1、绪论Introduction to Preclinical Courses,夏 强，PhD浙江大学医学院生理学系医学院科研楼C座518室电话：88208252Email：,2009级临床前课程概论,学习要求,掌握临床前课程与临床医学课程的分类和内容，以及临床前课程与临床课程的关系了解以问题为基础的学习的设计理念、基本过程和基本实施方式掌握临床前课程概论的主要内容和教学目标熟悉教育部和卫生部联合颁布的本科医学教育标准临床医学专业的基本内容,我国临床医学专业的课程设置,我国第一部由教育部和卫生部联合发布的临床医学专业本科医学教育标准（2008年9月）中推荐的课程设置：思想道德修养课程自然科学课程（
2、通常包括数学及物理、化学等）生物医学课程行为科学、人文社会科学以及医学伦理学课程公共卫生课程临床医学课程,几个国际医学教育标准和要求,世界医学教育联合会2003年版本的本科医学教育全球标准（http:/www.wfme.org/）世界卫生组织西太平洋地区本科医学教育质量保障指南（http:/www.wpro.who.int）国际医学教育组织全球医学教育最基本要求（ http:/www.iime.org/）,临床前的课程类别和目的,生物医学课程：通常包括人体解剖学、组织学与胚胎学、生物化学、生理学、分子生物学、细胞生物学、病原生物学、医学遗传学、医学免疫学、药理学、病理学、病理生理学等课程的内容
3、，还包括体现这些生物医学内容的整合课程等形式的课程。目的：为医学生学习临床专业课程打下坚实的生物医学基础行为科学、人文社会科学以及医学伦理学课程：通常包括心理学、社会医学、医学社会学、医学伦理学、卫生经济学、卫生法学、卫生事业管理等学科的内容。人文素质教育课程通常包括文学艺术类、医学史等知识内容。目的：使医学生适应医学科学的发展和医疗卫生服务的需求公共卫生课程：通常指预防医学和（或）卫生学等课程，涵盖流行病学、卫生统计学、健康教育、初级卫生保健以及劳动卫生与职业病学、卫生毒理学、环境卫生学、营养与食品卫生学、儿少卫生学、妇幼保健学等有关内容。目的：培养学生的预防战略和公共卫生意识，使其掌握群体
4、保健的知识和技能,怎么学习医学课程？,以学科为基础discipline based以器官系统为基础organ or system based以问题为基础problem based ,以学科为基础的课程体系,优点：体现医学科学系统性、基础性、完整性，循序渐进教学，方便教学实施与管理，节省财力缺点：以教师讲授为中心、以学科为中心，学科界限分明，各学科之间、基础学科与临床学科之间缺乏必要的联系,以器官系统为基础的课程体系,优点：按照人体解剖结构，按某一器官系统把相关的解剖、生理、病理、疾病的临床表现，乃至诊断和治疗原则综合起来组织课程，以加强学科间的联系和减少课程间的重复，使基础与临床结合得到较好的
5、解决缺点：课程结构不稳定，教学难度大,以问题为基础的课程体系,优点：打破了传统课程体系，围绕临床问题综合组织相关学科内容为课程，加强了基础医学与临床的联系，精简课程，使学生早期接触临床，直接从临床工作实际出发，提高学生独立学习和解决问题能力缺点：缺乏基础知识的系统性,北美国家医学院校教育特点,全球大多数top医学院在北美早期接触临床基础和临床渗透使用标准化病人和模拟病人以问题为基础的学习（problem based learning）,Dr. Charles Sidney Burwell(Dean of HMS from 1935 to 1949),At an HMS graduation i
6、n the late 1940s, he said “Half of what we have taught you is wrong. Unfortunately, we dont know which half.”Dr. Burwell was a cardiologist who specialized in circulation changes associated with heart disease. He is credited with bringing attention to obstructive sleep apnea syndrome. In 1944, while
7、 Dr. Burwell was Dean, women entered Harvard Medical School for the first time on an equal basis with men.,It has been estimated that, from the beginning of civilization 5,000 yearsago or more until 2003, humanity created a total of five exabytes (billiongigabytes) of information. From 2003 to 2010,
8、 we created this amount every twodays. By 2013, we will be doing so every ten minutes, exceeding within hoursall the information currently contained in all the books ever written.So it isnt that we need more knowledge; it is that we need to distinguishbetween what we know and what we dont know, thro
9、ugh what Firestein calls“controlled neglect”. Researchers must selectively ignore vast quantities offacts and data that block creative solutions, and focus on a narrow range ofpossibilities.To make discoveries, researchers need to look beyond the facts.”Ignorance includes an important discussion abo
10、ut scientific errors and theirpropagation in textbooks. I admit that I passed one on in my last book, TheBelieving Brain (Times Books, 2011): I repeated as gospel the fact that thehuman brain contains about 100 billion neurons. Firestein reports that it isactually around 80 billion, and that the num
11、ber of glial cells is an order ofmagnitude smaller than most textbooks state.The neural spike recorded by neuroscientists as a fundamental unit of brainactivity, Firestein reminds us, is an artefact of our measuring devices andignores other forms of neural activity. Even the famous and widely printe
12、dtongue map, which shows sweet flavours sensed on the tip of the tongue,bitter on the back and salt and sour on the sides, is wrong the result of amistranslation of a German physiology paper. These and other errors arise as aresult of our lack of scepticism towards the knowledge we have.”,PBL的起源,PBL
13、：problem-based learning，基于问题的学习由美国神经病学教授Barrows于1969年在加拿大McMaster University首先建立指导理念：成年人教育以自我引导为基础的特点推进以学生为中心的教育方式培养学生终生学习技能,PBL的主要目标,通过问题进行学习，实现知识的整合和应用促进自我导向的学习，达到认知目标通过小组学习，促进团队合作,7步法PBL基本过程,目前我国高等医学教育人才培养模式的主要不足,课程体系仍然以生物医学学科为主，以学科为中心，以传授知识为宗旨。课程门数多，学生负担重教学内容滞后，人文社会科学、新兴学科、边缘学科少教学计划安排基本是基础、临床、实习
14、三段式，基础与临床割裂，理论脱离实际教学方法和手段落后，以教师、课堂、书本为中心，以注入式为主，缺乏创造力、自学能力培养和个性发展，现代化教学技术手段运用不足评价方法落后，评价质量标准低，以考知识记忆、认知能力为主，缺乏对实践能力考核的现代方法,“临床前课程概论”课程的产生,八年制学习进程的需要为PBL教学模式做好准备为基于系统的模块化教学做好准备,“临床前课程概论”教学目标,导航课程通过“临床前课程概论”的学习，使未接触医学课程的学生能了解和熟悉临床前课程（包括生物医学、行为科学、人文社会科学以及医学伦理学、公共卫生的主要相关课程）的基本知识和构架，为以后按照PBL教学模式和器官系统模块化学
15、习医学课程打下坚实的知识框架结构基础，保证PBL和模块化课程教学新模式的顺利进行,“临床前课程概论”的内容,主要介绍涉及生物医学、行为科学、人文社会科学以及医学伦理学、公共卫生的主要相关课程15门：生物医学类：11（13）门，医学细胞生物学、医学遗传学、人体解剖学、组织学与胚胎学、生理学、生物化学、医学分子生物学、医学免疫学、医学微生物学、人体寄生虫学、病理生理学、病理学、药理学行为科学、人文社会科学以及医学伦理学类：3门，医学心理学、医学伦理学、卫生法学公共卫生类：1门，预防医学,学科归属,学科门类：理学一级学科：生物学二级学科：植物学动物学生理学水生生物学微生物学神经生物学遗传学发育生物学
16、细胞生物学生物化学与分子生物学生物物理学生态学,学科归属,学科门类：医学一级学科：基础医学二级学科：人体解剖和组织胚胎学免疫学病原生物学病理学与病理生理学法医学放射医学航空、航天与航海医学,学科归属,学科门类：医学一级学科：临床医学二级学科：内科学儿科学老年医学神经病学精神病与精神卫生学皮肤病与性病学影像医学与核医学临床检验诊断学护理学外科学妇产科学眼科学耳鼻咽喉科学肿瘤学康复医学与理疗学运动医学麻醉学急诊医学,学科归属,学科门类：医学一级学科：公共卫生与预防医学二级学科：流行病与卫生统计学劳动卫生与环境卫生学营养与食品卫生学儿少卫生与妇幼保健学卫生毒理学军事预防医学,学科归属,学科门类：医学
17、一级学科：药学二级学科：药物化学药剂学生药学药物分析学微生物与生化药学药理学,学科归属,学科门类：教育学一级学科：心理学二级学科：基础心理学发展与教育心理学应用心理学,学科归属,学科门类：哲学一级学科：哲学二级学科：马克思主义哲学中国哲学外国哲学逻辑学伦理学美学宗教学科学技术哲学,学科归属,学科门类：法学一级学科：法学二级学科：法学理论法律史宪法学与行政法学刑法学民商法学（含：劳动法学、社会保障法学）诉讼法学经济法学环境与资源保护法学国际法学（含：国际公法、国际私法、国际经济法）军事法学,医学细胞生物学Medical Cell Biology,细胞生物学是从细胞的显微、亚显微和分子三个水平对细
18、胞的各种生命活动开展研究的科学（卫生部规划教材医学细胞生物学，陈誉华主编）细胞生物学（Cell biology）旧称细胞学（Cytology），是研究细胞的形态结构、生理机能、发育、生活史，以及各种胞器及讯息传递路径的学科。研究范围专注在生物学的微观与分子层次（维基百科）医学细胞生物学是以医学的角度，从细胞水平，显微水平，亚显微水平研究细胞形态，功能的科学（维基百科）Cell biology (also called cellular biology or formerly cytology, from the Greek kytos, “container”) is an academic
19、discipline that studies cells their physiological properties, their structure, the organelles they contain, interactions with their environment, their life cycle, division and death. This is done both on a microscopic and molecular level. Cell biology research encompasses both the great diversity of
20、 single-celled organisms like bacteria and protozoa, as well as the many specialized cells in multicellular organisms like humans（Wikipedia）The study of the internal workings of cells at the microscopic and molecular level - it is closely linked to molecular biology （cancerweb.ncl.ac.uk/omd/）,医学遗传学M
21、edical Genetics,医学遗传学是用人类遗传学的理论和方法来研究遗传病从亲代传至子代的特点和规律、起源和发生、病理机制、病变过程及其与临床关系（包括诊断、治疗和预防）的一门综合性学科（卫生部规划教材医学遗传学，左伋主编）医学遗传学（英文：medical genetics）是将遗传学应用于医学的科学，研究领域涵及临床遗传学（clinical genetics）、生化遗传学（biochemical genetics）、细胞遗传学（cytogenetics）、分子遗传学（molecular genetics）、常见疾病的遗传学（例如神经管缺陷）、遗传咨询（genetic counselin
22、g）等学科（维基百科） Medical genetics is the specialty of medicine that involves the diagnosis and management of hereditary disorders. Medical genetics differs from Human genetics in that human genetics is a field of scientific research that may or may not apply to medicine, but medical genetics refers to th
23、e application of genetics to medical care. Genetic medicine is a newer term for medical genetics and incorporates areas such as gene therapy and personalized medicine （Wikipedia）The study of the aetiology, pathogenesis, and natural history of human diseases which are at least partially genetic in or
24、igin（cancerweb.ncl.ac.uk/omd/）,人体解剖学Human Anatomy,人体解剖学是阐述正常人体器官的形态结构、生理功能及其生长发育规律的科学（卫生部规划教材系统解剖学，柏树令主编）人体解剖学（anthropotomy或human anatomy）是研究正常人体形态结构的科学。广义的解剖学包括宏观解剖学（gross anatomy，以肉眼观察的解剖学）、组织学（微观的以显微镜观察的解剖学）、细胞学和胚胎学（加上时间轴的解剖学）。解剖学又可分为系统解剖学和局部解剖学。系统解剖学着重在人体构成的各系统分析，而局部解剖学注重在于人体部分区域的分析，因而与外科学联系紧密（维
25、基百科） Human anatomy, which, with physiology and biochemistry, is a complementary basic medical science is primarily the scientific study of the morphology of the adult human body. Anatomy is subdivided into gross anatomy and microscopic anatomy. Gross anatomy (also called topographical anatomy, regio
26、nal anatomy, or anthropotomy) is the study of anatomical structures that can be seen by unaided vision. Microscopic anatomy is the study of minute anatomical structures assisted with microscopes, which includes histology (the study of the organization of tissues), and cytology (the study of cells) （
27、Wikipedia）,组织学与胚胎学Histology and Embryology,组织学是研究机体微细结构及其相关功能的科学。胚胎学主要是研究从受精卵发育为新生个体的过程及其机制的科学（卫生部规划教材组织学与胚胎学，邹仲之，李继承主编）組織學（Histology）是一門生物組織的微觀研究，研究它們的形成、構造和功能。胚胎学是研究活着的有机体的形成、早期发育和发展的生物学的分支（维基百科） Histology (from the Greek = tissue) is the study of the microscopic anatomy of cells and tissues of pl
28、ants and animals. It is performed by examining a thin slice (section) of tissue under a light microscope or electron microscope. The ability to visualize or differentially identify microscopic structures is frequently enhanced through the use of histological stains. Histology is an essential tool of
29、 biology and medicine. （Wikipedia）Embryology (from Greek , embryon, “unborn, embryo”; and -, -logia) is the study of the development of an embryo. An embryo is defined as any organism in a stage before birth or hatching, or in plants, before germination occurs. Embryology refers to the development o
30、f the fertilized egg cell (zygote) and its differentiation into tissues and organs. After cleavage, the dividing cells, or morula, becomes a hollow ball, or blastula, which develops a hole or pore at one end. （Wikipedia）,Ernst Haeckel embryo drawings,生理学Physiology,生理学是研究生物体及其各组成部分正常功能活动规律的科学（卫生部规划教材
31、生理学，朱大年主编）Physiology (from Greek , physis, nature, origin; and -, -logia) is the study of the mechanical, physical, and biochemical functions of living organisms. Physiology has traditionally been divided between plant physiology and animal physiology but the principles of physiology are universal,
32、no matter what particular organism is being studied. （Wikipedia）The science concerned with the normal vital processes of animal and vegetable organisms, especially as to how things normally function in the living organism rather than to their anatomical structure, their biochemical composition, or h
33、ow they are affected by drugs or disease.（http:/）,Physiology: the study of the logic of life,Exercise Physiology,Aviation, high-altitude, and space physiology,Diving and Hyperbaric physiology,Leonardo da Vinci (1452-1519) (Italian),生物化学Biochemistry,生物化学是研究生物体内化学分子与化学反应的科学，从分子水平探讨生命现象的本质（卫生部规划教材生物化学，
34、周爱儒主编）Biochemistry is the study of the chemical processes in living organisms. It deals with the structure and function of cellular components, such as proteins, carbohydrates, lipids, nucleic acids, and other biomolecules.（Wikipedia）Biochemistry is the chemistry of living organisms and of the chemi
35、cal, molecular, and physical changes occurring therein. （http:/）,Simplistic overview of the chemical basis of love, one of many applications that may be described in terms of biochemistry.,医学分子生物学Medical Molecular Biology,分子生物学是一门从分子水平研究生命现象、生命的本质、生命活动及其规律的科学。医学分子生物学是分子生物学的一个重要分支，是从分子水平研究人体在正常和疾病状态下
36、生命活动及其规律的一门科学（卫生部规划教材医学分子生物学，药立波主编）Molecular biology is the study of biology at a molecular level. The field overlaps with other areas of biology and chemistry, particularly genetics and biochemistry. Molecular biology chiefly concerns itself with understanding the interactions between the various s
37、ystems of a cell, including the interactions between DNA, RNA and protein biosynthesis as well as learning how these interactions are regulated. （Wikipedia）,Signalling pathways that regulate cyclins,Schematic relationship between biochemistry, genetics and molecular biology,医学免疫学Medical Immunology,医
38、学免疫学是研究人体免疫系统的结构和功能的科学（卫生部规划教材医学免疫学，金伯泉主编）Immunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. It deals with, among other things, the physiological functioning of the immune system in states of both health and disease; malfunc
39、tions of the immune system in immunological disorders (autoimmune diseases, hypersensitivities, immune deficiency, transplant rejection); the physical, chemical and physiological characteristics of the components of the immune system in vitro, in situ, and in vivo. （Wikipedia）The science concerned w
40、ith the various phenomena of immunity, induced sensitivity, and allergy. （http:/）Study of the structure and function of the immune system. （http:/）,Main features of tuberculosis: from infection to host defence,Inflammatory and immune cells involved in asthma,医学微生物学Medical Microbiology,医学微生物学主要研究与医学有
41、关的致病性微生物的生物学特性、致病和免疫机制以及特异性诊断、防治措施，以控制和消灭感染性疾病和与之有关的免疫损伤等疾病，达到保障和提高人类健康水平的目的（卫生部规划教材医学微生物学，李凡，刘晶星主编）Medical microbiology is a branch of microbiology which deals with the study of microorganisms including bacteria, viruses, fungi and parasites which are of medical importance and are capable of causin
42、g diseases in human beings. It includes the study of microbial pathogenesis and epidemiology and is related to the study of disease pathology and immunology. （Wikipedia）The science concerned with microorganisms, including fungi, protozoa, bacteria, and viruses. （http:/）,An agar plate streaked with m
43、icroorganisms,Bacteria display a large diversity of cell morphologies and arrangements,Escherichia coli: Scaning electron micrograph of Escherichia coli, grown in culture and adhered to a cover slip,天花Smallpox,Contrary to the rash in smallpox（天花）, the rash in chickenpox（水痘） occurs mostly on the tors
44、o, spreading less to the limbs.,Poliomyelitis（小儿麻痹症）,Denervation of skeletal muscle tissue secondary to poliovirus（脊髓灰质炎病毒） infection can lead to paralysis.,人体寄生虫学Human Parasitology,人体寄生虫学是研究与人体健康有关的寄生虫的形态结构、生活活动、生存繁殖规律，阐明寄生虫与人体和外界环境因素相互关系的一门科学（卫生部规划教材人体寄生虫学，李雍龙主编）Parasitology is the study of parasi
45、tes, their hosts, and the relationship between them. （Wikipedia） One of the largest fields in parasitology, medical parasitology is the study of those parasites which infect humans. （Wikipedia）The branch of biology and of medicine concerned with all aspects of parasitism. （http:/）,Malaria（疟疾）,Anophe
46、les albimanus mosquito feeding on a human arm. This mosquito is a vector of malaria and mosquito control is a very effective way of reducing the incidence of malaria.,The life cycle of malaria parasites in the human body.,Leishmaniasis（黑热病）,Life cycle of Leishmania,Cutaneous leishmaniasis ulcer on l
47、eft forearm,Cutaneous leishmaniasis in the hand of a Central American adult,病理生理学Pathophysiology,病理生理学是一门研究疾病发生、发展、转归的规律和机制的科学（卫生部规划教材病理生理学，金惠铭，王建枝主编）Pathophysiology is the study of the disturbance of normal mechanical, physical, and biochemical functions, either caused by a disease, or resulting fr
48、om a disease or abnormal syndrome, or condition that may not qualify to be called a disease. （Wikipedia） Derangement of function seen in disease; alteration in function as distinguished from structural defects. （http:/）,Brain herniation （脑疝）types： 1) The brain squeezes under the falx cerebri in cingulate herniation 2) The brainstem herniates caudally 3) The uncus and the hippocampal gyrus herniate into the tentorial notch 4)The cerebellar tonsils herniate through the foramen magnum in tonsillar herniation.,
