Tag Archives: medical physiology

Lighting the Spark: Engaging Medical Students in Renal Physiology
Jessica Dominguez Rieg, PhD
Department of Molecular Pharmacology and Physiology
University of South Florida Morsani College of Medicine

Recently, I spent some time reflecting on the way we teach physiology at my institution. One thing that kept coming to my mind- why does renal physiology get such a bad reputation? We often hear medical students commenting that renal physiology was the hardest topic of the first year, that there’s too much math involved, and concepts like acid-base and electrolyte disorders are too difficult to grasp. Does a negative attitude about renal physiology really matter in the long run? If the students can successfully pass USMLE Step 1, can I rest easy knowing they are competent in understanding how the kidneys function? Or can I, a basic science faculty, make a bigger impact on how these students view the renal system?

Chronic kidney disease is a growing public health concern in the United States, affecting roughly 40 million adults. Given the increasing burden of disease, an aging population, and modern medicine that is keeping patients with end-stage kidney disease alive longer, we need a robust workforce in nephrology. However, the field of nephrology is in the middle of a major crisis, and there is significant concern that there will not be an adequate workforce to meet the healthcare needs of patients afflicted with kidney disease. Only 62% of available nephrology fellowship positions were filled in the 2019 National Resident Matching Program match and less than 45% of positions were filled by U.S. MD graduates, making nephrology one of the least competitive subspecialties1. When does the waning interest in nephrology begin? Many think it starts early in a medical student’s academic journey.

I recently surveyed our medical students at the University of South Florida Morsani College of Medicine (250 respondents) and found that 60% of students agreed or strongly agreed that the topic of nephrology is interesting and yet close to one-third of them agreed or strongly agreed that renal pathophysiology is too complex and challenging for them. When asked what makes the biggest impact on their future career choice, 60% indicated that having role models and mentors in the specialty field was high impact; however, less than half of the students felt they had been exposed to encouraging role models or mentors in nephrology. Students ranked rotations during clerkships as having the highest impact in career choice; and yet our students are first exposed to nephrology during their Internal Medicine clerkship in their 3rd year, which only last 8 weeks. Not surprisingly, students ranked didactics in the preclinical years as having the lowest impact on career choice. What if we can change that? Perhaps there is too little done too late- and we just can’t get enough momentum going to gain a critical mass of students interested in nephrology. Is there anything that we, as medical physiology educators, can do to help? We can light the spark!

1. Make it matter. The complexity of renal physiology must be taught with meaningful clinical context. Students need to understand the clinical importance of what they are learning or there is a high chance they will get turned off from the very beginning. One of the best ways I have found to make it matter, is to work closely with my clinical colleagues. Not only can they provide (and co-teach) examples of how to

2. Make it digestible. Students often get overwhelmed by the level of detail that is expected in the renal block. We must ensure we are giving them the important content in bite-sized pieces so they have time to think about it, apply it, and understand it. I give our students a blank nephron map2 at the beginning of the renal block and ask that they work together to fill it out. On the last day of the renal block, we go through the maps together as a summary of renal function. Students like having all the transporters, hormones and key characteristics about each region of the nephron in one place. It helps them organize their knowledge and also gives them something to refer to in Year 2 and beyond.

3. Make it relatable. At our institution, students get renal physiology at the end of Year 1, so they’ve had all other organ systems besides reproductive physiology. I use many analogies throughout the renal system and always to try to highlight the similarities with the intestinal tract, which they are more familiar with at that point in time. After all, the nephron is like a “mini-intestine”, with similar histological features and transporter profiles. By relating the new renal content to something they’ve seen before, it can help make it a little easier to understand (and allows them to make systemic connections).

4. Make it stick. Students struggle with grasping acid-base disturbances. Consistent repetition and practice problems is key! Many times, students learn multiple ways to approach interpreting acid-base disturbances (different formulas, different values for expected compensatory responses, etc.) depending on who is teaching. This can be frustrating and confusing for students. We have found that having all faculty that teach some aspect of acid-base balance use a single resource, a step-by-step guide to interpreting acid-base disturbances3, has been very helpful in ensuring consistency in what we teach. Students also work through many practice problems in interpretation of arterial blood gases, starting in Year 1, again in Year 2, and again during the clerkships. The result is that students have gone from scoring less than 50% on NBME acid-base questions, to close to 90%- it’s sticking!

5. Make it fun! One of the notoriously challenging lectures in our preclinical years is integration of acid-base, volume, and electrolyte disorders. Traditionally, it was a lecture given by a nephrologist and was very technical and clinically oriented. However, students were lost and overwhelmed. So, I partnered with an internal medicine physician and we revamped the session into a fun, interactive series of cases where we co-facilitated discussion. Students were introduced to the 14th book of Lemony Snicket’s A Series of Unfortunate Events: The Hazardous Hospital, where they were asked to investigate the mysterious health issues of Sir Cornelius. The cases we presented were challenging and framed with very relevant basic science concepts, and students loved it! Not only did they have fun while learning, but they really appreciated having a basic scientist and clinician teaching together.

In conclusion, renal physiology is challenging and may be contributing to a lack of interest in a career in nephrology. As medical physiology educators, we have the ability to work with our clinical colleagues and revamp how we teach the renal system. We can get students engaged and excited about renal physiology by making the content clinically relevant, digestible, relatable and fun. After all, there needs to be a spark to light the fire!

References:

  1. National Resident Matching Program, Results and Data: Specialties Matching Service 2019 Appointment Year. National Resident Matching Program, Washington, DC. 2019
  2. Robinson PG, Newman D, Reitz CL, Vaynberg LZ, Bahga DK, Levitt MH. A large drawing of a nephron for teaching medical students renal physiology, histology, and pharmacology. Advances in Physiology Education. 42:2, 192-199, 2018.
  3. DeWaay D, Gordon J. The ABC’s of ABGs: teaching arterial blood gases to adult learners. MedEdPORTAL. 2011;7:9038.

Dr. Dominguez Rieg is a faculty member in the Department of Molecular Pharmacology & Physiology at the University of South Florida Morsani College of Medicine. She is the Course Director for the Gastrointestinal, Endocrine, Renal and Reproductive Systems block and the Physiology Integration Director that is responsible for mapping physiology content objectives across the entire curriculum. She teaches endocrine, renal and reproductive physiology and renal pathophysiology in multiple courses in the pre-clerkship years. She received her PhD in Physiological Sciences from the University of Arizona. Her research interests are kidney-intestine crosstalk and intestinal function in the context of systemic diseases such as obesity and diabetes. When she’s not at work, she is enjoying time with her young daughter and four German Shepherds.

Emerged Idea Led to a Unique Experience in Elephant’s City
Suzan A. Kamel-ElSayed, VMD, MVSc, PhD
Associate Professor, Department of Foundational Medical Studies
Oakland University

In May 2019, the physiology faculty at the Oakland University William Beaumont School of Medicine Department of Foundational Medical Studies received an email from Dr. Rajeshwari, a faculty member in JSS in a Medical College in India.

While Dr. Rajeshwari was visiting her daughter in Michigan, she requested a departmental visit to meet with the physiology faculty. Responding to her inquiry, I set up a meeting with her and my colleagues where Dr. Rajeshwari expressed her willingness to invite the three of us to present in the 6th Annual National Conference of the Association of Physiologists of India that was held from Sept. 11-14, 2019, in Mysuru, Karnataka, India.

The conference theme was: “Fathoming Physiology: An Insight.” My colleague then suggested a symposium titled “Physiology of Virtue,” where I could present the physiology of fasting since I fast every year during the month of Ramadan for my religion of Islam. To be honest, I was surprised and scared at my colleague’s suggestion. Although I fast every year due to the Quranic decree upon all believers, I was not very knowledgeable of what fasting does to one’s body. In addition, I faced the challenge of what I would present since I did not have any of my own research or data related to the field of fasting. Another concern was the cultural aspect in talking about Ramadan in India and how it would be received by the audience. However, willing to face these challenges, I agreed and admired my colleague’s suggestion and went forward in planning for the conference.

After Dr. Rajeshwari sent the formal invitation with the request for us to provide an abstract for the presentation, I started reading literature related to fasting in general. Reading several research articles and reviews, I was lost in where to begin and what to include. I began to ponder many questions: How will I present fasting as a virtue? Should I bring in religious connections? Will I be able to express spiritual aspects from a Muslim’s perspective? I decided that the aim of my presentation would be to describe how a healthy human body adapts to fasting, and the outcomes that practicing fasting has on an individual level and on the society as a whole. In addition, I found that focusing on the month of Ramadan and etiquettes of fasting required from Muslims had many physiological benefits and allowed me to have a real-world example in which fasting is present in the world.

Visiting India and engaging with physiologists from all over India was a really rich experience. The hospitality, generosity and accommodation that were provided was wonderful and much appreciated. The conference’s opening ceremony included a speech from the University Chancellor who is a religious Hindu Monk, along with Vice Chancellors, the organizing chair, and the secretary. In addition, a keynote speech on the physiological and clinical perspectives of stem cell research was presented by an Indian researcher in New Zealand. I was also able to attend the pre-conference workshops “Behavioral and Cognitive Assessment in Rodents” and “Exercise Physiology Testing in the Lab and Field” free of charge.

For my presentation, I included the definition, origin and types of fasting. In addition, I focused on the spiritual and physical changes that occur during Ramadan Intermittent Fasting (RIF). Under two different subtitles, I was able to summarize my findings. In the first subtitle, “Body Changes During RIF,” I listed all the changes that can happen when fasting during Ramadan. These changes include: activation of stress induced pathways, autophagy, metabolic and hormonal changes, energy consumption and body weight, changes in adipose tissue, changes in the fluid homeostasis and changes in cognitive function and circadian rhythm. In the second subtitle, “Spiritual Changes During RIF,” I presented some examples of spiritual changes and what a worshipper can do. These include development of character, compassion, adaptability, clarity of mind, healthy lifestyle and self-reflection. To conclude my presentation, I spoke of the impacts RIF has on the individual, society, and the global community.

In conclusion, not only was this the first time I visited India, but it was also the first time for me to present a talk about a topic that I did not do personal research on. Presenting in Mysuru not only gave me a chance to share my knowledge, but it allowed me to gain personal insight on historical aspects of the city. It was a unique and rich experience that allows me to not hesitate to accept similar opportunities. I encourage that we, as physiology educators, should approach presenting unfamiliar topics to broaden our horizons and enhance our critical thinking while updating ourselves on research topics in the field of physiology and its real-world application.  Physiology education is really valued globally!

Suzan Kamel-ElSayed, VMD, MVSc, PhD, received her bachelor of Veterinary Medicine and Masters of Veterinary Medical Sciences from Assiut University, Egypt. She earned her PhD from Biomedical Sciences Department at School of Medicine in Creighton University, USA. She considers herself a classroom veteran who has taught physiology for more than two decades. She has taught physiology to dental, dental hygiene, medical, nursing, pharmacy and veterinary students in multiple countries including Egypt, Libya and USA. Suzan’s research interests are in bone biology and medical education. She has published several peer reviewed manuscripts and online physiology chapters. Currently, she is an Associate Professor in Department of Foundational Medical Studies in Oakland University William Beaumont School of Medicine (OUWB) where she teaches physiology to medical students in organ system courses. Suzan is a co-director of the Cardiovascular Organ System for first year medical students. Suzan also is a volunteer physiology teacher in the summer programs, Future Physicians Summer Enrichment Program (FPSP) and Detroit Area Pre-College Engineering Program (DAPCEP) Medical Explorers that are offered for middle and high school students. She has completed a Medical Education Certificate (MEC) and Essential Skills in Medical Education (ESME) program through the Association for Medical Education in Europe (AMEE) and Team-Based Learning Collaborative (TBLC) Trainer- Consultant Certification. She is also a member in the OUWB Team-Based Learning (TBL) oversight team. Suzan is an active member in several professional organizations including the American Physiological Society (APS); Michigan Physiological Society (MPS); International Association of Medical Science Educators (IAMSE); Association of American Medical Colleges (AAMC); Team Based Learning Collaborative (TBLC); Egyptian Society of Physiological Sciences and its Application; Egyptian Society of Physiology and American Association of Bone and Mineral Research (ASBMR).