r a c t l c a l sessions t Nine I h sessions