Combination of didactic lecture with problem-based learning sessions in physiology teaching in a developing medical college in Nepal

Physiology teaching as an essential part of medical education faces tremendous criticism regarding curriculum design, methods of implementation, and application of knowledge in clinical practice. In the traditional method of medical education, physiology is taught in the first year and involves little interdisciplinary interaction. The Manipal College of Medical Sciences, Pokhara, Nepal (affiliated with the Kathmandu Univ.) started in 1994 and adopted an integrated curriculum drawn along the lines of the student-centered, problem-based, integrated, community-based, elective-oriented, and systematic (SPICES) medical curriculum. Here, physiology is taught for the first 2 yr of the 4.5-yr Bachelor of Medicine, Bachelor of Surgery course. Methodology adopted is as follows. For a particular topic, objectives are clearly defined and priority content areas are identified. An overview is given in a didactic lecture class to the entire batch of 100 students. Tutorial classes are conducted thereafter with smaller groups of students (25/batch) divided further into five subgroups of five students each. In these sessions, a problem is presented to the students as a focus for learning or as an example of what has just been taught. Each problem was accompanied with relevant questions to streamline the students' thought processes. A tutor is present throughout the session not as an instructor but as a facilitator of the learning process. A questionnaire sought students' opinion on the usefulness of this approach, relevance of the combination of problem-based learning (PBL) sessions and didactic lectures in understanding a particular topic and relating clinical conditions to basic mechanisms, and improvement of performance on the university final examination. The majority of the students opined that the combination of didactic lectures and PBL sessions was definitely beneficial regarding all the above-mentioned aspects of learning. The university results corroborated their opinion. Thus it may be considered that a judicious mixture of didactic lectures and PBL sessions is beneficial as a teaching module of physiology in medical schools.     

The biology of cancer metastasis or, 'you cannot fix it if you do not know how it works'.

The major cause of death from cancer is the relentless growth of metastases that are resistant to conventional therapy. The pathogenesis of a metastasis is complex and requires that tumor cells complete a sequence of potentially lethal interactions with various host factors. The finding in 1973 that metastasis is a selective process and the finding in 1977 that malignant neoplasms are heterogeneous and contain few preexisting metastatic subpopulations have added a new dimension to our understanding of cancer and its spread. This understanding is now contributing to the design of better therapies against disseminated metastasis.     

Pay it forward: refuse dump from leaf‐cutting ants promotes caterpillar digestive performance by increasing plant nitrogen content

1. The activity of soil‐disturbing animals that increase soil nutrients can affect the carbon : nitrogen (C : N) ratio of plants, which, in turn, may determine the transfer of energy and nutrients through higher trophic levels. However, the strength and sign of this indirect effect depend on whether enhanced nutrient substrates increase plant foliar nutrients and/or plant defensive traits. 2. We investigated how the nutrient‐rich refuse dumps of the leaf‐cutting ant Acromyrmex lobicornis, as a result of their direct effects on thistles, indirectly impact the growth rate and digestive performance of a generalist chewing herbivore. We also included the application of commercial fertilisers to test whether the enhanced soil nutrients comprises the mechanism behind the impact of refuse dumps on the upward cascade effects. 3. Thistles growing on nutrient‐rich substrates (i.e. ant refuse dumps and fertilised soil) had more and larger leaves, up to 80% lower C : N ratios, and higher physical defences compared to plants growing on steppe soil. Caterpillars showed an enhanced digestive performance and growth rate when feed on nutrient‐rich plants and were able to adjust the C : N ratio of their excretion to regulate the relative acquisition of nutrients. 4. The positive effect of nutrient‐rich substrates on caterpillar feeding efficiency suggest that the enhanced nutritional quality of the thistles could compensate for the negative effects of the increased physical defences. The results of the present study indicate how organisms that increase soil nutrient availability may diminish the stoichiometric constraints at the base of food chains, enhancing the development and growth rate of herbivores and, thus, indirectly mediating plant–herbivore interactions.     

You wrote it; you own it!

Authors of papers published in Rockefeller University Press journals (The Journal of Cell Biology, The Journal of Experimental Medicine, or The Journal of General Physiology) now retain copyright to their published work. This permits authors to reuse their own work in any way, as long as they attribute it to the original publication. Third parties may use our published materials under a Creative Commons license, six months after publication.     

You wrote it; you own it!

Authors of papers published in Rockefeller University Press journals (The Journal of Cell Biology, The Journal of Experimental Medicine, or The Journal of General Physiology) now retain copyright to their published work. This permits authors to reuse their own work in any way, as long as they attribute it to the original publication. Third parties may use our published materials under a Creative Commons license, six months after publication.     

Don't forget the children.

Serious illness or hospitalization of a parent is potentially destructive to the mental health of the child. Stress is caused by both the separation and the illness itself. If the physician does not ensure that the situation is explained to the child, it is likely the child will be confused and frightened and any attempts at clarification will be blocked in the attendant family dysfunction. The general principles of prevention are to share the facts of the situation with the child and to allow him his natural and varied reactions. The family interview is useful in clearing up misunderstandings, sharing feelings and working out family roles.