Introduction to Human Physiology

1. Introduction to Human Physiology XIA Qiang（夏强）, PhD Department of Physiology Zhejiang University School of Medicine Email: xiaqiang@zju.edu.cn Tel: 88206861

2. [From: Faculty/Faculty/Physiology 2018; m-learning.zju.edu.cn]

3. ACGME Core Competencies The Accreditation Council for Graduate Medical Education (ACGME) https://ecfmg.org/echo/acgme-core-competencies.html • In 2002, the ACGME launched a competency initiative called the Outcome Project • As a result of this project, ACGME identified six ACGME Core Competencies to be used by GME programs to evaluate their residents in training • The six ACGME Core Competencies are: • patient care • medical knowledge • practice-based learning and improvement • interpersonal and communication skills • professionalism • systems-based practice http://www.abms.org/board-certification/a-trusted-credential/based-on-core-competencies/

4. Core Competencies by ACGME • Patient Care患者照护: • Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. • Medical Knowledge医学知识: • Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. • Interpersonal and Communication Skills人际交流技能: • Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to: • communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds; • communicate effectively with physicians, other health professionals, and health related agencies; • work effectively as a member or leader of a health care team or other professional group; • act in a consultative role to other physicians and health professionals; and, • maintain comprehensive, timely, and legible medical records, if applicable. • Professionalism职业精神: • Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: • compassion, integrity, and respect for others; • responsiveness to patient needs that supersedes self-interest; • respect for patient privacy and autonomy; • accountability to patients, society and the profession; and, • sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

5. Core Competencies by ACGME • Practice-Based Learning and Improvement基于实践的学习能力: • Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. Residents are expected to develop skills and habits to be able to meet the following goals: • identify strengths, deficiencies, and limits in one’s knowledge and expertise (self-assessment and reflection); • set learning and improvement goals; • identify and perform appropriate learning activities; • systematically analyze practice using quality improvement (QI) methods, and implement changes with the goal of practice improvement; • incorporate formative evaluation feedback into daily practice; • locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems (evidence-based medicine); • use information technology to optimize learning; and, • participate in the education of patients, families, students, residents and other health professionals. • Systems-Based Practice基于系统的实践: • Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to: • work effectively in various health care delivery settings and systems relevant to their clinical specialty; • coordinate patient care within the health care system relevant to their clinical specialty; • incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate; • advocate for quality patient care and optimal patient care systems; • work in interprofessional teams to enhance patient safety and improve patient care quality; and • participate in identifying system errors and implementing potential systems solutions.

6. Graduate Attributes and Capabilities Attitudes Knowledge Skills

7. 来华留学生医学本科教育（英语授课）质量控制标准暂行规定来华留学生医学本科教育（英语授课）质量控制标准暂行规定 • 第四条 • 来华留学生医学本科教育（英语授课）的总体目标是培养基础医学知识扎实、临床技能规范、职业素质良好的医学本科毕业生，为其进一步深造打下一定基础，也为他们在医学研究、卫生行政管理等方面的发展奠定基础。 • Article 4The overall goal of the undergraduate medical education program in English for international students in China is to train the undergraduate students to develop solid medical knowledge, standardized clinical skills, and an appropriate professional attitude, and to lay the foundation for their further study in medical research, health administration, etc. http://www.moe.gov.cn/publicfiles/business/htmlfiles/moe/s3123/201002/82574.html

8. Attitudes 第七条 医学本科毕业留学生应具备如下职业素质与思想道德： 　　（1）愿为卫生事业的发展和人类身心健康奋斗终身。 　　（2）关爱病人，将预防疾病、驱除病痛作为自己的终身责任，将提供临终关怀作为自己的道德责任，将维护民众的健康利益作为自己的职业责任。 　　（3）坚持原则，发挥卫生资源的最大效益。 　　（4）树立终身学习观念，认识到持续自我完善的重要性。 　　（5）尊重每一个人，尊重个人信仰。 　　（6）具有实事求是的科学态度，对于自己不能胜任的医疗问题，主动寻求其他医师的帮助。 　　（7）具有创新意识。 　　（8）具有团队合作精神。 　　（9）依法行医，会用法律保护病人和自身的权益。

9. Article 7International graduates of the undergraduate medical program shall demonstrate professionalism and ethics quality through exhibiting: (1) Willingness to dedicate themselves to enhancing the health profession and fostering the well-being of the mind and body; (2) Good care for patients, recognition of lifelong responsibility to prevent disease and eliminate symptoms, the moral obligation to provide hospice care, and the professional responsibility to safeguard the health interests of human beings; (3) Ability to uphold principles and make full use of health resources; (4) Devotion to lifelong learning and continuous self-improvement; (5) Respect for each individual and their beliefs; (6) Scientific attitude by seeking truth from evidence and getting help from other doctors when they are unable to solve medical problems by themselves; (7) Sense of innovation; (8) Spirit of teamwork; (9) Ability to practice medicine in accordance with the laws and to use the laws to protect patients and their own rights and interests.

10. Knowledge 第八条 医学本科毕业留学生应具备如下知识： 　　（1）掌握基本汉语知识，了解中国概况。 　　（2）掌握与医学相关的数学、物理学、化学、生命科学、行为科学和社会科学等基础知识，并能应用于未来的学习和医学实践。 　　（3）掌握人体正常结构和功能，正常心理状态。 　　（4）掌握各种常见病、多发病（包括精神疾病）的发病原因，认识环境因素、社会因素及行为心理因素对疾病形成与发展的影响，认识预防疾病的重要性。 　　（5）掌握各种常见病、多发病的发病机制、临床表现、诊断及防治原则。 　　（6）掌握基本的药理知识及临床合理用药原则。 　　（7）掌握正常妊娠和分娩、产科常见急症、产前及产后保健原则，以及计划生育医学知识。 　　（8）掌握健康教育和疾病预防原则，掌握缓解与改善疾患和残障、康复以及临终关怀有关知识。了解全科医学的基本知识。 　　（9）掌握临床流行病学的有关知识。 　　（10）掌握传染病的发生、发展以及传播的基本规律，掌握常见传染病的防治原则。 　　（11）基本掌握公平有效分配和合理使用有限资源的原则。 　　（12）了解中国传统医学的基本特点和中医的辨证论治原则，树立整体观念。

11. Article 8International graduates of the undergraduate medical program shall demonstrate the knowledge and understanding of: (1) Basic Chinese language and today's China; (2) Mathematics, physics, chemistry, life science, behavioral science and social sciences, as they are related to medicine, and how to use this knowledge to guide their medical practice; (3) Body structure and function in human beings, human behavior, and normal state of mind; (4) Causes of common diseases and frequently-occurring diseases including mental illnesses, the impact of environmental, social, behavioral and psychological factors on the occurrence and development of diseases and the importance of disease prevention; (5) Pathogenesis, clinical symptoms, diagnosis and preventive ways of common diseases and frequently-occurring diseases; (6) Basic knowledge of pharmacology and clinical principles of rational drug use; (7) Normal pregnancy and delivery, common obstetric emergency treatment, principles of prenatal and postnatal health care, and family planning; (8) Health education and disease prevention, common diseases, disabilities, rehabilitation, hospice care, and general practice; (9) Knowledge of clinical epidemiology; (10) Basic patterns of development and spread of infectious diseases, and prevention of common infectious diseases; (11) Principles of fair and effective distribution of health care services and rational use of limited medical resources; (12) Basic characteristics of Traditional Chinese Medicine and its application based on an overall analysis of the patient's condition.

12. Skills 第九条 医学本科毕业留学生应具有如下能力： 　　（1）全面、系统、正确地采集病史的能力。 　　（2）系统、规范地进行体格及精神检查的能力，规范书写病历的能力。 　　（3）较强的临床思维和表达能力。 　　（4）内科、外科、妇产科、儿科等各科常见病、多发病的诊断、处理能力。 　　（5）一般急症的诊断、急救及处理能力。 　　（6）选择使用合适的临床诊断、治疗手段的能力。 　　（7）运用循证医学的原理进行医学实践，完善诊治方法。 　　（8）具有与病人及其家属进行交流和调动病人合作的能力。 　　（9）具有与医生及其他医务人员进行交流沟通的能力。 　　（10）结合临床实际，能够独立利用图书馆和现代信息技术研究医学问题及获取新知识与相关信息。 　　（11）能够对病人和公众进行有关健康生活方式、疾病预防等方面知识的宣传教育。 　　（12）具有自主学习和终生学习的能力

13. Article 9 International graduates of the undergraduate medical program shall be able to: (1) Collect medical history comprehensively, systematically and correctly; (2) Perform systematic and standardized physical and psychiatric examinations and write standard records; (3) Make and express accurate clinical judgments; (4) Diagnose and treat common and frequently-occurring diseases in internal medicine, surgery, obstetrics and gynecology, pediatrics and other branches of medicine; (5) Diagnose and treat general emergency cases; (6) Select appropriate clinical diagnosis and treatment for patients; (7) Improve treatment methods in medical practice by using the principles of evidence-based medicine; (8) Communicate with patients and their families effectively and encourage patient cooperation; (9) Share their experience with doctors and other medical personnel effectively; (10) Analyze medical problems independently and acquire new knowledge and relevant information based on clinical practice, with the help of library databases and modern information technology; (11) Publicize relevant knowledge about healthy lifestyles and disease prevention to patients and the general public; (12) Study more independently and throughout their lives.

14. Learning Philosophy I hear and I forget, I see and I remember, I do and I understand.

15. Handheld device software • Epocrates: drugs, medical calculator, clinical database • >3300drugs • More than 45% medical doctors used • DynaMed: evidence based medicine database • DynaMed is THE MOST CURRENT point-of-care reference

16. http://guides.library.harvard.edu/hms/mobileApps

17. Course Structure • Lectures: 80 academic hours • 5 a.h./week • 2 a.h. on Wed., 3 a.h. on Thur. • Practicals: 64 a.h. • 4 a.h./week • Begin from second week

18. Evaluation • “Double pass” policy: • Total >= 60 • Final examination >= 60 • Weekly assessments & midterm exam >= 60 Participation: 5% Practical reports: 15% Weekly assessments (from Spring Week 2 on), mini-tests at lecture & midterm exam: 30% Final examination: 50%

19. Recommended textbook • Widmaier EP, Raff H, Strang KT (2010 or later) Vander’s Human Physiology: The Mechanisms of Body Function, McGraw-Hill. • Reference textbook: • Kim E. Barrett, Susan M. Barman, Scott Boitano and Heddwen L. Brooks. Ganong’s Review of Medical Physiology, 25e [http://www.accessmedicine.com] [ZJU IP]

20. Course website • Course website: • http://m-learning.zju.edu.cn • Demo

21. Human Physiology • Specificcharacteristics, functions and mechanisms of the human body that make it a living being What ? How ?

22. Body Components skin = barrier entry = respiratory & GI transport = CV & diffusion exit = renal & GI Differentiated Cells - specialized function Tissues - groups of cells with related function (muscle, nervous, connective, & epithelium) Organ- functional unit Organ system – several organs act together to perform specific function

23. ICF ISF plasma organs external environment internal environment Fluid Compartments

24. Body Fluid = 60% of Body Weight (BW) Plasma 5% of BW Extracellular Fluid 1/3, 20% of BW Interstitial Fluid 15% of BW 70 kg Male, 42 L Intracellular Fluid 2/3, 40% of BW Internal environment

26. Homeostasis • Homeostasis(from the Greek words for “same” and “steady”): maintenance of static or constant conditions in the internal environment • Central theme of physiology Walter B. Cannon

27. Components of Homeostasis: • Concentration of O2 and CO2 • pH of the internal environment • Concentration of nutrients and waste products • Concentration of salt and other electrolytes • Volume and pressure of extracellular fluid

28. How is homeostasis achieved? ----Regulation Body's systems operate together to maintain homeostasis: Skin system Skeletal and muscular system Circulatory system Respiratory system Digestive system Urinary system Nervous system Endocrine system Lymphatic system Reproductive system

29. Homeostasis and Illness

30. Regulation of body functions • Nervous Regulation • Humoral Regulation • Autoregulation

31. Nervous regulation Reflex Knee jerk reflex

32. Reflex Arc • Receptor • Afferent (sensory) nerve • Reflex center (brain or spinal cord) • Efferent (motor) nerve • Effector

33. Hormone Endocrine cells Receptor Hormone Humoral regulation Traditional description of humoral regulation by hormone

34. Endocrine action:the hormone is distributed in blood and binds to distant target cells • Paracrine action:the hormone acts locally by diffusing from its source to target cells in the neighborhood • Autocrine action:the hormone acts on the same cell that produced it

35. Neuroendocrine (Neurosecretion) Vasopressin Oxytocin

37. Autoregulation Definition:Intrinsic (independent of any neural or humoral influences) ability of an organ to maintain a constant blood flow despite changes in perfusion pressure Mechanism: Stretch-activated constriction of vessels Significance: Maintenance of near-constant cerebral, renal and coronary blood flow

38. 80~180 mmHg

39. Control systems of the body CYBERNETICS or Control and Communicationin the Animal and the Machine (MIT Press 1948) Norbert Wiener (1894-1964) Originator of Cybernetics

40. Stimulus Response Control Center Effectors 1. Non-automatic Control System Open-loop system Seldom seen under physiological conditions Stress

42. Stimulus Response Control Center Effectors 2. Feedback Control System Closed-loop system Automatic control Negative feedback Positive feedback

43. Negative feedback:common A change in a condition leads to responses from the effectors which counteracts that change

44. Examples: Regulation of blood pressure, Regulation of body temperature, Regulation of hormone release…

45. Correction Gain= Error Gain of the negative feedback: The degree of effectiveness with which a control system maintains conditions

46. + Positive feedback:uncommon A change in a condition leads to responses from the effectors which amplifies that change

47. Examples: Child birth Micturition Blood coagulation Vicious circle under pathophysiological conditions…

48. Disturbance Monitor Stimulus Response Control Center Effectors 3. Feed-forward Control Often seen in nervous system Rapid Adaptive control Examples: some muscle contraction, conditioned reflex

50. Summary • Terms: • Internal environment • Homeostasis • Negative feedback • Positive feedback • Regulation of body functions