Кафедра патофизиологии


Заведующий кафедрой патофизиологии Первого МГМУ имени И.М. Сеченова 
член-корр. РАН, 
профессор Петр Францевич Литвицкий

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STRATEGY of TEACHING PATHOPHYSIOLOGY in XXI CENTURY

Professor Peter F. Litvitskiy              

Innovation concept of high medical education is being formed recently. Basic principles of this concept are applicable to teaching pathophysiology. At the same time the rational methods of pathophysiology teaching are able to optimize general approaches to educational process.

Innovation concept of teaching fundamental discipline “Pathophysiology” comprises the following basic features:

1) pathophysiology is the science on the essence of diseases and pathological processes; 2) pathophysiology basic method (both as an academic discipline and scientific specialization) is modeling; 3) the goal of studying pathophysiology in a medical high school is to teach both students and doctors skills (!) to solve efficiently their professional problems! 4) the object of pathophysiology studying consists of three components: – a disease, – typical pathological processes, – typical forms of pathology of organs and their systems; 5) the most effective method of pathophysiology teaching – showing how to solve practical medical problems; 6) an optimal principle of education process organization is the one based on modules! 7) continuity and succession of studying pathophysiology (within the systems of post graduate professional education and continuous professional development of a specialist) – are the necessary basis for a doctor’s professional growth; 8) special curriculums for doctors of various specializations are required for education process; 9) continuous monitoring - of students and trainees’ (customers for educational services), opinions, as well as opinions of employers (users of specialists) in respect of content and quality of education process is required for optimization of education process.

Pathophysiology is the science on the essence of disease and pathological processes. Human being is the common object for studying of all medical disciplines. Some of the disciplines (e.g., anatomy and physiology) study and describe laws of the human activity as a norm, i.e. develop “normology” of a human being. Most of the medical specializations study laws of nature/mechanisms of a patient’s vital activity (i.e. study a human being’s pathology). Pathophysiology is among them.
Pathophysiology is the part of medicine and biology, that: studies and describes actual causes, mechanisms and laws of emergence, development and termination of diseases and pathological processes; formulates principles and methods of their detection (diagnostics), treatment and prevention; develops the doctrine of a disease and an ailing organism, formulates theoretical guidelines in medicine and biology. Therefore, it is pathophysiology (in medicine and biology) that studies the essentials of illnesses: causes and conditions of their emergence, logic of their development and outcomes. The above is presupposed by the etymology of the term “pathophysiology” (pathos – suffering, illness; physis – nature, essence; logos – science): science on the nature of a disease. At different times and in different countries they also used terms like “general pathology”, “pathology”, “experimental medicine”, “comparative physiology”, “general and comparative pathology” to denote pathophysiology.                                                    
The main method of pathophysiology is modeling. Recently discussion on what is the main method of pathophysiology has been resumed. Experiment on animals has been considered the one for many years. But it is well-known that earlier and, especially, in our days pathophysiologists have been conducting various research on patients as well as experiments with human cells and tissues.
All pathophysiologists use methods of creating theoretical (logical) models of pathogenesis, carry out mathematical and computer modeling of diseases. However, the main and specific method of pathophysiology (both as medico-biological science and as an academic discipline) is the method of diseases and pathological processes modeling, as well of modeling of a patient as such. Pathophysiologists were the ones who developed and implemented pathological processes modeling in medicine!
The very emergence of pathophysiology was required by necessity to describe the essentials of what was concealed from a doctor when examining and treating a patient – i.e. mechanisms of emergence, development and outcome of a disease. It was necessary to simulate those mechanisms, together with the role of pathogenic factors, with the help of “artificial copies” of diseases – their models; describe them with medical terms, parameters and provisions, i.e. carry out intellectual modeling.
In principle, modeling can be dual: physical (material) or formalized (non-material, virtual).
Physical or material modeling on real physical objects (animals, their organs, cells, etc.). This type of modeling is a widely spread and informative method. At the same time, it is known, that modeling of human diseases on animals has significant disadvantages. They are determined by generic and social differences between animals and human beings. That is why they use opportunities of modern instruments and know-how, in order to estimate the injured organs condition, their changes, biochemical and electrophysiological characteristics – directly on a patient. The data received during clinical research allows pathophysiologists, first, to study laws of development and outcome of diseases directly on a patient; second, to give material for explaining etiology and pathogenesis of human diseases; to use it as the basis for development of methods for human diseases diagnostics; finally, to estimate whether the treatment has been effective.
Another type of modeling – formalized (non-material) modeling of diseases. It is the kind of logic or intellectual modeling. It is wide spread in pathophysiology and is realized as logical, mathematical, computer etc. modeling. We all use widely logical or intellectual modeling in the process of teaching students, while helping them to fulfill situational clinical, laboratory and other tasks.
Logical modeling of diseases and pathological processes, as well as of a patient as such, is widely used in clinical and scientific practice. One of the forms of intellectual modeling is medical (iatric) way of thinking. Students gain the basics of medical way of thinking in the process of carrying out pathophysiological analysis of experimental or clinical data, when fulfilling situational tasks in class.
The process of pathophysiological analysis carried out by students simulates a doctor’s behavior, who creates a model of a disease and of a patient as such, develops methods of disease diagnostics, as well as algorithms of its treatment. Pathophysiological analysis of the data on a patient, drawing the conclusion due to the results of the data estimation, are an option of intellectual modeling for a doctor to fulfill his actual professional tasks.
Medical way of thinking is one of forms of modeling: intellectual modeling of a patient and his disease. After examination of a patient, studying of the biochemical, electrophysiological, functional and other research results, a doctor creates a patient and his disease model. Taking the above into consideration he models a scheme of diagnostic search, methods of therapy and disease prevention in case of a particular patient. The basics of medical thinking in a medical high school are grounded in the process of especially teaching students the method of pathophysiological analysis of the data when they fulfill situational tasks.
The next issue I would like to discuss is the goal of the academic discipline “Pathophysiology”. To our mind, the goal of the discipline “pathophysiology” in a medical high school is to teach both students and doctors ability to solve their professional – i.e. medical tasks. and that must be done by using notions, concepts and methods of pathophysiology!
The goal can be achieved by carrying out specific pathophysiological analysis: analysis of the data on the pathological process, the disease and the patient on the whole. It can be data on electrophysiological, biochemical, genetic, functional and other changes in the human organism during emergence, development and outcome of a pathological process or a disease.
What problems can be solved with the help of pathophysiological analysis of the data on a pathological process or a disease? In the course of carrying out pathophysiological analysis of the above data we can define and reason the following: – etiology of a pathological process or a disease; – key-elements of their pathogenesis; – the most informative methods and principles of their detection (diagnostics); – principles and methods of their effective treatment and prevention. It is such approach to teaching pathophysiology in a medical high school – teaching on the basis of pathophysiological analysis of the data on a pathological process or a disease when fulfilling professional tasks in the department of pathophysiology - that allows: to form the basics of rational thinking and, what is more important, of effective actions of a doctor; to master methodology and “technique/know-how” of medical activity on the basis of a system pathophysiological analysis of situations; to purposefully use knowledge, methods and methodology of pathophysiology in the course of the above activity; to learn the skills of transforming factological form of the knowledge into professionally activated one!
On the basis of our long-standing experience teaching pathophysiology with the help of fulfilling medical tasks on the basis of pathophysiological analysis of the data on the pathological process or a disease – is one of the most effective teaching methods in a medical high school. It is significant that the above is related not only to teaching students on the pregraduate stage, but also of doctors on postgraduate stage, as well as within the system of continuous professional development of specialists.
Pathophysiologists are discussing the important issue on the subject or object of studying pathophysiology both as an academic discipline and scientific branch of study. They mention such notions as “inadequate function of the organs and tissues”, “vital activity of the ailing organism” or “changed functions of the organism” and the like. That is right to a certain extent. Nevertheless, these notions do not cover the whole range of pathophysiology as a subject!
Тo my mind, the subject (object) of pathophysiology studying and teaching are the following three phenomena: 1) diseases; 2) typical (stereotypiacl) pathological processes (for instance, inflammation, fever, hypoxia, extreme conditions, etc.); 3) typical forms of pathology of particular organs and their systems (for instance, anemia, abnormal heart rhythms, respiratory inefficiency of lungs, typical digestion failure in the gastro-intestinal tract, hepatic insufficiency (failure), typical kidney functions disorder, etc.). It should be noted that subject of pathology is characterized from the point of view of fulfilling specific tasks of Pathophysiology. These tasks of pathophysiology are detection and description of: causes and laws of diseases and pathological processes emergence (i.e. their etiology); mechanisms of their development, as a complex of pathogenic and adaptable processes (i.e. their pathogenesis); their evidence/presentations; principles of their diagnostics; algorithms of their treatment and prevention.
We have been intensively discussing the problem of “compatibility” of pre- and post diploma/postgraduate medical education recently in Russia!
It has become obvious that continuity and succession of studying pathophysiology in the systems of: - pre degree education; - post graduate education; - continuous professional development of a specialist – is the basis required for professional growth of a doctor. At present the concept of systematic, multi-stage teaching of pathophysiology has been developed and being implemented in practice by the department of pathophysiology of Sechenov First Moscow State Medical University. This system includes: – the basic cycle (course) of teaching pathophysiology in the 3-d year of the pre degree stage; – course of “Clinical pathophysiology (syndrome approach)”. It is delivered during the last year of the pre degree stage. Its purpose is studying of the most frequent human pathological syndromes. Mainly, syndromes of insufficiency of organs and their systems functions; – course of “Clinical pathophysiology (syndrome-nosological approach)”. It is delivered during physicians’ post-diploma specialization stage. Its purpose is studying of the most socially significant acquired human diseases and syndromes.
Such system of teaching pathophysiology provides, in our opinion, optimal conditions for high quality of doctors’ fundamental education, as well as for their continuous professional development.

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PATHOPHYSIOLOGY

( in Greek pathos - suffering, disease; physis – nature, essence; logos - the study of ) may be literally translated from Greek as «The study of the nature and origins of disease».

Academic pathophysiology is a clinically oriented training course and a scientific discipline which:

• discovers and describes consistent patterns as well as precise causes and mechanisms of emergence, development and outcomes of diseases, pathological processes, states and reactions;

• determines principles and methods for their diagnosis, treatment and prevention;

• formulates theory of disease and ill organism in general, basic principles and concepts of biology and medicine.

The subject of pathophysiological studies may embrace:

• diseases, morbid conditions, pathological syndromes, states, processes and reactions;

• typical pathological processes;

• typical forms of pathology of tissues, organs and their systems.

The leading method of pathophysiology is modeling of diseases, pathological syndromes, states, processes and reactions as well as modeling of whole patient.

The objectives of pathophysiology in medical university educational process are:

l to acquire the skills to:

a) conduct pathophysiological analysis of patients with respect to causes, mechanisms and outcomes of leading pathological processes and forms of pathology;

b) formulate principles and substantiate methods for their diagnosis, treatment and prevention;

l to develop methodological grounds and intellectual tools for efficient clinical reasoning and practical activity in health care field.

Pathophysiological analysis of clinical cases (exercised by students during training classes) helps to develop clinical thinking and problem-solving strategies based on thorough understanding of the patient.

Three generations of talented educators and well-known researchers worked in the Department of Pathophysiology contributing their shares to make it meet international quality standards in the field of education of both scientific researchers and clinical health workers.

The Department employees are involved in promising scientific research as well. Education staff members of the Department of Pathophysiology:

l studied the key role of reactive oxygen species and free radicals (including organic and inorganic molecules) in adaptive reactions in normal conditions and especially in such forms of pathology as tumors, atherosclerosis, coronary insufficiency and myocardial infarction, gastric and duodenal ulcer disease, drug addiction (scientific works by professors A.Kh. Kogan, P.F. Litvitskiy, S.V. Pirozhkov, assistant professor A.S. Sizykh);

l discovered and described the substantial features of pathogenesis, methods of diagnosis and treatment of such processes/forms of pathology as hypoxia, disorders of respiratory system, kidneys and liver, hemostatic system, ischemic stroke, the systemic form of arthritis, serum sickness, peritonitis, disorders of the protein metabolism (scientific works by professors N.I. Losev, V.A. Voynov, S.V. Pirozhkov, O.L. Morozova, assistant professors S.P. Sergeeva, V.V. Padalko, T.E. Karaoglanova, I.A. Budnik, Z.SH. Manasova, L.D. Maltseva, N.V. Samburova, post graduate V.N. Sakharov);

l described the mechanisms of tissue and organ injury in alcoholism and some forms of substance abuse (scientific works by professors S.V. Pirozhkov, E.B. Tezikov);

l substantiated the concept of coronary insufficiency as a combination of ischemic and reperfusion syndromes, and not only ischemic as had been believed before (scientific work by professor P.F. Litvitskiy);

l developed the concept of reperfusion cardiac syndrome in patients with transitory coronary insufficiency (scientific work by professor P.F. Litvitskiy);

l revealed the consistent behavioral patterns observed in students with psychoemotional stress (scientific work by assistant professor N.S. Andriutsa).

The scientific school of the Department of Pathophysiology of I.M. Sechenov First MSMU gave a significant contribution to the regional and international pathophysiology, pathology and clinical medicine. Notable staff and alumni of the school were the Heads of Departments and laboratories in Moscow, Saint Petersburg, Kiev, Grozny, Warsaw, Oxford as well as in some other world universities.

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