UW Division of Gastroenterology - Gut Course (HuBio 551): Spring 2009

	Updated: 03/25/09 11:21 AM

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Introduction

Welcome to Human Biology 551, the “Gut Course.” We wish to start the course introduction by making the following audacious statement: The Gastrointestinal Tract is the most important organ system of the body. We base this observation on several simple, self-evident facts:

First, all other organs of the body metabolize nutrients for energy and cell growth. In the absence of those nutrients, these organs starve. The GI tract is the principal site of intake of nutrients. The evolution and function of the GI tract ensures the maximal absorption of nutrients and water to support life’s functions. Before the advent of modern agriculture and Whole Foods, one’s next meal and drink of water were often in doubt.
Second, an M.I.T. Media Lab study in the early 1990s, which looked at how computer technology could reproduce the sensation of bodily pleasure, clearly showed that the human body was happiest when something was either entering or leaving it. The GI tract is a major bodily portal of both entry and exit.
Third, we make the observation that when one’s bowels are not happy, there is an extremely high likelihood the person is not happy.

Logical Thinking vs Regurgitating Facts

This course will be one of the most challenging you will take during your medical training, since the learning paradigm is about to change on several levels. Our purpose is to train you to think, rather than memorize facts and regurgitate them back. For most of your training to date, you have been asked to memorize and then answer multiple choice or true-false questions. In the practice of medicine we have never encountered a patient who presents with a complaint of abdominal pain and has a multiple choice response system tattooed on their body: (A) Peptic ulcer, (B) Biliary colic, or (C) Reflux esophagitis.

Our main teaching objective is to help you to think about gastrointestinal problems in an organized, logical way, to solve problems that patients present to you, and to question the current dogma.

More Than One Correct Answer to a Problem

Patients present with a series of complaints and symptoms and the physician must reason and formulate a hypothesis as to their etiology. The hypothesis should be built around a base of knowledge, then tested and refined. In this course you are going to be asked to use a knowledge base of normal gastrointestinal, hepatobiliary, and pancreatic physiology to hypothesize a reasonable explanation for how disease states interfere with normal function to yield signs and symptoms of illness. There may be different but logical answers to explain an illness—and thus, more than one correct answer to a question. Many students find it difficult to accept this concept.

Small Group Sessions

The majority of the learning in this course will take place in small group sessions that are taught using the Socratic Method. While attendance is not mandatory and your grade will not be based on class participation, participation is highly recommended, because the group interaction reinforces the course content and learning methods. Simply reading the syllabus, memorizing and highlighting every other word will not teach you the proper reasoning skills to explain and solve a patient’s problem. In group interactions, as in their future medical careers, students are challenged to explain their thinking, reinforcing their ability to solve patient problems in real time.

Small Group Participation

In your small group sessions, you will be expected to participate and will be called to the front of the class to lead a discussion or answer questions. Our purpose is not to embarrass you, but to train you to be placed on the spot. This process will make many students extremely uncomfortable, since everyone has a fear of looking foolish. We specifically want to teach you to overcome this fear. For the rest of your career, you will be constantly put on the spot. Your patients and other health professionals will consistently ask your opinion. You must learn to articulate your thoughts in real time, in a clear concise manner. Thus, the Gut Course is a preparation for real life.

Reading Assignments

Each day there is an assignment for reading a part of the syllabus before coming to class. Completing the reading will ensure you are prepared for the small group sessions. We will not attempt to tell you everything. Instead we will try to tell you what we think is important. We have simplified complex concepts and may be guilty of some oversimplifications. The syllabus is not meant to be a comprehensive textbook, but rather to serve as a compilation of relevant facts and concepts that act as your knowledge base. In this course we do not attempt to cover all important diseases that affect the gut, liver, pancreas, and biliary system, but to highlight those that are most important and/or most readily understood from basic pathophysiologic principles. We strive to provide an understanding of normal structure and function of the gastrointestinal tract, so that you can learn to apply this knowledge to abnormal structure and function by the study of selected disease models. You will have ample opportunity to learn more about other gastrointestinal diseases during your basic clerkships and during the courses you select during your last two years. We hope that you will be motivated to read in depth on these topics as you mature as physicians—there is an extensive literature in these fields that is growing constantly.

Faculty Planning Sessions

The faculty puts a great deal of effort into the small group teaching sessions. Each day, for 2.5 hours prior to meeting with the entire class, the course faculty meet and review the lesson plans for the day. We discuss our current understanding of a particular disease or physiologic state and teach/argue with each other as to what facts have been proven, and which concepts remain open to question. Once assigned to a small group, you cannot change instructors. Our experience during years of teaching the course with these methods is that all groups do essentially the same from a grading perspective. While some instructors may have better jokes or be more entertaining, their students learn no more or less than students in other groups. It is also important that students learn to interact with all types of personalities and learn from different teaching styles. Finally, we want to emphasize that our goal is for you to successfully make the transformation from being a memorizing machine to becoming a thoughtful, reasoning physician.

Whom to Contact for Help

If you are having difficulty, please talk with your Group Instructor or with
Bruce D. Silverstein, MD.

Disabled Student Services

If you would like to request special academic accommodations due to a disability, please contact Disabled Student Services at 448 Schmitz, Box 355839, (206) 543-8924, (TTY) 543-8925, or uwdss@u.washington.edu. Additional information is also available at the UW DSS website. You will need a letter from the Dean of Student Affairs indicating that you have a disability that requires academic accommodations. Please present the letter to Dr. Silverstein so that the accommodations you might need for this class can be arranged.

Acknowledgments

We wish to acknowledge the help of other people who have contributed to the course. Most of this year’s syllabus was completely re-written to reflect the most current concepts, knowledge and thinking. Individual authors are noted in the table of contents. Dr. Don Ostrow served as editor in chief of this syllabus and we thank him for his countless hours of research, organization and effort. It was a huge undertaking. Nancy Silverstein drew some of the diagrams. Carrie Silverman developed the course website. Rocky Yeh and Kristine Killen helped with the Gut slide set. We also gratefully acknowledge constructive suggestions from Drs. R. Barreras, W. Friend, J. Meisel, S. Rosen and C. Rohrmann. We apologize if we inadvertently left any other course contributors out of the credits.