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| Course Objectives |
Pharmacology builds on key concepts of physiology, biochemistry, microbiology and pathology to explain the mechanisms, uses, and adverse effects of pharmaceuticals used in clinical medicine. The primary objective is to provide future physicians with a strong knowledge base of fundamental aspects of pharmacology and therapeutics that will: 1) permit them to optimally benefit from the clinical years of instruction; and 2) allow them to continue building proficiency in pharmacology throughout their careers. This is achieved by stressing basic principles of drug action, pharmacokinetics, pharmacodynamics and toxicity while describing the characteristics of major drugs used for management of cardiovascular, CNS and endocrine disorders, and treatment of infectious diseases and cancer.
The location of the pharmacology course during the last half of the second year is designed to foster the development of an integrative understanding of drug interactions with complex physiological and pathological processes. Thus, the course both reinforces prior basic science instruction, and illustrates practical applications of such knowledge for the medical practitioner in a timely manner (immediately preceding the start of clinical rotations). In addition, when possible, efforts are made to coordinate pharmacology lectures with the second half of the pathology and pathophysiology taught during the same period so that the materials complement one another and increase understanding. Students should be aware that Medical Pharmacology provides a novel integrative review of broad areas of conceptual and factual knowledge relating to physiology, biochemistry, microbiology and pathology in the context of clinical therapeutics. Thus, knowledge of pharmacology as well as the other basic science disciplines should still be fresh and vibrant when the students begin their clinical rotations (a key objective of the course). Moreover, the timing and integrative nature of pharmacology should provide tangible benefits in terms of preparation for USMLE Step 1 (which follows shortly after completion of the course).
COURSE FORMAT AND TEACHING PHILOSOPHY.
Instructional material in Medical Pharmacology is presented in the form of 72 lecture hours, 12 clinical correlation conferences in pharmacology (two-hours each), and 6 laboratory demonstrations (two hours each). This instruction is supported by a general pharmacology textbook (BASIC AND CLINICAL PHARMACOLOGY, 7th edition; B.G. Katzung, editor, 1998). The teaching philosophies underlying these various formats are detailed below.
1. Lectures:
Pharmacology, like other medical subjects, is a complex discipline that provides multiple challenges to medical educators. Faculty must cover the basic principles of pharmacological science needed to understand drug actions and patient dosing (receptors, pharmacodynamics, pharmacokinetics, biotransformation, toxicology, etc.). However, they also must describe the major therapeutics available and their uses; and there are over four thousand FDA-approved drugs which can be grouped into dozens of distinct categories based on mechanism of action or therapeutic use. Moreover, for any given mechanism or use, multiple agents generally exist, often with important differences among one another.
Experience has taught us that information overload is a serious peril for medical students studying pharmacology. After a certain threshold of content and/or complexity has been reached, student retention and understanding may deteriorate rather than improve. Thus, our lectures seek to distill the ocean of information down to the core concepts and facts that will be most helpful to students in upcoming clinical rotations as well as in Step 1 of the USMLE. Key elements of our approach to lectures are: 1) organization in what is presented; and 2) selectivity in material covered to avoid excessive factual information that dilutes the core knowledge base. In particular, pharmacology faculty are encouraged to give "chalk-talks" in which they first present an outline of the lecture, and then work through the material using the "chalk-board" at a pace you can understand and retain while making a complete set of notes. We try to limit the photocopies handed out per lecture to a few figures, tables or structures that are essential for the topic covered. We generally avoid use of slide shows in which numerous complex figures and tables, with limited value as learning or study aids, are briefly presented in a darkened room ill-suited for note-taking. On the other hand, our faculty do recognize the need to explain the practical relevance of the material to your future careers, and we strive to make our lectures as interesting and clinically relevant as possible given our content- and time-constraints.
2. Clinical Correlation Conferences in Pharmacology:
These conferences are offered by clinical faculty who provide their insights into the therapeutic concepts and practical issues confronting practicing physicians with respect to the use of drug therapy in disease management. These conferences may include case presentations; in-depth-discussions of diagnostic or pathophysiological issues influencing use of medications; discussions of emerging new approaches to drug therapy for selected disorders, or other aspects of clinical medicine relevant to understanding drug actions, uses or abuse.
3. Laboratory Demonstrations in Pharmacology:
These sessions consist of videotaped animal experiments from past years which demonstrate important concepts and principles relating to drug actions. Students gain a unique opportunity to see these pharmacological concepts and principles at work in living animals. The experimental recordings and measures used are physiologically and clinically relevant. The USMLE Step 1 has a history of presenting similar types of experiments and data in questions in their exams to test student knowledge of important pharmacological concepts.
4. Textbooks:
The pharmacology faculty have selected the pharmacology textbook edited by Katzung (BASIC AND CLINICAL PHARMACOLOGY) for use in the course. It is of moderate size (1151 pgs.), yet has a comprehensive content, presents important concepts in some detail, and is frequently updated. However, we hear that many students prefer to use PHARMACOLOGY REVIEW printed by Lippencott Inc.(1997). Students should be aware that PHARMACOLOGY
REVIEW is primarily designed as a study aid for students reviewing pharmacology in preparation for Step 1 of the USMLE. It is short (475 pgs.), and has an appealing layout that makes excellent use of figures and tables to summarize information; however, it is not a comprehensive textbook in pharmacology. PHARMACOLOGY REVIEW lacks the detail and conceptual content of BASIC AND CLINICAL PHARMACOLOGY and may oversimplify complex topics. Also, it is not as frequently updated in order to stay current with changes in pharmacological science and describe new drugs approved for use or soon to emerge. If you use PHARMACOLOGY REVIEW be aware that the same material presented in different ways can sometimes produce confusion that wastes precious study time to resolve. This is particularly true when a short text that tries to simplify a complex topic is compared to a larger text or lecture that gives a more thorough treatment of the topic. Also, several important new therapeutics are not described in the current edition of PHARMACOLOGY REVIEW (olanzapine, alendronate, troglitazone, etc.).
Probably the most well known pharmacology textbook is GOODMAN AND GILMAN’S THE PHARMACOLOGICAL BASIS OF THERAPEUTICS, 9th edition. (1996) Editors: Hardman, J.G. et al., McGraw-Hill. This text is very comprehensive, provides detailed historical, conceptual and scientific background on pharmacology, and also provides detailed descriptions of numerous drugs and their uses. Its size (1905 pgs. loaded with small text and lots of complex figures and tables) and fine detail make it impractical for use as a general course textbook, in our opinion. Also, due to its size and complexity, it is not as frequently updated as BASIC AND CLINICAL PHARMACOLOGY. However, it is an excellent reference textbook which can be very useful. Most, if not all, pharmacology faculty own and consult GOODMAN AND GILMAN.
RECOMMENDATIONS FOR STUDY.
To successfully complete Medical Pharmacology come to all scheduled classes and be prepared to listen and write a complete set of notes during class. Also, ask questions during class or shortly after if there are topics you wish clarified. Read relevant sections of the assigned textbook chapters before or shortly after the lecture to aid comprehension. You should do well on our exams if you do the above, and then carefully study your class notes and review relevant material in your textbook before examinations. This should also allow you to achieve a satisfactory score in pharmacology in Step 1 of the USMLE.
Make use of any other educational resource or strategy that helps you understand and retain the material. However, beware of too many hardcopy sources; they may result in confusion, or waste time if you must search through stacks of transcripts or books looking for a topic. Consider attending the free review sessions with pharmacology graduate students scheduled during the course. A new Medical Pharmacology Web Site (see below) can quickly link you to a group of internet sites with excellent computer-based learning/study programs for pharmacology. Our Medical Pharmacology Web Site is designed to be efficient with your time and can also offer self-assessment. Visit our web site for a stimulating change of pace when you’re tired of your primary study materials, or want to see where you’re at in your studies.
Reading an old transcript from last year while only listening to the lecture diminishes the educational value inherent in personally writing your own set of lecture notes! Also, verbatim transcripts from the preceding year almost amount to a second textbook if you count their total lines of text, and they generally lack the focus on key facts and concepts seen in a good set of class notes. Thus, reliance on old transcripts may be an inefficient use of your study time. Last year’s transcripts may also contain outdated information or lack important new information given the current pace of research and new drug development. On the other hand, old transcripts can be very useful for interpreting ambiguous class notes, or clarifying a point about a lecture that you were not sure about or totally missed for some reason or other.
When you know an upcoming topic concerns an area you dread or poorly mastered in the past (e.g., renal physiology, cardiac electrophysiology), then do a little background study before class to improve your comprehension during lecture. We do provide quick, integrative reviews of basic physiology, biochemistry and pathology appropriate to the topic to jog your memory; however, such reviews are greatly abbreviated by our need to present new information.
Your final score in Medical Pharmacology is based on three major unit examinations, a comprehensive final miniboard exam (from the NBME) and two short mini-quizzes (see below). The mini-quizzes (22 questions each) account for only 4-8% of your final score, and are offered about two weeks before the first two major unit examinations. Mini-quizzes cover a limited amount of material and are designed to give you an opportunity to objectively assess how well you are learning the material before you take a major examination. Take advantage of this opportunity and study for the mini-quizzes. If you perform poorly or marginally on a mini-quiz after studying for it, then you will have time to improve your study strategy for major exams.
Basic science faculty in pharmacology are generally available in their labs during the week to answer your questions about a lecture or topic. Don’t be bashful about dropping by and asking questions. If they are too busy, they will be glad to give you a time when you can come back. The only rule here is don’t ask our faculty to spoon feed you a lecture that you failed to attend or slept through. Ask legitimate questions that you had after listening to the lecture or studying the material. Clinical faculty with patient care duties are harder to contact after a lecture due to their schedules and varied work locations. Don’t hesitate to ask them any questions you have at the end of the lecture before they leave. If you miss them then, you will need to call their offices and schedule a time to ask your questions. Alternatively, you might discuss your questions with a basic science member of the pharmacology faculty who lectures on related topics.
STUDENT EVALUATION.
Students take 5 in-house tests (2 small mini-quizzes and 3 major unit exams) and one NBME subject exam (miniboard). All students must achieve a final score of 66% or greater to pass Medical Pharmacology; there are no exceptions. It should be noted that scores on NBME miniboard exams (based on a ranking method) are appropriately transformed before use in the Medical Pharmacology scoring system. The in-house and NBME tests are weighted as follows:
In-house exams and mini-quizzes.....................50 or 70% of score.
NBME comprehensive subject exam ............ 30 or 50% of score.
Four different methods are used to calculate each student’s final course score, and the highest final score calculated is used (see below). This system recognizes that some students perform better on the in-house tests, while others do better in the comprehensive final NBME subject exam.
| Method 1 | Method 2 | Method 3 | Method 4 | |
| 3 unit exams (100 questions each) | 42% | 46% | 62% | 66% |
| 2 mini-quizzes (22 questions each) | 8% | 4% | 8% | 4% |
| NBME subject miniboard exam | 50% | 50% | 30% | 30% |
Students must have a written doctor’s excuse for absence during exams due to illness. In the event of illness, or a personal or family emergency requiring absence during an exam, students should contact the Course Director (C. Andrew Powers, Ph.D., 914-594-4136) or the Department office (914-594-4116) as soon as possible. Excused absences will be allowed to take an a make-up exam on the material covered.
The MEDICAL PHARMACOLOGY WEB SITE.
The Course Director and the NYMC Webmaster have created a Medical Pharmacology Web Site which contains a variety of optional educational and information resources. An Education Resource Center in the site will quickly link you to internet sites offering computer-based learning/study programs suitable for use by medical students taking Medical Pharmacology. These resources (which are briefly described in our web site) are efficient with your time, and provide novel and refreshing study aids that may be helpful when you get burned out on other study methods. Also, our web site can link you to a computer program which will let you design a quiz to quickly assess you knowledge on specific or broad topic areas.
Another useful feature of our the Medical Pharmacology Web Site is the Pharmacology News Center. This resource show-cases a selected group of internet information services designed for physicians. These are excellent services, and also are free! We believe they will demonstrate how information technology available over the internet can make it easier for you to stay up-to-date on the latest medical news and research in pharmacology, as well as in other areas. We anticipate you’ll want to continue using these or similar types of services long after you’ve graduated from NYMC and entered practice.
The Medical Pharmacology Web Site has a Pharmacology Bulletin Board for posting questions or comments, and initiating discusssions that may be of wide interest to students taking the course. We hope this page will facilitate communication and feedback on the course, or pharmacology in general. Finally, an Other Resources page has been included to provide a place to post additional information or novel internet links that students may request, or that our faculty may wish to provide in responding to student questions, comments or discussions.
The Medical Pharmacology Web Site is reached by opening the Faculty Web Page for the course director (C. Andrew Powers, Ph.D.), and then clicking the icon for the Medical Pharmacology Web Site. Faculty web page listings are located in the Graduate School of Basic Medical Sciences domain of the NYMC Web Site (just two clicks off the NYMC home page).
