Teaching
medical
AMAURI Department
physiology
in Brazil
B. BARTOSZECK of Physiology,
Federal
University
of Parana,
80001
Curitiba, Parana, Brazil
Bartoszeck, Amauri B. Teaching medical physiology in and two with MS degrees. It provided instruction to an Brazil. Am. J. Physiol. 263 (Adv. Physiol. Educ. 8): SIZ-SE, average of 85 undergraduate medical students each se1992.--n analysis of physiology teaching in Brazil is carried mester. The average unit of basic medical sciences (physout basedon data collected from a questionnaire sent to 78 iology) faculty includes two members with MD degrees, medical schools.It investigates faculty graduate degrees,time one with a PhD degree, and two with MS degrees. It spent on teaching, audiovisual equipment available, evaluation to an average of 63 undergraduate of student performance, books in current use, and areasof re- provided instruction medical students each semester. Exceptions to the above search.Local results as comparedwith those from an internaand one unit (located in tional sample have shown a preference for lectures and that pattern are three departments large departments are more concerned with research, but states of Sao Paulo and Rio de Janeiro), which have as changesare underway to introduce computer simulations and many as 30 faculty members each. modular instruction as a meansto improve teaching. Faculty members are usually appointed to work for periods of 20 or 40 h/wk. On average, departments of basic science;educational innovation
is based on a survey of Brazilian medical schools. It has three aims: to describe the strengths and weaknesses of physiology teaching in Brazil, to make available data for those seriously involved in teaching, and to attract support for Brazilian physiology teaching from national and international organizations. The teaching of physiology has been a matter of constant concern for the Brazilian Society of Physiology (SBFIS) and the Brazilian Association of Medical Education. In the mid-1980s SBFIS organized the Committee for Undergraduate Teaching, which published booklets describing complete courses in Medical Physiology (11) and Comparative Physiology. THIS ARTICLE
METHODS
A 14-question survey was developedto obtain information about the present status of physiology teaching in medical schoolsin Brazil (seeTable 1). It was concernedwith the graduate degreesheld by faculty, how the faculty spendtheir working hours, how many undergraduate medical students they teach eachsemester,how classesare taught, and whether learning objectives are used. The survey inquired about which technological resources,besidesbooks,were in use.Other questionsfocusedon the format of examinations and on whether instruction wasevaluated.The concluding questionsinvestigated the sourceof the work force in physiology. There were concluding open-ended questions that sought information about areasof research,deficiencies, and areaswhere departments of physiology and units of basic medical sciences(physiology) excelled. The questionnaire was mailed to all 78 accredited medical schoolsacrossthe country that are attached to public (either state or federally funded) and private universities. These schoolsprovide physiology instruction to medical undergraduate students either via formal departments of physiology or via units of basic medical sciences(physiology). Departments in state or federally run universities usually carry out research,but few units in private universities do so. RESULTS
Teachers from 23 departments of physiology and nine units of basic medical sciences returned the completed questionnaire by early 1990, a 41% return. The average department of physiology faculty includes four members with MD degrees, three with PhD degrees, s12
physiology spent more time on teaching (34.5% of weekly time) than doing research (28.5%), committee work or administrative service (22.0%), or other things (15.0%). One exception was that the faculty of units of basic medical sciences on average spent more time than faculty in departments (50.0% of weekly time) in other, nonspecified activities (probably related to joint appointments). Furthermore, two departments reported that they spend 60% of their weekly time on teaching. On the other hand, the second largest department (19 members) and the largest unit (9 members) responding to the survey, which were staffed by a larger percentage of members with PhD degrees than other groups, reported respectively that 75 and 50% of their weekly time was dedicated to research (Table 2). Although in general more time was devoted to teaching than to any other single activity, it was done mainly through the lecture format in departments and in units (52.5 and 63.0% of total teaching time, respectively). Laboratory practical classes were carried on as a secondary activity (36.0 and 34.0% of total teaching time for departments and units, respectively), most often as a demonstration performed by the teacher and rarely as a hands-on activity with student participation. Small group discussions accounted for a small percentage of total teaching time of either departments or units (12 and 3.5%, respectively; Table 3). Written learning objectives have been adopted by 71.0% of the departments and 78.0% of the units responding to the survey. On the topic of audiovisual material, the survey showed that practically all departments and units of physiology used slides and transparencies as educational resource material. Videotape instruction was reported as being used by 25% of the respondents, and &mm films by only 16% of responding departments. None of the units made use of films. The use of the computer as a technological aid was reported by 29% of the departments, but none of the units made use of them. Among the departments that adopted a textbook, 87% of them recommended Guyton’s Textbook of Medical Physiology in Portuguese translation (9). Twenty-six percent of the departments recommended that students also
1043-4046/92 $2.00 Copyright 0 1992 The American Physiological
Society
Downloaded from www.physiology.org/journal/advances by ${individualUser.givenNames} ${individualUser.surname} (129.186.138.035) on January 16, 2019.
TEACHING
PHYSIOLOGY
Table 1. Questionnaire sent to departments of physiology and units of basic medical sciences 1.
2.
3.
4.
5. 6.
7. 8. 9.
How many faculty members in categories below are teaching medical physiology? a) MD b) PhD c) MS How many undergraduate medical students are enrolled each semester? a) 1st semester b) 2nd semester How many hours are spent by faculty members in each activity below? a) Teaching b) Research c) Committee work or service d) Other things How many hours/week is physiology being taught by each format below? a) Lecture b) Laboratory practical classes c) Small group discussion Are written objectives for learning set at beginning of your course of physiology? Which technological aid or aids are used? a) Videotape b) &mm films c) Slides d) Transparencies e) Microcomputer Which textbook of physiology is adopted? a) 1st choice b) 2nd choice Which supplementary text is used? a) 1st choice b) 2nd choice Which exam format or formats are used? a) Multiple choice b) Essays c) Oral examination d) Other (please describe) In what way (or ways) was evaluation of physiology instruction done? a) By students b) By peers c) Other d) None Which degree or degrees does your department/ unit grant? a) PhD b) MS c) None Which fields of research does your department/unit carry on? What are your department’s or unit’s deficiencies and pressing needs? Which field in your department/unit is considered as strong/weak?
Sns
IN BRAZIL
Table 2. Average weekly hours and percentage of total work week that faculty in either departments or units of basic medical sciencesspent in teaching,
research, committees, and other activities Department Average
%
weekly hours
of total work week
Teaching 13.79 Research 11.37 Committees 8.72 Other 6.14 Total work week, 40 h.
Unit
Average
%
weekly hours
of total work week
34.5
10A30
27.0
28.5 22.0
5.66 3.66
14.15 8.32 50.52
15.0
20.21
Table 3. Average weekly hours and percentage of total teaching time devoted to each format of instruction for departments and units of basic medical sciences Department Average weekly hours
% of total teaching time
Unit Average weekly hours
% of total teaching time
Lecture 7.23 52.5 6.77 63.0 Laboratory 4.95 36.0 3.66 34.0 practical Small group 1.61 12.0 0.37 3.5 discussion Total work week, 40 h; for average total teaching time per week for departments and units, see Table 2.
by Malnic and Marcondes (12) and Fisiologia Humana (Human Physiology) by Tavares, Furtado, and Santos (24) SLprisingly, essays continue to be used as the primary 10. form of examination (departments, 87.5%; units, loo%), although they require many hours for grading. However, 62.5% of the departments and 55.5% of the units also used multiple-choice questions as a secondary examination format. 11. Evaluation of the quality of physiological instruction was done by students (61.0%) and by peers (29%) in the departments. On the other hand, units reported that evaluation was more often done by peers (44.5%) than by 12. students (22.0%). Information about the origin of the work force in phys13. iology was also obtained. The questionnaire revealed that 25% of responding departments granted MS degrees and 14. only 8% granted PhD degrees in physiology. The units granted no graduate degrees because they are a collection of faculty from a number of different basic disciplines and offer no graduate courses. Information on research was use a second textbook, Houssay’s Fisiologia Humana (Human Physiology; 10). The majority of the units (89%) also also obtained. Eight of the total of 24 of the responding departments carried out research in neurophysiology, adopted Guyton’s textbook, and as a second text they (22.0%) recommended de Mello Aires’ Fisiologia BcEsica seven in circulation, six in muscle and exercise, and four in excretion, nutrition, reproduction, and metabolism. (Basic Physiology; 7). Departments frequently suggested that students use a Few units performed any research except in circulation supplementary text, 48% suggesting Mountcastle’s Med- and in metabolism. Surveyed departments and units listed their deficienicaZPhysiology (Portuguese translation; 17) and 39% suggesting Selkurt’s Physiology (P’ortuguese translation; 19). cies and most pressing needs (Table 4). Most of the departments indicated a need for research equipment, labOn the other hand, 33% of the units suggested as suppleoratory supplies, and a substantial raise in research funds. mentary texts both Fisiologia RenaZ (Renal Physiology) Downloaded from www.physiology.org/journal/advances by ${individualUser.givenNames} ${individualUser.surname} (129.186.138.035) on January 16, 2019.
s14
TEACHING
PHYSIOLOGY
Table 4. Major deficiencies and pressing needs of departments and units of basic medical sciences Area
of Deficiency and Need
Research equipment Changes in curricular Better research funds Better salaries Larger academic staff Laboratory supplies Books and journals Teaching aids Better space
Number of Departments
load
13 3 10 2 5 11 4 4 2
Number of Units
4 1
4 3 2 1
A common complaint of both departments and units was a lack of reagents and teaching equipment needed to run quality laboratory courses. Another weak point was that teachers were overloaded with classes; in addition to medical physiology they had teaching obligations in a variety of dental, pharmacy, nursing, veterinary medicine, and other undergraduate courses. DISCUSSION
The number of faculty in Brazilian departments and units of physiology is in the range of 5-7 members, typical of developing countries like Zimbabwe and Ethiopia in Africa and Chile or Ecuador in South America (22, 23). This is significantly fewer than the 12-13 members reported for departments in the United States and Canada (8, 16). Historically the most successful medical schools (those that have attracted the largest number of qualified faculty) were first established in southeastern Brazil, where today they comprise 56% of the total number of medical schools. Physicians have been the basis of the Brazilian physiology work force, and this is also the case in Africa (22). Only more recently, when graduate courses were established locally, have candidates for research training stopped going abroad for graduate training. Thus on average more people with MD degrees have been involved in teaching (42% of the total in departments and 40% in units) than those with PhD degrees, quite different from the situation in United States medical schools where 72.5% of the faculty held the PhD degree (4,16). Because data showed that more time is spent in teaching than in other activities, it is of interest to know what teaching approaches are being used. The traditional lecture format dominated in Zimbabwe (2l), in Brazil, and in the United States (4), with less emphasis placed on practical classes (4,8) and small group discussion (16). This international trend continues in spite of recommendations to significantly reduce the number of lecture hours and turn students toward independent learning and problem solving (15) M’any Brazilian medical schools have made preliminary efforts to promote independent learning by setting cognitive learning objectives [similar to basic physiology concepts (6)], as has been done elsewhere (16, 20). Problem-based learning modules (5) have been used to improve the teaching of medical physiology as was re-
IN BRAZIL
ported by Bartoszeck for the teaching of neurophysiology in Brazil (1). While audiovisual equipment was being used by nearly all departments and units, full advantage has not been taken of videotaped labs (16) and computer-based instruction (13). Although there is a significant number of schools that are moving to this media, following a tendency noticed at medical schools in the United States (4), few simulations have been developed in Brazil (2, 18). There are a large number of translated textbooks for teaching physiology in Brazil, which is not the case in other developing countries (21). There are a few textbooks that were originally written in Portuguese. Among the former, Guy-ton’s was more popular here than at medical schools in the United States (4, 16), followed by Houssay’s textbook. The most prevalent form of examination was shown to be the essay, which was also common in Zimbabwe (21), instead of multiple-choice questions, which have been most heavily used in United States medical schools (4, 16) Department and unit policymakers were moving to define new parameters to evaluate the physiology instruction delivered to better serve their students. Research that has been performed in Brazil in the area of physiology reflected that reported in South America (3) Brazilian physiologists have shared with those from developing countries in Africa and South America (2L 23) acute deficiencies in research equipment and funds, laboratory supplies, journals, and modern teaching aids, as well as a heavy teaching load. In conclusion the first steps for analyzing physiology teaching in medical schools within Brazil have been outlined. Although more time is spent in teaching, it seems that innovative methods are only slowly being adopted by the teaching community; there are a few preliminary efforts in the technological development of this country in producing computers, software, and videocassettes. Evaluation of instruction, teaching aids, allocation of funds, and laboratory supplies are issues that deserve mature consideration by Brazilian educational planners. The author acknowledges valuable suggestions and revision of this manuscript by Dr. Joel A. Michael. Address for reprint requests: A. B. Bartoszeck, Dept. of Physiology, Federal Univ. of Parana, cx Postal 3276,800Ol Curitiba, Parana, Brazil Received
12 July
1990; accepted
in final
form
1 June
1992.
REFERENCES 1. Bartoszeck,
2.
3.
4. 5.
6.
A. B. 0 uso da tecnica de modulos no ensino de neuroendocrinologia e neurofisiologia. Abstr. Ann. Meet. Fed. Brazilian Sot. Exp. Biol. 3rd Caxambu, Brazil 1988, p.431. Bartoszeck, A. B. Ensino de Fisiologia assistido por microcomputador. Abstr. Ann. Meet. Fed. Brazilian Sot. Exp. Biol. 4th Caxambu, Brazil 1989, p.488. Cardinali, D. P. (editor). Abstracts from 16th Congress0 de la Association Latinoamericana de Ciencias Fisiologicas. Acta Physiol. Pharmacol. Latinoam. 38: 389-733, 1988. Carlin, R. D. Survey results and recommendation for a change in U.S. medical physiology curricula. Acad. Med. 64: 202-207, 1989. Coulson, R. L. Problem-based student centered learnig of cardiovascular system using the problem-based learning module (p.b.1.m.). Physiologist 26: 220-224, 1983. Dawson-Sauders, B., P. L, Feltovich, R. L. Coulson, and D. E. Steward. A survey of medical school teachers to identify
Downloaded from www.physiology.org/journal/advances by ${individualUser.givenNames} ${individualUser.surname} (129.186.138.035) on January 16, 2019.
TEACHING
7. 8.
9. 10. 11. 12. 13. 14. 15.
PHYSIOLOGY
basic biomedical concepts medical students should understand. Acad. Med. 65: 448-453, 1990. De Mello Aires, M. Fisiologia Bbsica. Rio de Janeiro: Guanabara and Koogan, 1985. Guyer, K. E., J. L. Poland, and H. R. Seibel. Anatomy, biochemistry, and physiology laboratory programs in the education of physicans. South. Med. J. 68: 1120-1124, 1975. Guyton, A. C. Textbook of Medic& Physiology (7th ed.). Rio de Janeiro: Guanabara and Koogan, 1989. Houssay, B. A. Fisiologia Humana (5th ed.). Rio de Janeiro: Guanabara and Koogan, 1984. Malnic, G. Programas Para 0 Ensino de FisioZogia. Ribeirao Preto, Sao Paulo: Sot. Bras. Fisiol., 1984. Malnic, G., and M. Marcondes. Fisiologia Renal (3rd ed.). Sao Paulo: EPU, 1986. Michael, J. A. Computer-based education in the biomedical sciences. Physiologist 28: 417-459, 1985. Michael, J. A. An agenda for research on teaching of physiology. Am. J. Physiol. 256 (Adv. Physiol. Educ.) 1: S514-S517, 1989. Michael, J. A., and A. A. Rovick. Problem solving in the preclinical curriculum: the uses of computer simulations. Med. Teacher 8: 19-25, 1986.
IN BRAZIL
s15
16. Moriarty, C. M., F. J. Clark, and K. L. Kasten. Teaching of physiology in American medical schools. Physiologist 30: 265-268, 1987. 17. Mountcastle, V. B. Medical Physiology (13th ed.). Rio de Janeiro: Guanabara and Koogan, 1978. 18. Sabbatini, R. M. E. Biosim: a versatile program for interactive simulation of quantitative biological models in personal microcomputers. BraziLian J. Med. BioZ. Res. 16: 463, 1983. 19. Selkurt, E. E. Physiology (5th ed.). Rio de Janeiro: Guanabara and Koogan, 1986. 20. Silber, D. L., R. G. Williams, R. E. A. Paiva, D. D. Taylor, and R. Robinson. The SIU medical curriculum: systemwide objectives based instruction. J. Med. Educ. 53: 473-479, 1978. 21. Sparks, H. J. Physiology teaching in Zimbabwe. Physiologist 30: 249-260, 1987. 22. Sparks, H. J. A physiologist in Africa: lending a hand in developing contries. Physiologist 32: l-7, 1989. 23. Sparks, H. J., and E. A. Petropoulos. Departments of physiology in the third world: the struggle for survial and development. News Physiol. Sci. 3: 258-261, 1988. 24. Tavares, P., M. Furtado, and F. Santos. Fisiologia Humana. Sao Paulo: Liv. Atheneu, 1984.
Downloaded from www.physiology.org/journal/advances by ${individualUser.givenNames} ${individualUser.surname} (129.186.138.035) on January 16, 2019.
medical
AMAURI Department
physiology
in Brazil
B. BARTOSZECK of Physiology,
Federal
University
of Parana,
80001
Curitiba, Parana, Brazil
Bartoszeck, Amauri B. Teaching medical physiology in and two with MS degrees. It provided instruction to an Brazil. Am. J. Physiol. 263 (Adv. Physiol. Educ. 8): SIZ-SE, average of 85 undergraduate medical students each se1992.--n analysis of physiology teaching in Brazil is carried mester. The average unit of basic medical sciences (physout basedon data collected from a questionnaire sent to 78 iology) faculty includes two members with MD degrees, medical schools.It investigates faculty graduate degrees,time one with a PhD degree, and two with MS degrees. It spent on teaching, audiovisual equipment available, evaluation to an average of 63 undergraduate of student performance, books in current use, and areasof re- provided instruction medical students each semester. Exceptions to the above search.Local results as comparedwith those from an internaand one unit (located in tional sample have shown a preference for lectures and that pattern are three departments large departments are more concerned with research, but states of Sao Paulo and Rio de Janeiro), which have as changesare underway to introduce computer simulations and many as 30 faculty members each. modular instruction as a meansto improve teaching. Faculty members are usually appointed to work for periods of 20 or 40 h/wk. On average, departments of basic science;educational innovation
is based on a survey of Brazilian medical schools. It has three aims: to describe the strengths and weaknesses of physiology teaching in Brazil, to make available data for those seriously involved in teaching, and to attract support for Brazilian physiology teaching from national and international organizations. The teaching of physiology has been a matter of constant concern for the Brazilian Society of Physiology (SBFIS) and the Brazilian Association of Medical Education. In the mid-1980s SBFIS organized the Committee for Undergraduate Teaching, which published booklets describing complete courses in Medical Physiology (11) and Comparative Physiology. THIS ARTICLE
METHODS
A 14-question survey was developedto obtain information about the present status of physiology teaching in medical schoolsin Brazil (seeTable 1). It was concernedwith the graduate degreesheld by faculty, how the faculty spendtheir working hours, how many undergraduate medical students they teach eachsemester,how classesare taught, and whether learning objectives are used. The survey inquired about which technological resources,besidesbooks,were in use.Other questionsfocusedon the format of examinations and on whether instruction wasevaluated.The concluding questionsinvestigated the sourceof the work force in physiology. There were concluding open-ended questions that sought information about areasof research,deficiencies, and areaswhere departments of physiology and units of basic medical sciences(physiology) excelled. The questionnaire was mailed to all 78 accredited medical schoolsacrossthe country that are attached to public (either state or federally funded) and private universities. These schoolsprovide physiology instruction to medical undergraduate students either via formal departments of physiology or via units of basic medical sciences(physiology). Departments in state or federally run universities usually carry out research,but few units in private universities do so. RESULTS
Teachers from 23 departments of physiology and nine units of basic medical sciences returned the completed questionnaire by early 1990, a 41% return. The average department of physiology faculty includes four members with MD degrees, three with PhD degrees, s12
physiology spent more time on teaching (34.5% of weekly time) than doing research (28.5%), committee work or administrative service (22.0%), or other things (15.0%). One exception was that the faculty of units of basic medical sciences on average spent more time than faculty in departments (50.0% of weekly time) in other, nonspecified activities (probably related to joint appointments). Furthermore, two departments reported that they spend 60% of their weekly time on teaching. On the other hand, the second largest department (19 members) and the largest unit (9 members) responding to the survey, which were staffed by a larger percentage of members with PhD degrees than other groups, reported respectively that 75 and 50% of their weekly time was dedicated to research (Table 2). Although in general more time was devoted to teaching than to any other single activity, it was done mainly through the lecture format in departments and in units (52.5 and 63.0% of total teaching time, respectively). Laboratory practical classes were carried on as a secondary activity (36.0 and 34.0% of total teaching time for departments and units, respectively), most often as a demonstration performed by the teacher and rarely as a hands-on activity with student participation. Small group discussions accounted for a small percentage of total teaching time of either departments or units (12 and 3.5%, respectively; Table 3). Written learning objectives have been adopted by 71.0% of the departments and 78.0% of the units responding to the survey. On the topic of audiovisual material, the survey showed that practically all departments and units of physiology used slides and transparencies as educational resource material. Videotape instruction was reported as being used by 25% of the respondents, and &mm films by only 16% of responding departments. None of the units made use of films. The use of the computer as a technological aid was reported by 29% of the departments, but none of the units made use of them. Among the departments that adopted a textbook, 87% of them recommended Guyton’s Textbook of Medical Physiology in Portuguese translation (9). Twenty-six percent of the departments recommended that students also
1043-4046/92 $2.00 Copyright 0 1992 The American Physiological
Society
Downloaded from www.physiology.org/journal/advances by ${individualUser.givenNames} ${individualUser.surname} (129.186.138.035) on January 16, 2019.
TEACHING
PHYSIOLOGY
Table 1. Questionnaire sent to departments of physiology and units of basic medical sciences 1.
2.
3.
4.
5. 6.
7. 8. 9.
How many faculty members in categories below are teaching medical physiology? a) MD b) PhD c) MS How many undergraduate medical students are enrolled each semester? a) 1st semester b) 2nd semester How many hours are spent by faculty members in each activity below? a) Teaching b) Research c) Committee work or service d) Other things How many hours/week is physiology being taught by each format below? a) Lecture b) Laboratory practical classes c) Small group discussion Are written objectives for learning set at beginning of your course of physiology? Which technological aid or aids are used? a) Videotape b) &mm films c) Slides d) Transparencies e) Microcomputer Which textbook of physiology is adopted? a) 1st choice b) 2nd choice Which supplementary text is used? a) 1st choice b) 2nd choice Which exam format or formats are used? a) Multiple choice b) Essays c) Oral examination d) Other (please describe) In what way (or ways) was evaluation of physiology instruction done? a) By students b) By peers c) Other d) None Which degree or degrees does your department/ unit grant? a) PhD b) MS c) None Which fields of research does your department/unit carry on? What are your department’s or unit’s deficiencies and pressing needs? Which field in your department/unit is considered as strong/weak?
Sns
IN BRAZIL
Table 2. Average weekly hours and percentage of total work week that faculty in either departments or units of basic medical sciencesspent in teaching,
research, committees, and other activities Department Average
%
weekly hours
of total work week
Teaching 13.79 Research 11.37 Committees 8.72 Other 6.14 Total work week, 40 h.
Unit
Average
%
weekly hours
of total work week
34.5
10A30
27.0
28.5 22.0
5.66 3.66
14.15 8.32 50.52
15.0
20.21
Table 3. Average weekly hours and percentage of total teaching time devoted to each format of instruction for departments and units of basic medical sciences Department Average weekly hours
% of total teaching time
Unit Average weekly hours
% of total teaching time
Lecture 7.23 52.5 6.77 63.0 Laboratory 4.95 36.0 3.66 34.0 practical Small group 1.61 12.0 0.37 3.5 discussion Total work week, 40 h; for average total teaching time per week for departments and units, see Table 2.
by Malnic and Marcondes (12) and Fisiologia Humana (Human Physiology) by Tavares, Furtado, and Santos (24) SLprisingly, essays continue to be used as the primary 10. form of examination (departments, 87.5%; units, loo%), although they require many hours for grading. However, 62.5% of the departments and 55.5% of the units also used multiple-choice questions as a secondary examination format. 11. Evaluation of the quality of physiological instruction was done by students (61.0%) and by peers (29%) in the departments. On the other hand, units reported that evaluation was more often done by peers (44.5%) than by 12. students (22.0%). Information about the origin of the work force in phys13. iology was also obtained. The questionnaire revealed that 25% of responding departments granted MS degrees and 14. only 8% granted PhD degrees in physiology. The units granted no graduate degrees because they are a collection of faculty from a number of different basic disciplines and offer no graduate courses. Information on research was use a second textbook, Houssay’s Fisiologia Humana (Human Physiology; 10). The majority of the units (89%) also also obtained. Eight of the total of 24 of the responding departments carried out research in neurophysiology, adopted Guyton’s textbook, and as a second text they (22.0%) recommended de Mello Aires’ Fisiologia BcEsica seven in circulation, six in muscle and exercise, and four in excretion, nutrition, reproduction, and metabolism. (Basic Physiology; 7). Departments frequently suggested that students use a Few units performed any research except in circulation supplementary text, 48% suggesting Mountcastle’s Med- and in metabolism. Surveyed departments and units listed their deficienicaZPhysiology (Portuguese translation; 17) and 39% suggesting Selkurt’s Physiology (P’ortuguese translation; 19). cies and most pressing needs (Table 4). Most of the departments indicated a need for research equipment, labOn the other hand, 33% of the units suggested as suppleoratory supplies, and a substantial raise in research funds. mentary texts both Fisiologia RenaZ (Renal Physiology) Downloaded from www.physiology.org/journal/advances by ${individualUser.givenNames} ${individualUser.surname} (129.186.138.035) on January 16, 2019.
s14
TEACHING
PHYSIOLOGY
Table 4. Major deficiencies and pressing needs of departments and units of basic medical sciences Area
of Deficiency and Need
Research equipment Changes in curricular Better research funds Better salaries Larger academic staff Laboratory supplies Books and journals Teaching aids Better space
Number of Departments
load
13 3 10 2 5 11 4 4 2
Number of Units
4 1
4 3 2 1
A common complaint of both departments and units was a lack of reagents and teaching equipment needed to run quality laboratory courses. Another weak point was that teachers were overloaded with classes; in addition to medical physiology they had teaching obligations in a variety of dental, pharmacy, nursing, veterinary medicine, and other undergraduate courses. DISCUSSION
The number of faculty in Brazilian departments and units of physiology is in the range of 5-7 members, typical of developing countries like Zimbabwe and Ethiopia in Africa and Chile or Ecuador in South America (22, 23). This is significantly fewer than the 12-13 members reported for departments in the United States and Canada (8, 16). Historically the most successful medical schools (those that have attracted the largest number of qualified faculty) were first established in southeastern Brazil, where today they comprise 56% of the total number of medical schools. Physicians have been the basis of the Brazilian physiology work force, and this is also the case in Africa (22). Only more recently, when graduate courses were established locally, have candidates for research training stopped going abroad for graduate training. Thus on average more people with MD degrees have been involved in teaching (42% of the total in departments and 40% in units) than those with PhD degrees, quite different from the situation in United States medical schools where 72.5% of the faculty held the PhD degree (4,16). Because data showed that more time is spent in teaching than in other activities, it is of interest to know what teaching approaches are being used. The traditional lecture format dominated in Zimbabwe (2l), in Brazil, and in the United States (4), with less emphasis placed on practical classes (4,8) and small group discussion (16). This international trend continues in spite of recommendations to significantly reduce the number of lecture hours and turn students toward independent learning and problem solving (15) M’any Brazilian medical schools have made preliminary efforts to promote independent learning by setting cognitive learning objectives [similar to basic physiology concepts (6)], as has been done elsewhere (16, 20). Problem-based learning modules (5) have been used to improve the teaching of medical physiology as was re-
IN BRAZIL
ported by Bartoszeck for the teaching of neurophysiology in Brazil (1). While audiovisual equipment was being used by nearly all departments and units, full advantage has not been taken of videotaped labs (16) and computer-based instruction (13). Although there is a significant number of schools that are moving to this media, following a tendency noticed at medical schools in the United States (4), few simulations have been developed in Brazil (2, 18). There are a large number of translated textbooks for teaching physiology in Brazil, which is not the case in other developing countries (21). There are a few textbooks that were originally written in Portuguese. Among the former, Guy-ton’s was more popular here than at medical schools in the United States (4, 16), followed by Houssay’s textbook. The most prevalent form of examination was shown to be the essay, which was also common in Zimbabwe (21), instead of multiple-choice questions, which have been most heavily used in United States medical schools (4, 16) Department and unit policymakers were moving to define new parameters to evaluate the physiology instruction delivered to better serve their students. Research that has been performed in Brazil in the area of physiology reflected that reported in South America (3) Brazilian physiologists have shared with those from developing countries in Africa and South America (2L 23) acute deficiencies in research equipment and funds, laboratory supplies, journals, and modern teaching aids, as well as a heavy teaching load. In conclusion the first steps for analyzing physiology teaching in medical schools within Brazil have been outlined. Although more time is spent in teaching, it seems that innovative methods are only slowly being adopted by the teaching community; there are a few preliminary efforts in the technological development of this country in producing computers, software, and videocassettes. Evaluation of instruction, teaching aids, allocation of funds, and laboratory supplies are issues that deserve mature consideration by Brazilian educational planners. The author acknowledges valuable suggestions and revision of this manuscript by Dr. Joel A. Michael. Address for reprint requests: A. B. Bartoszeck, Dept. of Physiology, Federal Univ. of Parana, cx Postal 3276,800Ol Curitiba, Parana, Brazil Received
12 July
1990; accepted
in final
form
1 June
1992.
REFERENCES 1. Bartoszeck,
2.
3.
4. 5.
6.
A. B. 0 uso da tecnica de modulos no ensino de neuroendocrinologia e neurofisiologia. Abstr. Ann. Meet. Fed. Brazilian Sot. Exp. Biol. 3rd Caxambu, Brazil 1988, p.431. Bartoszeck, A. B. Ensino de Fisiologia assistido por microcomputador. Abstr. Ann. Meet. Fed. Brazilian Sot. Exp. Biol. 4th Caxambu, Brazil 1989, p.488. Cardinali, D. P. (editor). Abstracts from 16th Congress0 de la Association Latinoamericana de Ciencias Fisiologicas. Acta Physiol. Pharmacol. Latinoam. 38: 389-733, 1988. Carlin, R. D. Survey results and recommendation for a change in U.S. medical physiology curricula. Acad. Med. 64: 202-207, 1989. Coulson, R. L. Problem-based student centered learnig of cardiovascular system using the problem-based learning module (p.b.1.m.). Physiologist 26: 220-224, 1983. Dawson-Sauders, B., P. L, Feltovich, R. L. Coulson, and D. E. Steward. A survey of medical school teachers to identify
Downloaded from www.physiology.org/journal/advances by ${individualUser.givenNames} ${individualUser.surname} (129.186.138.035) on January 16, 2019.
TEACHING
7. 8.
9. 10. 11. 12. 13. 14. 15.
PHYSIOLOGY
basic biomedical concepts medical students should understand. Acad. Med. 65: 448-453, 1990. De Mello Aires, M. Fisiologia Bbsica. Rio de Janeiro: Guanabara and Koogan, 1985. Guyer, K. E., J. L. Poland, and H. R. Seibel. Anatomy, biochemistry, and physiology laboratory programs in the education of physicans. South. Med. J. 68: 1120-1124, 1975. Guyton, A. C. Textbook of Medic& Physiology (7th ed.). Rio de Janeiro: Guanabara and Koogan, 1989. Houssay, B. A. Fisiologia Humana (5th ed.). Rio de Janeiro: Guanabara and Koogan, 1984. Malnic, G. Programas Para 0 Ensino de FisioZogia. Ribeirao Preto, Sao Paulo: Sot. Bras. Fisiol., 1984. Malnic, G., and M. Marcondes. Fisiologia Renal (3rd ed.). Sao Paulo: EPU, 1986. Michael, J. A. Computer-based education in the biomedical sciences. Physiologist 28: 417-459, 1985. Michael, J. A. An agenda for research on teaching of physiology. Am. J. Physiol. 256 (Adv. Physiol. Educ.) 1: S514-S517, 1989. Michael, J. A., and A. A. Rovick. Problem solving in the preclinical curriculum: the uses of computer simulations. Med. Teacher 8: 19-25, 1986.
IN BRAZIL
s15
16. Moriarty, C. M., F. J. Clark, and K. L. Kasten. Teaching of physiology in American medical schools. Physiologist 30: 265-268, 1987. 17. Mountcastle, V. B. Medical Physiology (13th ed.). Rio de Janeiro: Guanabara and Koogan, 1978. 18. Sabbatini, R. M. E. Biosim: a versatile program for interactive simulation of quantitative biological models in personal microcomputers. BraziLian J. Med. BioZ. Res. 16: 463, 1983. 19. Selkurt, E. E. Physiology (5th ed.). Rio de Janeiro: Guanabara and Koogan, 1986. 20. Silber, D. L., R. G. Williams, R. E. A. Paiva, D. D. Taylor, and R. Robinson. The SIU medical curriculum: systemwide objectives based instruction. J. Med. Educ. 53: 473-479, 1978. 21. Sparks, H. J. Physiology teaching in Zimbabwe. Physiologist 30: 249-260, 1987. 22. Sparks, H. J. A physiologist in Africa: lending a hand in developing contries. Physiologist 32: l-7, 1989. 23. Sparks, H. J., and E. A. Petropoulos. Departments of physiology in the third world: the struggle for survial and development. News Physiol. Sci. 3: 258-261, 1988. 24. Tavares, P., M. Furtado, and F. Santos. Fisiologia Humana. Sao Paulo: Liv. Atheneu, 1984.
Downloaded from www.physiology.org/journal/advances by ${individualUser.givenNames} ${individualUser.surname} (129.186.138.035) on January 16, 2019.
