The Oklahoma

Pathophysiology Syllabus
Reviewed by Ogan Gurel
14 April 1994

I appreciated the opportunity to review the Oklahoma Pathophysiology syllabus. As you

know, an overview of my publishing philosophy was previously given in the
Microbiology Companion review. With that in mind, I’ll confine my comments here to
the most essential points.

A Thumbnail Sketch of 2nd year Pathophysiology

Nearly every medical school in the U.S. has a 2nd-year pathophysiology course or
equivalent which variously go by the name of Pathophysiology, Pathophysiology of
Organ Systems, Pathophysiology of Disease, Mechanisms of Disease, Clinical Problem
Solving, etc.. These courses are usually structured along subspecialty lines in Internal
Medicine — e.g. Endocrinology, Cardiology, etc. or similarly by Organ System — e.g.
Endocrine, Cardiovascular, etc. Nearly all of these courses have the same structure with
about one-third being conducted by didactic lecture and remaining time in small groups
led by a physician-preceptor. Each small group session focuses on one or two clinical
cases that highlight the major concepts discussed during the lectures. Exams are either
multiple-choice or essay, depending on the preferences of the individual section directors.
Since there is no good pathophysiology textbook, nearly every medical school
supplements its lectures with its own monolithic syllabus for the 2nd year
pathophysiology course. The Oklahoma syllabus here is one example.

Pathophysiology Syllabi
The format of these syllabi is usually very similar to the Oklahoma one in which a faculty
team makes contributions to isolated topics in the course. Each presentation varies in
quality and form and often is heavy on the text and light on illustrations. For both
students and faculty to accept a separate pathophysiology book, it must above all, be
complementary to their own printed materials. The book as it stands is too similar to
these other syllabi. Thus the students would be unconvinced that this book could help
them and the faculty would view this book as direct competition with their own syllabi.
There is, however, a strong need for a separate pathophysiology text/review book.
Several changes would help make the Oklahoma book complementary to traditional
syllabi and thus fill this gap. First, is a more conceptualized presentation, which can be
achieved by both by paring down text and increasing the number of illustrations.
Sections highlighting key concepts, essential points, etc. would be also very important.
Secondly, it might be a real coup if the book could incorporate some clinical cases with
accompanying small-group questions and. Students would most definitely read these in
addition to their regular materials.

The Oklahoma Syllabus is not uniform in presentation

Being a team product, the syllabus varies widely in substance and form. Some parts are
text; others are outline. Some have good illustrations; others have nearly no illustrations.
For a professionally published book that would appeal to students and faculty alike;
uniformity of presentation is essential.

The Oklahoma Syllabus follows the traditional pattern of medical

education.
As I outlined in my last review, medical education is moving away from the traditional,
fact-oriented approach to a more concept-based, problem-oriented approach. This
syllabus which more-or-less follows the traditional format runs the risk of being outdated.
Again, an emphasis on concepts & illustrations as well as on clinical cases and discussion
questions would make this book an enduring classic for the future rather than an
anachronism of the past.

We have, as JFK might have put it “a pathophysiology gap.” “Ask not what medical
students can do for us, ask what we can do for medical students.” If we can give them a
clear, unified, conceptually-oriented, well-illustrated book with accompanying discussion
of clinical cases then we will have gone a long way towards filling that gap.