Humane education in pathophysiology in modern medical education
By Dr. Jurij Streltschenko, National Medical University of Donetsk
Pathophysiology is one of the fundamental medical and biological disciplines that complete the theoretical training of physicians and shape their scientific worldview and medical thinking. The aim of this discipline is to investigate the specific characteristics of the course of life processes in a diseased organism, to identify the fundamental laws of origin, development, course, and outcome, and to form a medical understanding of the essential aspects of a disease process. Like every other biological discipline, pathophysiology must continuously evolve in light of ongoing scientific and technological developments.
One of the core directions for improving teaching is the humanization of medical education for future doctors. This issue is an important part of academic teaching in terms of developing methodological frameworks for medicine and forecasting future developments in the field. Today, this is particularly important, as the development of medicine demands not only a solid material foundation and modern technical infrastructure, but also a conceptual justification for the tasks to be addressed.
As a science, pathophysiology is an experimental medical discipline whose primary method involves pathophysiological experimentation and modeling. Live-animal experiments are carried out on various animal species, as well as on isolated organs, tissues, cells, and subcellular structures. Traditionally, pathophysiologists have attempted to replicate standard pathological processes in animals (such as inflammation, fever, allergies), simulate individual symptoms and disease syndromes (arterial hypertension and hypotension, seizures, renal and hepatic failure), and model specific human diseases (pneumonia, atherosclerosis, myocardial infarction) and infectious diseases.
All of the above pertains to the scientific aspect of pathophysiology. However, in today’s educational landscape, these dogmas should not be transferred into teaching. Firstly, a pathophysiological teaching experiment is no longer an actual experiment in the scientific sense—it merely serves to demonstrate a well-established medical fact or pathological process. Such demonstrations can be conducted without causing the death of animals, as all classic demonstration experiments have long been documented in educational films. In addition, modern training equipment, models, and computer programs can now simulate real-life experiments.
Secondly, the human organism is more complex than even that of highly developed organisms (such as apes). It is influenced by social factors. Conducting an experiment is fraught with difficulties due to the complexity of pathological processes: the need to simultaneously investigate multiple aspects, the impossibility of observing all factors at once, the non-repeatability of certain human pathological processes, and the presence of potential sources of error.
From this perspective, it is scientifically and pedagogically unrealistic to model human diseases comprehensively in animals.
Indeed, 50 to 100 years ago, when there were no projectors, computers, overhead transparencies, or video recorders, live experiments were the only way to provide students with a visual learning experience. But not today – when every student carries a smartphone with internet access and can watch educational videos in lecture halls or at home.
The majority of demonstration experiments are not demonstrative at all. Take, for example, the simulation of chills in rats and rabbits. What is demonstrative about it? The rise in body temperature and metabolic rate – something we’ve all experienced firsthand. Why is it necessary to administer fever-inducing substances to animals for this reason?
Another example: simulating hydrodynamic pulmonary edema in rats by injecting adrenaline. The only thing students see is the animal writhing in pain and agony due to a myocardial infarction. The animal is then dissected to examine the lungs. And for that, an animal must die? I could list many more experiments that have lost their educational value in today's world.
The root of all this lies in morally outdated textbooks and curricula used to teach pathophysiology. These are simply copied year after year from hopelessly outdated handbooks that are at least 50 to 70 years old. These textbooks state, year after year, that experimentation is the principal method of pathophysiology. But as we know today, demonstrating the death of an animal is by no means a method of pathophysiology.
If you dig a little deeper, you will see that the roots of all our manuals and methodological guides lies in the "Plan of Teaching the Discipline." If it says that you have to kill 15 frogs and 10 rats a day as part of a teaching session, then this information is uncritically incorporated into the teaching manuals. And if, heaven forbid, a lecturer deviates from this program, they become an outsider who does not fulfill the technical standards of the course and is deemed to be teaching incorrectly.
To break out of this deadlock, curricula and textbooks need to be reviewed and rewritten. This requires a substantial effort, which nobody wants to take on. Young lecturers lack the time; moreover, no one will allow young lecturers to rewrite textbooks and curricula. Senior lecturers sometimes find it difficult to keep up with the times or lack the motivation. So the way of teaching has simply continued since time immemorial.
However, the Department of Pathophysiology at the National Medical University of Donetsk was fortunate to meet people in 2012 who were not indifferent to the use of animal demonstration experiments in teaching. They are Corina Gericke (Vice Chair of Doctors Against Animal Experiments), Nick Jukes (Head of the International Network for Humane Education, InterNICHE), and Dmitrij Leporski from the Ukrainian InterNICHE representation.
The faculty of the Pathophysiology Department, led by the then head Professor Viktor Nikolaevich Yelsky (a member of the National Academy of Medical Sciences of Ukraine and Doctor of Medical Sciences), enthusiastically embraced the idea of eliminating animal-based demonstration experiments from the curriculum and replacing them with humane teaching methods.
Within two months, we were provided with a large collection of educational videos, some of which were recorded in the USSR, others created by colleagues from universities in independent Ukraine. We also received interactive educational software simulating various animal-based lab experiments (e.g. blood tests, ECG recordings, electroencephalography, experiments on open frog hearts, and arterial pressure monitoring).
In October 2013, two projectors and two laptops with cases were kindly donated to us for the purpose of demonstrating the materials and programs received. A agreement was also signed between the university (represented by the new head, Professor and Doctor of Medical Sciences Sergej Vladimirovich Zjablicev), Doctors Against Animal Experiments, and InterNICHE on close cooperation and the renunciation of animal experiments for teaching purposes.
In this way, the number of laboratory animals used for teaching purposes in the pathophysiology department has already been reduced by 85%. The remaining 15% will be replaced over the coming year by alternatives developed by us together with colleagues from other universities and international colleagues. These include various training devices, physical models, and interactive computer programs.
Thanks to the use of laptops and projectors, it is now possible to demonstrate a pathophysiological or laboratory experiment without the use of animals to an entire group, sometimes even two groups (in lectures even a whole class). This is a step toward the future. Increasing emphasis is being placed on the mutual training, on an active teaching process, which is nowadays called interactive education.
In this new interactive teaching process, I believe there is no place for bloody demonstration experiments on animals. They take up valuable time (you have to prepare the animal for the exercise, housing and feeding it, disposing of biological waste – all just a fraction of the difficulties associated with the use of animals) and the clarity of these experiments is questionable. There is also a shortage of medical instruments, reagents, and materials.
There are also examples of integrating veterinary institutions and medical universities. Medical students not only see suffering animals but can also help them, thereby improving their medical skills. This is the future of medical education.
Moreover, there is a trend toward using scientific material from animals who have become ill or injured naturally. This approach rules out the cruel simulation of a pathological process in healthy animals. Pathophysiology is getting closer to clinical medicine with each year passing. There is even a name for this specialty: “Clinical Pathophysiology”. Here, students learn to analyze material obtained from actual patients. In our time, with the development of visualization methods of internal body areas and laboratory diagnostics, I believe the use of animals in teaching should be a thing of the past.
Thus, the teaching of pathophysiology at the National Medical University of Donetsk is continuously being refined to meet the demands of modern science and the humanity of the highest medical education.
December 14, 2013
Dr. Jurij Streltschenko
National Medical University of Donetsk