Year 1 FM1: Fundamentals of Medicine
- Dr Lesley Robson
- l.g.robson@qmul.ac.uk
Introduction
The aims of the FunMed Module are:
- To develop independent learning and critical reasoning skills necessary for a University course
- To acquire basic Information Technology (IT) skills in accessing information and in word processing
- To develop time management skills in planning and scheduling work
- To work and communicate effectively in small groups
- To appreciate the development of modern medicine and its historical context
- To appreciate the historical, social and demographic characteristics of the East End of London, and the implications of these for the health of the local population
- To develop an understanding of normal biological structure and function, at the cellular and molecular level; and knowledge of cellular pathology and basic pharmacology sufficient to provide a foundation for subsequent stages
- To obtain a basic knowledge of anatomical terms and of the location of the main organs and structures, including the use of medical imaging
- To begin to understand the contribution of genetic, social, environmental, political, occupational and behavioural factors to health, illness and disease
- To begin to appreciate the effect of illness on people and their families
- To begin to understand the role of the doctor and other health professionals in society
- To prepare students for meeting patients in clinical settings, by addressing communication skills and ethical principles in the health professional - patient relationship
- To develop basic skills of resuscitation and emergency care
- To provide a broad overview of the entire MBBS course
Sessions
Lecture: Histology - Epithelia and Glands
- For each of the various types of epithelial tissue, can outline its structural characteristics, functional capabilities, cellular specialisations and be able to give an example of a body site where it would be located.
- Can name the various types of glands, relate their structure to their function, and give an example of where each might be found in the body.
- Can describe the basic structure of a mucosa and a serosa, and predict their functions from the different types of epithelial cell found on their surface.
Lecture: Anatomy - Introduction to the Skeleton
Lecture: Physiology- Homeostasis
- Be able to apply the principles of homeostasis to one human physiological system, from: body temperature; or blood glucose concentration; or body fluid volume.
- Be able to define homeostasis in relation to the physiological systems
- Be able to discuss the contribution of negative feedback, positive feedback and positive feedforward to the process of body homeostasis.
Lecture: Inclusivity, Diversity, and Healthcare
Lecture: Patients Great Expectations
Lecture: Introduction to Health Promotion & the NHS
- Consider why we have a national health service
- Have an overview of the Health and Social Care Act 2012
- Review the current structure of the NHS
- Identify social determinants of health
- Consider the importance of social determinant of health on individuals and communities
- Explain the meaning of ‘health’
- Know approaches to health promotion
- Understand the Primary, Secondary and Tertiary levels at which health promotion can take place
Lecture: Resilience and Mindfulness in Medicine
Ethics: Informed Consent, Moral Theories and Confidentiality
- Specify why the privileges associated with being a medical student carry with them the responsibility to respect the rights and dignity of patients
- Explain why obtaining consent is an integral part of successful clinical relationships and the key tenets of GMC policy
- Outline the types of information which should be communicated in order to obtain consent and the specific duties of medical students in this regard
- Differentiate between explicit and applied consent, indicating when each is important
- Understand the nature and outline the various forms of an ethical problem; identify examples of ethical problems in medicine
- Explain the interface between medical ethics and medial law.
- Outline the major moral theories and their criteria of identifying goodness
- Give examples of how each of these theories could be applied in medico-ethical decision making
- Describe the shortcomings of moral theories and suggest how they could be overcome
- Evaluate the importance of privacy in personal life, and why this might entail a right to confidentiality
- Outline why respect for confidentiality is such an important component of successful clinical relationships and of the key tenets policy.
- Describe the specific duties of medical students as regards confidentiality, and typical dangers of breaching it.
- Discuss arguments for and against the belief that confidentiality should be broken in the public interests, including the confidentiality of the clinical relationship
Lecture: Anatomy - Introduction to the Nervous System
- Explain the structural and the functional divisions of the nervous system
- Can explain the broad structure and function of the central nervous system
- Can explain the broad structure and function of the peripheral nervous system
- Can explain the broad structure and function of the somatic nervous system
- Can explain the broad structure and function of the autonomic nervous system
Lecture: Cell and Tissue Structure 1
Lecture: Cell and Tissue Structure 2
- Understand the functions of the principal components of the extracellular matrix and relate to cell function and disease
- Discuss the structure and function of inter-cellular connections in relation to tissue function eg adherens junctions, tight junctions, gap junctions, desmosomes, synapses and relate to disease
- Relate the specialised structure of the cell surface (microvilli, cilia, pseudopodia) to the functions of the tissues and cells concerned
Lecture: DNA Structure and Replication
- Describe, using simple diagrams, the structure of DNA and its organisation into nucleosomes, chromatin and chromosomes
- Outline the mechanism of DNA replication (synthesis) and describe how some antibiotics interfere in this process
- Explain the very low level of mistakes in the DNA replication process
- Outline methods of DNA repair with examples of inherited DNA repair defects
Lecture: The Human Genome and Chromosomes
- Describe the structure and organisation of the human genome.
- Understand the differences between coding and non-coding the DNA-sequences, introns and exons, control elements, pseudogenes, and repetitive sequences
- Define the terms used to denote variation in chromosome number and structure.
- Outline the genetics and clinical features of the common aneuploidy syndromes, and methods for prenatal diagnosis.
- Describe the functions of the X and Y chromosomes, and outline the process of X-inactivation.
Lecture: RNA Transcription
- Outline the key features of the genetic code
- Describe the Central Dogma and the basic structure of a gene
- Describe the process of transcription and explain the function of RNA polymerase
- What are the essential RNA species for translation
- Explain what a promoter is and its role in transcription
- Describe the events and regulation in the ribosome cycle of protein synthesis
- Describe the structural changes undergone by a newly synthesised polypeptide in order to constitute a biologically active protein in the appropriate site (post-translational modifications / targeting and sorting)
- How is RNA modified before leaving the nucleus?
- Describe the different types of RNA and their role in translation
- How does viral and bacterial interference effect protein translation
- Describe how antibiotics can interfere in the process of transcription
- Know that antibiotics are used to target ribosomes
- Outline protein synthesis defects in inherited disease
Lecture: Introduction to Clinical Skills
Lecture: Haemostasis and Trauma
Lecture: The Causes of Genetic Mutations
Lecture: Anatomy - Imaging
- Describe the uses of, and the differences between, the following medical imaging techniques: plain (X-Ray) films; computerised tomography (CT); magnetic resonance imaging (MRI).
- Discuss why knowledge of anatomy is vital to appreciate the applications of imaging to medicine.
- Discuss the use of contrast: Barium, iodine, gadolinium
Lecture: Histology - Connective Tissue
- Describe the categorisation, main structural features and functions of the connective tissues.
- Describe the different cell types found in mature connective tissue.
- Relate the composition of extracellular matrix components to the functional requirements of the various connective tissues.
- Compare and contrast the structure and functions of the two types of adipose tissue.
Lecture: Physiology - Body Fluids
- Be able to describe the distribution of body fluids within the body and the composition of intracellular and extracellular fluids.
- Be able to describe how water moves between different compartments of the body.
- Be able to discuss the contribution of ion pumps to the regulation of cell volume.
- Be able to discuss fluid balance and the role of the kidney in regulating blood osmolality and volume.
- State general disorders of fluid balance.
Lecture: RNA Translation
- Outline features of the genetic code [relating to translation]
- What are the essential RNA species for translation
- Understand the role of the ribosome in mRNA translation; how and where, including co-translational translocation of membrane and secreted peptides at the ER
- How does viral and bacterial interference effect protein translation
- Know that antibiotics are used to target ribosomes
- Outline protein synthesis defects in inherited disease
Lecture: Proteins
- Understand the role of the ribosome in mRNA translation; how and where, including co-translational translocation of membrane and secreted peptides at the ER
- Outline the common structural features of the amino-acids and the roles of their side chains in protein structure and function
- Describe the structure of proteins and the stabilising forces of the a-helix, b-pleated sheet and collagen triple helix
- Comprehend the problems of protein folding in vivo and the role of molecular chaperones in dealing with this
- Explain how post translational modifications can be important for stability and modulation of function
Lecture: Epigenetics
Lecture: Cell Signalling: 2nd Messengers
- Describe different types of cell to cell (intercellular) communication
- Describe the steps and components in a simple intracellular pathway
- Understand how signals may activate different responses in cells
- How intracellular signals can act as molecular switches via phosphorylation
- Explain the different types of intracellular and cell surface receptors
- Understand the importance of cell communication in physiological and pathophysiological conditions.
Lecture: Enzymes
- Define the following terms in relation to enzyme catalysis: substrate specificity; active site; activation energy; cofactor and co-enzyme; proenzyme.
- Explain the following terms in relation to enzyme catalysis: substrate specificity; active site; activation energy; cofactor and co-enzyme; proenzyme.
- Explain the effects on enzyme catalysis of changes in temperature and pH. Distinguish between competitive and non-competitive inhibition, giving a physiological example of each.
- Define the term isoenzymes and their value in diagnostic enzymology.
Lecture: Biological Energy
- Define the principal energy stores in human cells
- Describe the principal biological roles of ATP in relation to biosynthesis reactions, transport and motility
- Describe the principal mechanisms of energy generation within the cell and distinguish between ATP generation through substrate level phosphorylation and via the proton motive force
- Explain the significance of B-group vitamins in terms of coenzyme structure and function
Lecture: Sugars and Polysaccharides
- Distinguish between the terms monosaccharide, disaccharide and polysaccharide and name a physiologically important example of each group
- Define the terms: glycosidic bond; sugar esterification (phosphates + sulphates); amino sugar, giving a physiologically relevant example of each one
- Define the mechanism and biological importance of protein glycosylation
- Outline the structures and biological roles of glycogen, heparin, proteoglycan and bacterial lipo-polysaccharide
Lecture: Genetic Variation and Treating Genetic Disease
- Appreciate how much genetic variation we have: both rare and common variants
- Discuss how DNA polymorphisms can be detected and how they may be used to identify individuals
- Understand how prenatal diagnosis and PGD can be performed
- Appreciate how genetic variation may determine treatment options
- Think about the ethical issues with respect to personal genome sequencing
Lecture: Cell Division and its Control
- Describe the main features of the cell cycle
- Describe the main mechanisms and biological functions of mitosis and meiosis
- Discuss the role of genes in co-ordinating the cell cycle
- Give examples of human diseases associated with mutations in these genes
- Explain how some chemotherapeutic drugs may inhibit cell division in cancer cells
Lecture: Gender and Sexuality - Identity
Lecture: Lipids and Membranes
- Distinguish between essential and non-essential fatty acids and understand their importance as energy stores and as precursors of membrane lipids and paracrines
- Understand the composition and architecture of biological membranes
- Describe the physiological functions of cholesterol: as a component of biological membranes and as a precursor for steroid and bile salt synthesis
Lecture: Membrane Proteins
- Be able to describe and distinguish between: passive and facilitated diffusion, primary and secondary active transport, receptor-mediated endocytosis, and membrane channel activity
- Be able to describe the function of membrane proteins
- Relate the membrane protein composition of an intestinal epithelial cell to the transcellular uptake of glucose
- Distinguish between passive diffusion, facilitated diffusion, secondary active transport, and active transport giving examples of each in human tissues
- Describe the synthesis, folding and trafficking pathways for membrane proteins with reference to the CFTR chloride channel, mutation of which causes cystic fibrosis
- Relate specialisations of the plasma membrane to its function
- Describe how deficiencies in folding, trafficking and function of the CFTR protein cause cystic fibrosis
Lecture: Extracellular Matrix and Cell Adhesion
Lecture: Anatomy - Introduction to Body Cavities
- Describe the anatomical position and use correct anatomical terms to describe body directions, regions and body planes or sections.
- Locate and name the major body cavities and their subdivisions and list the major organs contained within them. Name the serous membranes and indicate their common function.
- Identify the main components of the cardiovascular, respiratory, digestive, urinary, endocrine and reproductive systems of the body.
- Locate the major organs in cross section and on MRI and CT
Lecture: Histology - Muscle and Nerve
- Compare and contrast the structure, function and location of the three major types of muscle.
- Describe the major responses of muscle to use and disuse.
- Relate the functional organisation of the neuromuscular synapse (junction) to the process of neuromuscular transmission.
- Outline the distinctive structural and functional characteristics of nervous tissue.
- Relate the structures of the neuronal cell body, dendrites, axon and synaptic terminal to their function.
Lecture: Introduction to Pharmacology
Lecture: Cell Differentiation, Cell Death and Stem Cells
Lecture: Drug Receptor Interactions
Lecture: Drug Administration and Elimination
- Describe the main routes of drug administration
- Identify the routes of administration that lead to 1st pass metabolism and how this contributes to the activity of a drug
- Recognise how phase I and phase II reactions contribute to the drugs elimination
- Describe how dosage regimes affect the activity of a drug
- Recognise the factors that affect drug interactions
Lecture: Introduction to Clinical Pharmacology
Lecture: Drug Discovery
- Be aware of the various milestones and pitfalls in drug development
- Gain an overview of the process of new drug identification, preclinical and clinical testing
- Understand the risks: identifying a drug candidate - what properties does it needs to have?; types of activities; selection of action; bioavaliability; safety
- Regulation: Phase I, II and III trials
Lecture: Why is Immunology Important?
- 1. To understand that immunology is related to disease including infections, autoimmunity and allergy (hypersensitivity).
- Be aware of the main players in the immune system including lymphocytes (T-cells, B cells and NK cells), myeloid cells (macrophages and granulocytes), dendritic cells and antibodies
- Appreciate that communication between cells is critical
- Realise the importance of long term immunological memory
Lecture: Physiology Acid base
Lecture: Genetic Inheritance of Disease
- Describe the different types of gene mutation and their consequences
- Describe, with examples, the different patterns of inheritance of single gene disorders
- Understand the basic principles of population genetics with reference to allele frequencies and Hardy-Weinberg equilibrium
- Explain how genetic variation contributes to common disease
- Define the following terms in relation to human genetics and disease: homozygous; heterozygous; proband; sibling; recessive; dominant; co-dominant; penetrance; anticipation; imprinting phenotype; genotype; allele
Lecture: How Does the Immune System Recognise Pathogens?
- Know how the immune system recognises antigens
- Know the meaning of the term antigen
- Introduce the idea that TCRs and BCRs are made with random antigen recognition capacities
- Understand the importance of distinguishing self from non-self
- Appreciate that innate immune cells recognise a limited array of microbial structures using pattern recognition receptors.
- Understand how T and B cells recognise antigens and how the diversity of antigen recognition receptors on these cells is generated.
- Be familiar with the basic structure of an antibody molecule.
- Understand the role of antigen presentation and the structure and function of major histocompatability complex (MHC) molecules.
Lecture: How Do We Eliminate Pathogens That Live Outside Cells?
Lecture: How Do We Eliminate Pathogens That Live Inside Cells?
Lecture: CD4 T-Cells - Master Controllers of the Immune System
- Know that Th1 cells drive cell-mediated immunity
- Know that Th2 cells drive humoral immunity
- Know that Th17 cells drive responses to extracellular bacteria
- Know that T-reg cells retrain immune responses
- Know that memory T-cells remember our infection history
- Appreciate that CD4 or helper T-cells orchestrate adaptive immun responses
Lecture: Cytokines - The Good and Bad of the Immune System
Lecture: Immunology, MMR and the Gut
- Critically appraise the results of controversial research papers reported in the medical and scientific literature
- Apply findings from the literature to answer questions raised by controversial research papers
- Understand the public health, ethical and scientific issues involved in fraudulent medical research
- Appreciate that most of the biomedical literature is generally not reproducible
Lecture: Anatomy - Introduction to the Cardiovascular System
- Identify the structural difference between arteries and veins related to function. Name and locate the major arteries and veins in the systemic circulation.
- Describe the position of the heart and identify the great vessels
- Follow the main vessels to the viscera and to the periphery, identifying the main vessels
- Differentiate between systemic, portal and pulmonary circulation
- Describe the general location of lymph nodes.
Lecture: Introduction to Pathology and Histopathology
Lecture: Biology of Cancer - What is Cancer?
- Define the terms: tumour, neoplasm, benign, malignant, histogenesis, differentiation, metastasis
- 3. To know the hallmarks of cancer and describe the alterations in physiology that collectively result in malignant growth
- Describe the role of gain of function mutations in oncogenes and loss of function mutations in tumour suppressor genes in cancer initiation and progression
Lecture: The Behaviour of Tumours
- Give a brief classification of benign and malignant tumours based on origin of cell and morphological features
- Identify and compare the behaviour between benign and malignant neoplasms
- Identify and describe the key features of metastasis
- Have a basic knowledge of grading and staging tumours
- Define the term paraneoplastic syndrome and give some examples
Lecture: Cancer - A Genetic Disease
Lecture: The Microbial World I: Bacteria
- Be able to distinguish between the different groups of pathogens
- Outline the structure of bacteria, emphasising differences from eukaryotic cells
- Describe how bacteria can be classified on the basis of staining properties and morphology
- Define the terms pathogen; commensal; opportunistic pathogen; carriage; colonisation resistance; virulence
- List those parts of the body which should be sterile and those which have a normal flora
Lecture: How Do Microbes Cause Disease?
- Describe portals of entry of pathogens and their adherence mechanisms
- For viruses, list their mechanisms of persistence, and explain their harmful effects (killing cells, alter functions of cells, giant cell formation, malignant change, hypersensitivity)
- For bacteria, list their mechanisms of persistence, describe how they make you ill, and how they survive the host response (involving stress, stealth, scavenging, striking back)
- Describe how pathogens are disseminated through host organs and how they exit from the host
Lecture: Treatment and Prevention: Bacteria
- Describe the principle of selective toxicity
- Describe the structure and function of targets in microbes that differ from their counterparts in the host
- Understand the main classes, mechanisms of action and spectrum of activity of commonly used antimicrobials
- To explain how attenuated and inactivated bacterial vaccines offer protection
- Understand the mechanisms and implications of inherent and acquired antimicrobial resistance in bacteria
Lecture: The Microbial World II: Viruses
Lecture: Infectious Disease - Epidemiology
Lecture: Physiology - Action Potentials
- Summarise, with an example of each, the features which distinguish the neural, endocrine, and paracrine intercellular communication systems.
- Given the intracellular and extracellular concentrations of Na+, K+and Cl-ions (for a generalised mammalian neuron), describe how these concentrations are maintained.
- Explain how the resting membrane potential is a consequence of the concentration gradients of ions across the plasma membrane and of the relative ion permeabilities of the membrane.
- Describe how ion channels can respond to voltage, with particular reference to the action potential.
- Draw a typical action potential, and describe the changes in ionic permeability that occur at each stage.
Lecture: Physiology - Electrical and Chemical Signalling
- Describe how the action potential is propagated down a myelinated and unmyelinated axon
- Be able to explain how changes in axon diameter and myelination affect the conduction velocity of axons
- Describe how the action potential is converted into a chemical signal at the synapse
- Explain why pre-synaptic calcium is important for chemical transmission
- Compare the effects of excitatory and inhibitory neurotransmitters on the post-synaptic membrane potential
Lecture: Introduction to Neoplasia
Lecture: Treatment and Prevention: Viruses
- Know the concept of inhibition of virus specific enzymatic activities
- How to inhibit cellular factors important for virus replication
- What are the treatment strategies and treatment side effects for selected viral infections
- Understand mechanisms leading to antiviral resistance
- Know current and future viral vaccines strategies
Lecture: Cancer Case Studies
Lecture: Neuronal Responses
Lecture: Introduction to the ANS
- Compare and contrast the SNS and ANS
- Draw labelled diagrams to show the general arrangement of motor and somatic reflexes.
- Name the divisions of the ANS, and describe the segmental organisation of the sympathetic and parasympathetic nervous systems.
- Draw a series of labelled diagrams to show the arrangement of nerve fibres in the divisions of the ANS at the anatomical and neurochemical and receptor levels,
- Describe how the adrenal medulla acts as a modified post-ganglionic cell.
- Briefly describe how the enteric nervous system can control gut function.
Lecture: Pharmacology of the ANS
- Be able to explain how neurotransmitters can produce electrical changes by activating / inhibiting receptors in the post-synaptic cell
- Be able to outline the role of G-proteins in coupling a hormone/NT receptor complex to a) adenylate cyclase; b) hydrolysis of inositol phospholipids
- By means of simple diagrams and suitable examples, be able to describe the properties of the receptor-regulated ion channels and the neurotransmitters which activate them
- Describe the major neurotransmitter systems in the central and peripheral nervous systems
- Describe the role of protein kinases in transmitting the intracellular effects of second messengers
- Explain how an action potential is initiated by the summation of synaptic inputs
MicAnat: Practical: Epithelia and Glands
- Recognise the various epithelial cell types in photomicrographs and predict their function from their structure
- Recognise glandular tissue in photomicrographs, identify the gland type and its likely function
- Understand and master the use of the system for classifying different types of lining epithelia based on number of layers and shape of cells on the surface
- Recognise, name and understand the function of different components of the basement membrane.
- Recognise the mucous and serous membranes in photomicrographs and be able to identify different structural components found in each of these complex tissues
MicAnat Practical: Connective Tissues
- Recognise the different types of connective tissue in photomicrographs
- Identify common cell types found in connective tissues
- Understand differences in the make-up of the extracellular matrix between various connective tissues and how types are differently organised
- Relate organisation of different types of connective tissue to their function
MicAnat Practical: Muscle and Nerve
- Recognise nervous tissue and be able to distinguish neural and glial components
- Show understanding of how different cell types within nervous tissue and the organisation of the tissue contribute to its functions
- Recognise different types of muscle and different components of muscle tissue in photomicrographs
MicAnat Practical: Investigative Procedures
PBL1: The Professional Student
PBL2: Fragile X Syndrome
PBL3: Child Abuse or Something Else
PBL4: Acid Base Problems
PBL5: Generic Versus Branded Drugs Which is Better?
PBL6: Dangerous Liaisons!
PBL7: The New Lump
PBL8: The Potential Problem of Antibiotic Resistance
Lecture: FUNMED Feedback Session