Introduction and Rationale
An insightful quote often credited to the Nobel Prize-winning physicist, Sir William Bragg, suggests that “the important thing in science is not so much to obtain new facts as to discover new ways of thinking about them.” In my classroom, a version of this sentiment is imbued in all learning; I emphasize that we learn not simply to gather and consider information, but more so to apply new information to improve our lives. This is particularly evident in the structure of my Anatomy and Physiology course. Each unit of the course is organized around the same central idea: the human body is comprised of structures whose compositions dictate the functions they can perform and thus, dysfunctions result from changes in structure – structure, function, dysfunction. In this way, students can see that there are reasons for the data and information they gather about structure and function (beyond just having the information). This information is critical for providing insight about dysfunctions, and even more useful where it allows us to develop new or improved solutions for dealing with particular dysfunctions.
In essence, my Anatomy and Physiology course seeks to demystify (for students) disease and medical intervention by grounding knowledge in the firm foundation of structure-function-dysfunction. When students fully appreciate this foundation, they are able to use it as a platform from which to jump to new ideas. – again, from new facts to new thinking. Effective medical interventions – from common antibiotic treatments to groundbreaking gene-based therapies – stem from the idea that by better understanding bodily structures and processes, humans can take advantage and manipulate biological systems to enhance health outcomes.
As an example, consider the following example from the digestive system. Even before we begin the digestive system unit, many students are familiar with the term heartburn. However, if pressed about the condition and its possible causes, most students might at best manage a vague description of a painful dysfunction associated with heart muscle. A handful of students might be able to characterize heartburn as a problem associated with the digestive tract, but even they generally do not present a coherent and/or reasonable theory of the case. In terms of structure-function-dysfunction, heartburn, usually due to gastroesophageal reflux, is explained thusly; in the stomach, hydrochloric acid mainly functions to activate the enzyme pepsin (necessary for protein digestion) and to eliminate microbes. The relatively thick-walled structure of the stomach and the presence of bicarbonate usually prevent the stomach lining from hydrochloric acid damage. The thin-walled, bicarbonate-free structure of the esophagus cannot adequately serve the same protective function. Consequently, a weakened gastroesophageal sphincter muscle for example, can result in backflow of acid into the esophagus causing pain and destroying the esophageal lining (Kumar, Abbas, & Aster, 2015). Fortified with an understanding of structural basis of the dysfunction, students are now able to understand, describe, and even predict the types of structural remedies that might restore normal function (e.g. ingesting compounds to neutralize the acid, surgically implanting foreign objects to reinforce the sphincter, surgically positioning wall of the stomach to support the sphincter, etc.)
The goal of the course is to help students see the body less so as a perplexing collection of opaque functions and confusing glitches, and more so as a concrete and knowable system. Deviations from optimum healthfulness – injury, disease, aging, etc. – can be better understood (and eventually remedied) as knowledge of the body’s structure deepens. More straightforwardly, I push my students to embrace the idea that we explore the parts of the body, so we can know how those parts work; because it is by understanding how the parts work, that we might be able to address any problems that arise. To allude again to Bragg, we continually gather new facts to drive new thinking: new understanding and new solutions.
Throughout the Anatomy and Physiology course, the structure-function-dysfunction paradigm is applied to the various organ systems of the body. The curriculum unit presented here is to be a short segment taught within a broader unit of the course that covers the structure, function, and dysfunction of the skeletal system. Prior to engaging with specific content of this curriculum unit, students will have been introduced to and explored the idea that the structures of the skeletal system cooperate to serve several critical functions; interaction between the muscular system and the skeletal system allows the bones in the body to move; the axial skeleton, consisting of the skull, sternum, ribs and vertebral column, provides protection for the vital organs and soft tissues such as the brain, heart, and spinal cord; bones and cartilage, the only two rigid and dense parts of the body, provide shape and structure, maintain the body upright, and provide a framework to which all other soft tissues (muscle and organs) can attach; bones are the site of blood cell production; bones are an important site for mineral storage, especially calcium.
The curriculum unit presents a number of diseases and medical conditions that result in bone loss as representative disorders that students can explore in order to gain a better understanding of normal and abnormal functioning of the skeletal system. Osteoporosis, for example, is a skeletal disorder characterized by a loss of bone mass and decreased bone mineral density. The deterioration in microarchitecture of bone results in an increased risk of fracture. The curriculum unit establishes a foundation of normal bone development and function from which students will explore various skeleton-related dysfunctions alongside remedies and/or interventions; therefore, the curriculum unit reinforces students’ understanding of the skeletal system by challenging them to thoroughly consider what happens when something goes wrong with it. With a more substantial understanding of the underlying science (molecules, mechanisms, pathways and the like), students will be able to rise to the curriculum unit’s challenge of considering and grappling with risks, consequences, and ethical considerations associated with humans’ abilities to manipulate human biology in these specific ways.
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