The haunting memory of a trauma patient.
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Biomedical subjects
Publications and source records attributed to J Engelberg.
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The development of the integrative dimensions of physiology will require texts and forms of study that differ from those to which we have become accustomed in the areas of specialization. The following two types of texts lie at the heart of integrative study: framework statements and case histories. Framework statements are scientific aphorisms that summarize integrative insights; ordered chains of these statements form conceptual frameworks that stimulate integrative dialogue and thought. Case histories are stories that portray the events in the life of a living being, generally human. The nature of these texts, how framework statements are created, and methods of how texts of this kind may be used in group dialogues are discussed.
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Concern is growing about the ability of categorical medicine residency programs, structured within academic health centers, to provide balanced, progressive, postgraduate internal medicine education. Detrimental factors, including over-representation of critically ill patients, shortened length of hospitalization, stress, discontinuity between undergraduate and graduate training, rotational assignments driven by hospital service imperatives, and total costs, may all negatively affect internal medicine residency education. Therefore, an experimental accelerated internal medicine (AIM) curriculum combining 3 years of undergraduate with 3 years of graduate internal medicine education has been initiated by the Department of Medicine and the College of Medicine at the University of Kentucky. After completion of the third year and during the first 13 months of the AIM curriculum, selected students are rotated through an integrated series of educational experiences that incorporate all of the requirements for graduation from medical school and progressively advance the students' skills, knowledge, and responsibilities to that of a second-year resident. Thereafter, the curriculum is similar to that of the categorical residents, except that more ambulatory care and off-site rotations are interspersed to better provide the educational experiences representative of the practice of internal medicine. Evaluations of the first groups of AIM residents indicate that their performance has equaled that of the control residents who graduated after 4 years from the College of Medicine. Furthermore, the AIM residents report general acceptance by their fellow residents and attending physicians and report no undue stress in making the transition.
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Complex clinicopathological conferences from the New England Journal of Medicine are used to introduce first-year medical and graduate students to scientific reasoning at the level of the whole organism and to help them mobilize and integrate the knowledge obtained in their previous studies. The approach involves outlining the etiology of the case history. This becomes a framework for thought allowing students to easily cope with the profusion of data. The method is cost effective: a single professor can interact with a large class, yet engage students on a one-to-one basis. It is a powerful adjunct to, but does not replace, lecture or small group activities such as problem-based learning. An annotated case history involving diabetes mellitus is provided.
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Science education in the United States at all academic levels is widely perceived to need direct assistance from professional scientists. The current dearth of quality applicants from this country to medical and graduate schools suggests that our existing undergraduate and high school science curriculum is failing to provide the necessary stimulus for gifted students to seek careers in the health sciences. Recognizing the need to become more directly helpful to high school and college science teachers, members of the faculty of the Department of Physiology and Biophysics at the University of Kentucky College of Medicine held a 5.5-day Physiology Summer Workshop during June, 1989. Participants included 25 college teachers from Kentucky and 5 other states plus 22 Kentucky high school teachers. The presence of the two levels of educators provided communication about curricular concerns that would be best addressed by mutual action and/or interaction. Each day's activities included morning lectures on selected aspects of organ system and cellular physiology, a series on integrative physiology, and afternoon laboratory sessions. The laboratory setting allowed the instructor to expand on principles covered in lecture as well as provided the opportunity for in-depth discussion. A selection of evening sessions was presented on 1) grants available for research projects, 2) obtaining funds for laboratory equipment, and 3) graduate education in physiology.
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