Introduction to the Course of Basic Medical Sciences

1. Xia Qiang, MD & PhD Department of Physiology Rm C518, Block C, Research Building, Zhejiang University School of Medicine, Zijingang Campus Tel: 88208252 Email: xiaqiang@zju.edu.cn Introduction to the Course of Basic Medical Sciences

2. Dr. Charles Sidney Burwell(Dean of HMS from 1935 to 1949) • At an HMS graduation in the late 1940s, he said “…Half of what we have taught you is wrong. Unfortunately, we don’t know which half.” • Dr. Burwell was a cardiologist who specialized in circulation changes associated with heart disease. He is credited with bringing attention to obstructive sleep apnea syndrome. In 1944, while Dr. Burwell was Dean, women entered Harvard Medical School for the first time on an equal basis with men.

3. 医学教育的三代改革 • 第一代医学教育改革：1900+ • 以科学为基础 • 学科的课程设置 • 第二代医学教育改革：1960+ • 以问题为基础 • 基于问题的学习 • 第三代医学教育改革：2000+ • 以系统为基础 • 以胜任力为导向

4. 从Flexner到Harden Harden RM, Sowden S, Dunn WR. Some educational strategies in curriculum development: The SPICES model. Med Educ. 1984; 18:284-297 Abraham Flexner Ronald M. Harden

5. PRISMS模型 Bligh J (2001). PRISMS: New educational strategies for medical education. Medical Education, 35:520-521 John Bligh

6. 基于胜任力的医学教育模型

7. 大学课程面向的对象 • 课程面向对象——已经是成人的大学生 • 成人学习的主要特点： • 学习是有目的的 • 学习是自愿的 • 学习应当是主动的，不是被动的 • 应该设定清晰的学习目的和最后目标 • 需要反馈 • 应该提供思考的机会

8. 新时期对我国医学教育课程体系的新要求 • 21世纪医学人才的培养目标： • 医学与自然科学、社会科学、生命科学越来越广泛的交叉渗透 • 现行的基于学科的课程体系无法适应社会对医学人才的需求 • 国际的： • 世界医学教育联合会1999年提出的《医学教育全球标准》 • 世界卫生组织和世界医学教育联合会2001年联合提出的《本科医学教育国际标准》 • 国际医学教育专门委员会2002年提出的《全球医学教育最基本要求》 • 国内的： • 我国教育部卫生部2008年联合提出的《本科医学教育标准》

9. 我国医学教育主要课程体系 • 基于学科的课程体系 • 通识、基础医学、临床医学“三段式” • 以学科为主的教学模式 • 基于系统的课程体系 • 按照人体器官系统组织课程的教学模式 • 基于模块的课程体系 • 通常是根据器官系统或某一主题组织课程，综合了医学、人文社科、伦理等知识内容 • 以问题为中心的课程体系

10. Discipline-based system • 优点： • 体现医学科学系统性、基础性、完整性，循序渐进教学，方便教学实施与管理，节省财力 • 缺点： • 以教师讲授为中心、以学科为中心，学科界限分明，各学科之间、基础学科与临床学科之间缺乏必要的联系

11. Problem-based system • 优点： • 打破了传统课程体系，围绕临床问题综合组织相关学科内容为课程，加强了基础医学与临床的联系，精简课程，使学生早期接触临床，直接从临床工作实际出发，提高学生独立学习和解决问题能力 • 缺点： • 缺乏基础知识的系统性

12. Organ/System-oriented system • 优点： • 按照人体解剖结构，按某一器官系统把相关的解剖、生理、病理、疾病的临床表现，乃至诊断和治疗原则综合起来组织课程，以加强学科间的联系和减少课程间的重复，使基础与临床结合得到较好的解决 • 缺点： • 课程结构不稳定，教学难度大

13. International criterion • 世界医学教育联合会(World Union of Medical Education)提出的本科医学教育国际标准(International criterion of medical education for undergraduate students)，分为九大领域共计36个亚领域 • 2 教育计划 • 2.6 课程计划结构、组成和期限 • 高标准： • 课程计划应该将基础学科与临床学科整合 • 学科整合包括课程组成部分的横向（并行课程）和纵向（先后课程）的整合

14. 模块化课程举例

32. What is MEDICINE? • Medicine is the art and science of healing. It encompasses a range of practices evolved to maintain and restore human health by the prevention and treatment of illness • The word medicine is derived from the Latin ars medicina, meaning the art of healing

33. What is MEDICINE? • The science of diagnosing, treating, or preventing disease and other damage to the body or mind (http://www.thefreedictionary.com/medicine) • Medicine is concerned with maintaining or restoring human health through its study, diagnosis, and treatment (http://www.bio-medicine.org/medicine-definition/Medicine/)

34. The Rod of Asclepius, with its single snake, is an ancient Greek symbol associated with medicine 蓝色生命之星交叉的六条臂象征着急救医疗系统的六大功能：发现、报告、反应、现场抢救、运输途中监护、转至院内救治 医神之蛇杖(rod of Asclepius)：一條蛇盤繞一根杖的，稱為醫神之蛇杖(rod of Asclepius)。所說的醫神叫阿斯克勒庇奧斯，他是太陽神阿波羅的兒子。 赫密斯之杖(caduceus)：兩條蛇之上有一對翼的，稱為赫密斯之杖(caduceus)。赫密斯(Hermes)是希臘神話裡神的信使，專管冶煉金術士。因為到了十六世紀末，煉金術士與醫學關係密切，赫密斯之杖漸漸地成為一些醫療組織採用的象徵。现代人将双蛇杖视为贸易和运输行业的象征，也象征著医学以及炼金术。 但專業醫療組織認為醫神之杖才是最正統的，而採用赫密斯之杖的多是醫療行業的商業組織。

35. Main branches of medicine • Basic sciences of medicine (基础医学): this is what every physician is educated in, and some return to in biomedical research • Medical specialties (专科) • Interdisciplinary fields (跨学科领域): where different medical specialties are mixed to function in certain occasions

36. Basic Sciences of Medicine • Anatomy (解剖学) is the study of the physical structure of organisms. In contrast to macroscopic or gross anatomy, cytology and histology are concerned with microscopic structures. • Biochemistry (生物化学) is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components. • Biostatistics (生物统计学) is the application of statistics to biological fields in the broadest sense. A knowledge of biostatistics is essential in the planning, evaluation, and interpretation of medical research. It is also fundamental to epidemiology and evidence-based medicine. • Cytology (细胞学) is the microscopic study of individual cells. • Embryology (胚胎学) is the study of the early development of organisms. • Epidemiology (流行病学) is the study of the demographics of disease processes, and includes, but is not limited to, the study of epidemics. • Genetics (遗传学) is the study of genes, and their role in biological inheritance. • Histology (组织学) is the study of the structures of biological tissues by light microscopy, electron microscopy and immunohistochemistry. • Immunology (免疫学) is the study of the immune system, which includes the innate and adaptive immune system in humans, for example. • Medical physics (医学物理学) is the study of the applications of physics principles in medicine. • Microbiology (微生物学) is the study of microorganisms, including protozoa, bacteria, fungi, and viruses. • Neuroscience (神经科学) includes those disciplines of science that are related to the study of the nervous system. A main focus of neuroscience is the biology and physiology of the human brain and spinal cord. • Nutrition (营养学) is the study of the relationship of food and drink to health and disease, especially in determining an optimal diet. Medical nutrition therapy is done by dietitians and is prescribed for diabetes, cardiovascular diseases, weight and eating disorders, allergies, malnutrition, and neoplastic diseases. • Pathology as a science (病理学) is the study of disease—the causes, course, progression and resolution thereof. • Pharmacology (药理学) is the study of drugs and their actions. • Physiology (生理学) is the study of the normal functioning of the body and the underlying regulatory mechanisms. • Toxicology (毒理学) is the study of hazardous effects of drugs and poisons.

37. Medical Specialties • Surgery (外科学): "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in "General Surgery." • General surgery (普通外科学) • Trauma surgery (创伤外科学) • Cardiovascular surgery (心血管外科学) • Neurosurgery (神经外科学) • Maxillofacial surgery (颌面外科学) • Orthopedic surgery (骨科学) • Otolaryngology (耳鼻喉学) • Plastic surgery (整形外科学) • Oncologic surgery (肿瘤外科学) • Vascular surgery (血管外科学) • Pediatric surgery (小儿外科学) • Anesthesiology (麻醉学)

38. Medical Specialties • Medicine (内科学): "Medicine" refers to the practice of non-operative medicine, and most subspecialties in this area require preliminary training in "Internal Medicine". • Cardiology (心脏病学) • Critical care medicine (危重医学) • Endocrinology (内分泌学) • Gastroenterology (胃肠病学) • Hematology (血液病学) • Hepatology (肝病学) • Infectious diseases (感染病) • Nephrology (肾脏病学) • Oncology (肿瘤学) • Proctology (直肠病学) • Pulmonology (肺脏病学) • Rheumatology (风湿病学) • Sleep disorder (睡眠障碍) • Neurology (神经病学) • Geriatrics (老年病学) • Pediatrics (儿科学) • Family Practice (全科医学)

39. Medical Specialties • Diagnostic specialties: • Clinical laboratory sciences (临床检验学) are the clinical diagnostic services which apply laboratory techniques to diagnosis and management of patients. In the United States these services are supervised by a pathologist. The personnel that work in these medical laboratory departments are technically trained staff who do not hold medical degrees, but who usually hold an undergraduate medical technology degree, who actually perform the tests, assays, and procedures needed for providing the specific services. Subspecialties include Transfusion medicine, Cellular pathology, Clinical chemistry, Hematology, Clinical microbiology and Clinical immunology. • Pathology as a medical specialty (病理学) is the branch of medicine that deals with the study of diseases and the morphologic, physiologic changes produced by them. As a diagnostic specialty, pathology can be considered the basis of modern scientific medical knowledge and plays a large role in evidence-based medicine. Many modern molecular tests such as flow cytometry, polymerase chain reaction (PCR), immunohistochemistry, cytogenetics, gene rearrangements studies and fluorescent in situ hybridization (FISH) fall within the territory of pathology. • Radiology (放射学) is concerned with imaging of the human body, e.g. by x-rays, x-ray computed tomography, ultrasonography, and nuclear magnetic resonance tomography. • Clinical neurophysiology (临床神经生理学) is concerned with testing the physiology or function of the central and peripheral aspects of the nervous system. These kinds of tests can be divided into recordings of: (1) spontaneous or continuously running electrical activity, or (2) stimulus evoked responses. Subspecialties include Electroencephalography, Electromyography, Evoked potential, Nerve conduction study and Polysomnography. Sometimes these tests are performed by techs without a medical degree, but the interpretation of these tests is done by a medical professional.

40. Medical Specialties • Other: • Ophthalmology (眼科学) exclusively concerned with the eye and ocular adnexa. Combines conservative and surgical therapy, and has its own College. • Dermatology (皮肤科学) is concerned with the skin and its diseases. In the UK, dermatology is a subspecialty of general medicine. • Emergency medicine (急诊医学) is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies. • Obstetrics and gynecology (妇产科学) (often abbreviated as OB/GYN) are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine are generally practiced by gynecological specialists. • Palliative care (姑息护理) is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal illnesses including cancer and heart failure. • Pediatrics (儿科学) is devoted to the care of infants, children, and adolescents. Like internal medicine, there are many pediatric subspecialties for specific age ranges, organ systems, disease classes, and sites of care delivery. • Physical medicine and rehabilitation (or physiatry) (物理医学和康复【物理疗法】) is concerned with functional improvement after injury, illness, or congenital disorders. • Psychiatry (精神病学) is the branch of medicine concerned with the bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related non-medical fields include psychotherapy and clinical psychology.

41. Interdisciplinary fields • General practice, family practice, family medicine or primary care (全科医学) is, in many countries, the first port-of-call for patients with non-emergency medical problems. • Many other health science (健康科学) fields, e.g. dietetics (营养学) • Bioethics (生物伦理学) is a field of study which concerns the relationship between biology, science, medicine and ethics, philosophy and theology. • Biomedical Engineering (生物医学工程) is a field dealing with the application of engineering principles to medical practice. • Clinical pharmacology (临床药理学) is concerned with how systems of therapeutics interact with patients. • Conservation medicine (保护医学) studies the relationship between human and animal health, and environmental conditions. Also known as ecological medicine, environmental medicine, or medical geology. • Disaster medicine (灾难医学) deals with medical aspects of emergency preparedness, disaster mitigation and management. • Diving medicine (潜水医学) (or hyperbaric medicine) is the prevention and treatment of diving-related problems. • Evolutionary medicine (进化医学) is a perspective on medicine derived through applying evolutionary theory. • Forensic medicine (法医学) deals with medical questions in legal context, such as determination of the time and cause of death. • Gender-based medicine (性别医学) studies the biological and physiological differences between the human sexes and how that affects differences in disease. • Hospital medicine (医院医学) is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are called hospitalists in the USA. • Medical humanities (医学人文学) includes the humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice. • Medical informatics (医学信息学), medical computer science, medical information and eHealth are relatively recent fields that deal with the application of computers and information technology to medicine.

42. Interdisciplinary fields • Nosology (疾病分类学) is the classification of diseases for various purposes. • Preventive medicine (预防医学) is the branch of medicine concerned with preventing disease. • Community health (社区卫生) or public health is an aspect of health services concerned with threats to the overall health of a community based on population health analysis. • Occupational medicine (职业医学)'s principal role is the provision of health advice to organizations and individuals to ensure that the highest standards of health and safety at work can be achieved and maintained. • Aerospace medicine (航空航天医学) deals with medical problems related to flying and space travel. • Osteopathic medicine (骨病医学), a branch of the U.S. medical profession. • Pharmacogenomics (药理基因学) is a form of individualized medicine. • Sports medicine (运动医学) deals with the treatment and preventive care of athletes, amateur and professional. The team includes specialty physicians and surgeons, athletic trainers, physical therapists, coaches, other personnel, and, of course, the athlete. • Therapeutics (治疗学) is the field, more commonly referenced in earlier periods of history, of the various remedies that can be used to treat disease and promote health [1]. • Travel medicine (旅行医学) or emporiatrics deals with health problems of international travelers or travelers across highly different environments. • Professions complementing physicians • Nursing specialties (护理专业): specialties performed by Nurses. • Mid-level practitioners (中级专业医师): performance of medical sciences by other certified people than physicians or nurses; Nurse practitioners, practitioners of medical psychology, midwives and physician assistants, treat patients and prescribe medication in many jurisdictions. • Allied health professions (健康相关职业): a diverse set of clinical healthcare professions distinct from medicine and nursing. • Urgent care (急救护理) focuses on delivery of unscheduled, walk-in care outside of the hospital emergency department for injuries and illnesses that are not severe enough to require care in an emergency department. In some jurisdictions this function is combined with the emergency room. • Veterinary medicine (兽医学); veterinarians apply similar techniques as physicians to the care of animals.

43. Branches of Medicine （中国分类） • 基础医学： • 人体解剖学、组织学和胚胎学、生理学、生物化学、微生物学、寄生虫学、免疫学、病理学、病理生理学、分子生物学、医学遗传学、药理学 • 公共卫生与预防医学 • 临床医学 • 口腔医学 • 中医学 • 法医学 • 护理学 • 药学

44. Basic Medical Sciences • Morphological courses: • 人体解剖学、组织学和胚胎学、病理学 • Functional courses: • 生理学、病理生理学、药理学、生物化学、分子生物学、免疫学 • Mixed courses: • 医学遗传学、微生物学、寄生虫学

45. 我校现有七年制教学计划一览