Barreiros Neuparth, Nuno Manuel

Bensabat Rendas, António Manuel

English

Hrčak - Portal of scientific journals of Croatia

 76 Psychiatria Danubina, 2016; Vol. 28, Suppl. 2, pp S260–S262 Medicina Academica Mostariensia, 2016; Vol. 4, No. 1-2, pp 76-78 Letter to Editor © Medicinska naklada - Zagreb, Croatia PATHOPHYSIOLOGY AS AN AUTONOMOUS DISCIPLINE  IN THE MEDICAL CURRICULUM IN PORTUGAL -  REACTION TO CHURILOV’S PAPER Nuno Manuel Barreiros Neuparth1,2 & António Manuel Bensabat Rendas1,3 1Pathophysiology Department, NOVA Medical School, Lisbon, Portugal 2CEDOC, Chronic Diseases Research Centre, NOVA Medical School | Faculdade de Ciências Médicas,  Universidade NOVA de Lisboa, Lisboa, Portugal 3NOVA University, Lisboa, Portugal *  *  *  *  *  António Bensabat Rendas, at the Faculty of Medical Sciences of NOVA University, in Lisbon, founded the first department of Pathophysiology, in Portugal in 1982. Although with a background in Experimental Pathology, from his PhD Thesis from the University of London (Cardiothoracic Institute), the original commit-ment given to him by the Medical School was to orga-nise a joint physiology and pathophysiology department which later became separated both for teaching and research functions. In 1987 the Problem-Based Learning (PBL) project was started, in collaboration with the Southern Illinois School of Medicine, in the United States, aiming at developing integrated pathophysiological reasoning and involving students in the learning process. In those years, teaching of medical students in Portugal was rather traditional, teacher-centred, discipline oriented and mostly lecture-based. The reason why it was so successfully applied to a single discipline such as pathophysiology was because its nature and specifities allows truly integration of basic sciences knowledge and the PBL methodology facilitates to cross the bridge to clinical medicine using real patient problems, although specially adapted. “After 3 years of using short-case presentations in small-group discussions, the project, in 1990, started aiming to develop the acquisition of pathophysiological knowledge in a clinical context and develop the other objectives of PBL - medical reasoning, self-learning, and motivation.” (Bensabat Rendas et al. 1998). In the PBL project we have used complete patient simulations, the PBL module, to develop information-searching and reasoning skills in a context closer to the future professional career. We believe that the introduction of PBL in a single discipline, in our medical school, was also made possible due to Pathophysiology’ s learning objectives - integrating knowledge from various basic sciences and using clinical examples to make pathophysiological knowledge easier to learn. A frequent criticism made about PBL use in the preclinical years relates to the fact that students have to extract information from a clinical case without any previous knowledge about history-taking methods or differential diagnosis. In this respect, our experience is similar to that reported by other groups (Barrows 1986), as we found out that our students used the clinical information to learn pathophysiology and were not primarily concerned about reaching a diagnosis. On the basis of this experience, we consider that PBL allowed our students to acquire relevant pathophysio-logical knowledge (Corrêa et al. 2003), but, because we have developed our strategies more toward educational interaction, we were still lacking evidence about students’ understanding of the concepts during the learning process. That’s why we have introduced the use of concept mapping in the PBL pathophysiology course since 2003 (Rendas et al. 2006). Although concept mapping was noted from the start as a significant innovation aimed to promote meaningful learning (Watson 1989), few studies have been reported in medical education, even fewer have been related to PBL and none in pathophysiology. From Croatia there is an integrative approach through algorithms and etiopathogenetic clusters (Kovac 2014).  Research in Pathophysiology  Since the foundation of the Department, it was planned to install in Portugal a multidisciplinary laboratory specialized in human functional evaluation. Our main expertise was, however, in the respiration field but not just related to the pulmonary area. This expertise allowed the installation of a lung function laboratory, unique in Portugal at that time. The basic equipment for lung function was first acquired followed by innovative techniques like the Respitrace® monitor (Sackner 1996), occlusion pressure for the evaluation of ventilatory control (Bárbara et al. 1995), a dosimeter for bronchial provocation tests (Gamboa et al. 1997), exhaled nitric oxide (Caires et al. 2008) and exhaled Nuno Manuel Barreiros Neuparth & António Manuel Bensabat Rendas: PATHOPHYSIOLOGY AS AN AUTONOMOUS DISCIPLINE  IN THE MEDICAL CURRICULUM IN PORTUGAL - REACTION TO CHURILOV’S PAPER Medicina Academica Mostariensia, 2016; Vol. 4, No. 1-2, pp 76–78   77 breath condensates (Martins et al. 2012). These research activities led to seven PhD thesis, not only in respiratory disease but also on integrated mechanisms of disease (see table 1).   Table 1. Research on mechanisms of disease Mota Carmo, M Mechanisms of dyspnea Neuparth, N Lung hyperinflation in asthma Gamboa, T Airways reactivity and hyperoxia Botelho, MA Functional capacity in elderly Bárbara, C Pathophysiology of hypercapnia in COPD  Fradique, A Mechanisms of metastases in gastric cancer Martins, PC Air pollution and bronchial inflammation  Since 2007, we belong to the NOVA Medical School Research Center – CEDOC (Chronic Diseases Research Center) that is focused mainly in Biomedical, Translational and Clinical Research on chronic diseases (www.cedoc.unl.pt). Our research group recently evolved from “respiratory diseases” to “integrated pathophysiological mechanisms of disease”. This research group includes now 30 investigators, of which 11 PhDs (10MDs). 8 lines of research are currently being developed: 1) Air quality and respiratory diseases (Carreiro-Martins et al. 2014); 2) Mechanisms of pulmonary fibrosis (Wuyts et al. 2013, Robalo Cordeiro et al. 2016); 3) Aging and integrated mechanisms of disease (Carreiro-Martins et al. 2016); 4) Mechanisms of acute infection (Póvoa & Salluh 2013, Póvoa et al. 2014); 5) Mechanisms of viral infection (Paixão et al. 2014); 6) Biomarkers of disease (Martins et al. 2008); 7) Integrated mechanisms of cardiovascular disease (de Sousa Almeida, de Araújo Gonçalves et al. 2016); 8) Mechanisms of cough.  Conclusion The challenge is now to consolidate the teaching of pathophysiology to medical students giving them a holistic perspective of disease and a comprehensive knowledge of the causes and of the mechanisms of disease, making the bridge to clinical sciences. Concerning research in pathophysiology, it is important to pursue on the route to a multidisciplinary function laboratory where clinicians are challenged to discover new mechanisms of disease and to develop new monitoring tools such as biomarkers.  Acknowledgements: None. Conflict of interest : None to declare.  References 1. Barrows HS: The scope of clinical education. J Med Educ 1986; 61:23-33. 2. Bensabat Rendas A, Rosado-Pinto P & Gamboa T: Problem-Based Learning in Pathophysiology: Report of a Project and Its Outcome. Teaching and Learning in Medicine 1998; 10:34-39. 3. Bárbara C, Carmo MM, Rendas AB & Avila R: Control of breathing. Acta Med Port 1995; 8:433-440. 4. Carreiro-Martins P, Gomes-Belo J, Papoila AL, Caires I, Palmeiro T, Gaspar-Marques J, Leiria-Pinto P, Mendes AS, Paulo-Teixeira J, Botelho MA & Neuparth N: Chronic respiratory diseases and quality of life in elderly nursing home residents. Chron Respir Dis, 2016. 5. Carreiro-Martins P, Viegas J, Papoila AL, Aelenei D, Caires I, Araújo-Martins J, Gaspar-Marques J, Cano MM, Mendes AS, Virella D, Rosado-Pinto J, Leiria-Pinto P, Annesi-Maesano I & Neuparth N: CO(2) concentration in day care centres is related to wheezing in attending children. Eur J Pediatr 2014; 173:1041-1049. 6. Corrêa BB, Pinto PR & Rendas AB: How do learning issues relate with content in a problem-based learning pathophysiology course? Adv Physiol Educ 2003; 27:62-69. 7. de Sousa Almeida M, de Araújo Gonçalves P, Branco P, Mesquita J, Carvalho MS, Dores H, Silva Sousa H, Gaspar A, Horta E, Aleixo A, Neuparth N, Mendes M & Andrade MJ: Impact of Renal Sympathetic Denervation on Left Ventricular Structure and Function at 1-Year Follow-Up. PLoS One 2016; 11:e0149855. 8. Gamboa T, Neuparth N, Ribeiro da Silva I, Rosado Pinto J & Bensabat Rendas A: Methacholine dose-response slopes from maximal bronchial challenge tests in asthmatic children: methodological aspects. Lung 1997; 175:243-252. 9. Kovac Z: Integrative algorhythms and etiopathogenetic clusters as study methods to bridge the chasms between the basic science and clinical medicine. Mol Med 2014; 2:51-56. 10. Martins P, Caires I, Rosado-Pinto J, Lopes da Mata P, Torres S, Valente J, Borrego C & Neuparth N: The clinical use of exhaled nitric oxide in wheezing children. Rev Port Pneumol 2008; 14:195-218. 11. Martins PC, Valente J, Papoila AL, Caires I, Araújo-Martins J, Mata P, Lopes M, Torres S, Rosado-Pinto J, Borrego C, Annesi-Maesano I & Neuparth N: Airways changes related to air pollution exposure in wheezing children. Eur Respir J 2012; 39:246-253. 12. Paixão P, Piedade C, Papoila A, Caires I, Pedro C, Santos M, Silvestre MJ, Brum L, Nunes B, Guiomar R, Curran MD, Carvalho A, Marques T & Neuparth N: Improving influenza surveillance in Portuguese preschool children by parents' report. Eur J Pediatr 2014; 173:1059-1065. 13. Póvoa P & Salluh JI: Use of biomarkers in sepsis: many questions, few answers. Rev Bras Ter Intensiva 2013; 25:1-2. 14. Póvoa P, Spriet I & Zahar JR: Antibiotic dosing in the critically ill: asking the same questions but expecting different answers. Intensive Care Med 2014; 40:1780-1782. 15. Rendas AB, Fonseca M & Pinto PR: Toward meaningful learning in undergraduate medical education using Nuno Manuel Barreiros Neuparth & António Manuel Bensabat Rendas: PATHOPHYSIOLOGY AS AN AUTONOMOUS DISCIPLINE  IN THE MEDICAL CURRICULUM IN PORTUGAL - REACTION TO CHURILOV’S PAPER Medicina Academica Mostariensia, 2016; Vol. 4, No. 1-2, pp 76–78   78 concept maps in a PBL pathophysiology course. Adv Physiol Educ 2006; 30:23-29. 16. Robalo Cordeiro C, Campos P, Carvalho L, Campainha S, Clemente S, Figueiredo L, Jesus JM, Marques A, Souto-Moura C, Pinto Basto R, Ribeiro A, Serrado M & Morais A: Consensus document for the diagnosis and treatment of idiopathic pulmonary fibrosis: Join consensus of Sociedade Portuguesa de Pneumologia, Sociedade Portuguesa de Radiologia e Medicina Nuclear e Sociedade Portuguesa de Anatomia Patológica. Rev Port Pneumol, 2006. 17. Sackner MA: A simple and reliable method to calibrate respiratory magnetometers and Respitrace. J Appl Physiol 1985; 81:516-517. 18. Watson GR: What is concept mapping? Med Teach 1989; 11:265-269. 19. Wuyts WA, Agostini C, Antoniou KM, Bouros D, Chambers RC, Cottin V, Egan JJ, Lambrecht BN, Lories R, Parfrey H, Prasse A, Robalo-Cordeiro C, Verbeken E, Verschakelen JA, Wells AU & Verleden GM: The pathogenesis of pulmonary fibrosis: a moving target. Eur Respir J 2013; 41:1207-1218. Correspondence: Nuno Neuparth, MD, PhD  Laboratório de Fisiopatologia, CEDOC, NOVA Medical School,  Rua do Instituto Bacteriológico, 5, Piso 1, Sala 1.10 1150-190 Lisboa, Portugal E-mail: nuno.neuparth@nms.unl.pt 

PATHOPHYSIOLOGY AS AN AUTONOMOUS DISCIPLINE IN THE MEDICAL CURRICULUM IN PORTUGAL - REACTION TO CHURILOV’S PAPER

Abstract

Similar works

Full text

Available Versions

Hrčak - Portal of scientific journals of Croatia