- Email: [email protected]
Biochemistry in the medical curriculum
16 purpose or task achieved? One way of assessing the success of small-group teaching is to issue a questionnaire; in other words, to undertake a formal evaluation rather than relying on hearsay. Questionnaires need careful planning and professional advice: at the very least, copying or modifying someone else's questionnaire, is recommended.
Biochemistry in the Medical Curriculum
Conclusions In a recent book by Weatherall (The New Genetics and Clinical Practice5) the author called attention to the need, in his opinion, for a new generation of doctor who has a foot firmly planted on both the clinical and the basic sciences. There was, he said, a need for not only education but also of discussion of the issues involved at all levels. Of course, I am not talking here solely about the education of medical people. These skills are required by all professional scientists. The tutorial can start the process of discussion. This is important not only as a way of helping the understanding of concepts but also of taking an active and informed part in discussing the issues. This is totally different from learning something and then of reproducing it in an examination or of learning intellectual and technical skills that might conceivably be of use in future professional practice. It is the start to making a contribution in science. To summarise, I believe that we should aim to develop, in students, such mental skills as critical and analytical thinking, interpretation and deduction, as well as communication skills. Tutorial teaching and group discussion, if properly organised, must be one of our major ways of achieving these. In addition, in the sciences, there is the need to integrate different facts, see overall patterns and discern general principles. In this respect, too, smallgroup teaching would seem to offer the enlightened teacher outstanding opportunities. Most important of all is that a properly run tutorial will demand active involvement of all the students. Active involvement means that knowledge must have been remembered, digested, corrected, correlated, and can now be used. It has been reported that we remember about 20% of what we hear, about 30% of what we see, about 50% of what we see and hear, and 90% of what we do, that is, of what we actively participate in. Lectures and laboratory classes obviously have their place. However, I believe that tutorial teaching, although it is the most expensive system in terms of staff time, has greater potential than any other for effective teaching and for the production of a fully developed individual by our educational systems.
Introduction During the last fifty years, biochemical principles, concepts and technology have become increasingly important for the understanding of disease, clinical treatment and medical research. Advances in biochemical sciences have led to progress in medicine, and this is entirely recognised by the medical profession. However there is dissatisfaction with the teaching of biochemistry in medical schools, especially in the preclinical years. Doctors and clinical students have often criticised the teaching of biochemistry, saying that the bulk of biochemistry taught to them in their preclinical course has been only of minor value to them in their clinical studies, investigation and treatment.l-3 Biochemistry is considered as a hurdle by many. A general prevalence of dislike for biochemistry has built up over the years amongst students and this is disheartening to teachers. It has been said that biochemistry is a difficult subject, not only for the student, but also for the teacher and this opinion is widespread. 4-6 The fact that many attempts have been made to change the emphasis on formal conventional teaching highlights the problem. There have been many attempts at developing curricula to make biochemistry more relevant to the study of medicine and textbooks have been written with this objective. 7 That those doctors who have been through a system may from experience be able to improve that system for their successors must be acknowledged by the teachers and authorities in universities as part of a developing evaluation of medical education.
References t Mehler, A H (1983) 'Strategies in Biochemical Education' Biochem Educ 11, 95-118 2Newble, D and Cannon, R (1983) 'A Handbook for Clinical Teachers' MTP Press, Lancaster, UK 3Wood, A E (1981) 'Learning in Small Groups' in 'Biochemical Education' edited by Bryce, C F A, pp 141-155, Croom-Helm, London 4Bion, W R (1968) 'Experiences in Groups', Tavistock Press, London 5Weatherall, D J (1986) 'The New Genetics and Clinical Practice' (Second Edition), Oxford University Press, Oxford
B I O C H E M I C A L E D U C A T I O N 16(1) 1988
N CHANDRASEKHARAN
Department of Biochemistry Faculty of Medicine University of Malaya Kuala Lurnpur, Malaysia
Feedback We must recognise the importance of inputs from students, past and present, as well as the medical profession in general, as their understanding will facilitate appropriate remedial measures towards improving the teaching of biochemistry to medical students. In order to get feedback information on the problems associated with the teaching of biochemistry in the preclinical years, a questionnaire was distributed to all students towards the end of the academic session. The areas covered included the lectures, tutorials, practicals and general aspects of the course. Information was also obtained through discussion with clinical students, doctors in teaching institutions and hospitals. Information gathered by the medical students' society in earlier years was also utilised, s'9 The responses from students were analysed and are discussed in the context of views expressed by other educationists on this subject. The information presented here gives some feedback on the success or failure of
17 instructional programmes and staff in biochemistry as well as on areas of concern (Tables 1-6).
Objectives The objectives of the biochemistry course were not clear to the majority of students: they could not appreciate the purpose or relevance of the bulk of the biochemistry taught to them (Table 1). Students enroi in the medical faculty to become doctors and their major objective is the acquisition of skills needed for medical practice. Our objective as teachers is to equip medical students with an adequate biochemical background for the study of medicine, ie to facilitate the study and understanding of other medical disciplines. It is a course which should also prepare medical students for future years of medical education. 10 Many students had difficulty in coping with the firstyear medical curriculum. Of the three preclinical subjects, biochemistry was ranked as the subject liked most by only 16% of the respondents. Students thought that biochemistry was taught excessively in terms of the amount of time devoted to the subject. It is pertinent to ask whether professional biochemists should decide what is important for a medical student? Universities decide how many hours shall be spent on
different subjects and they inevitably do so on the basis of tradition and estimates of importance. Views of consumers are generally not taken into account and so curricular subject time and therefore importance can be perpetuated in an authoritarian and empirical way. There is intense competition for curricular time, as the amount of subject matter to be learnt keeps growing. Factual overload continues, for it is easier to add new material to the course than to delete it. Some traditional physiological chemistry topics are often deleted.1 The basic sciences like biochemistry cover such a vast range of knowledge that it is difficult for the student to have a profound understanding of any part. It must also be appreciated that basic medical education is a continuing process. Biochemistry is only one of the several subjects in the medical curriculum, and other subjects both basic and clinical are equally important, t2 There have also been advances in other areas. We have to be realistic in the time allocated for biochemistry as well as in selecting what biochemistry needs to be included in the curriculum. One of'the major complaints of students and doctors was the irrelevance of substantial parts of the course to medicine (Tables 1 and 2). Often the student finds difficulty in relating biochemistry to other disciplines such
Table 1 Students' responses to a questionnaire on the biochemistry course in the medical curriculum
Table 2 Students' attitudes to biochemistry (at the end of the biochemistry course)
Respondents
Respondents
(%) A Objectives not clear
55
B Difficulty in coping with the 1st year medical curriculum
45
C Application of biochemistry (taught in 1st year) to clinical years: very often quite often sometimes hardly ever
1 4 50 45
D Retention of biochemistry (as taught in the first year) for application in clinical years: good fair amount very little E How well has the department of biochemistry prepared you for the clinical years? very well quite well satisfactory poor
BIOCHEMICAL EDUCATION 16(1) 1988
0 9 91
0 8 41 50
(%) A Ranking amongst the three pre-clinical subjects (Anatomy, Biochemistry and Physiology) 1st 2nd 3rd
16 39 45
B Interest nil very much average
16 39 45
C Knowledge learnt nothing learnt a lot average
10 4 86
D Enjoyment boring very much average
5 9 86
E Future application very useful not perceived average
12 5 83
18 as anatomy, physiology, pharmacology and to the functioning of the body as a whole and thus the application of these concepts to the disease process. Substantial parts of the biochemistry course are irrelevant to the future needs of contemporary medical practitioners and are presented when the student is ill prepared to grasp their relevance and significance to clinical practice. 1,3
Tutorials, practicais and exams Some of the comments made by students are worth consideration, even though they are not revolutionary (Table 3). The traditional aim of supplementation and reinforcement of didactic material is very often not attainable. Very often there is no correlation between the practical classes and the lecture topics. Often the equipment and methods used affect the quality of results. Dissatifaction with practical classes is nothing new. 6 Table 3 Some of the comments of students on practicals and tutorials in biochemistry Tutors have insufficient knowledge for conduct of practicals and tutorials Benefits of tutorials vary with the topics and tutors Often practicals have no correlation with lecture topics Insufficient emphasis placed on objectives and principles of the practicals Unsatisfactory discussion of results The value of many of the practicals to practising physicians is limited. Often people who conduct these practicals are isolated from developments in clinical chemistry. In this connection a clinical chemistry format may be useful, as clinical chemistry determinations and clinical correlations may be more meaningful. There is a global trend to reduce practical classes, with the hope that practical class time, if reduced, will be filled by more lectures and tutorials. A depressing tendency indeed! For maximum benefit, participation from both students and staff is essential at tutorials and this calls for adequate preparation before coming to tutorial classes. 13 At present the learning of biochemistry is oriented towards overcoming examination hurdles. Medical students will continue to be overloaded with masses of factual information, whilst examinations will continue to assess merely the ability to recall specific facts, rather than their competence to apply basic principles in problem solution. 3.1o The requirements for studying medicine vary considerably. In some countries a basic science degree is a prerequisite for the study of medicine and such students have a high level of academic achievement. Textbooks designed for such students are often also prescribed for students with inadequate knowledge of English as well as
B I O C H E M I C A L E D U C A T I O N 16(1) 1988
lower entry qualifications. Some books require knowledge of extensive clinical situations. 7 Books which are recommended are at times not accepted and students resort to books used by their seniors.
What biochemistry should a practising physician know? It is appropriate to ask: are we preparing students to be physician-scientists, or for a teaching/research oriented career, or of course clinicians.12 Perhaps it would not be presumptuous to say that we would like to have a better clinician. Any review of the teaching of biochemistry must also take into account, in addition to the course content and context in which it is taught, the students and most important the teachers. Some of the suggestions made by students for improving the biochemistry course are listed in Tables 4 and 5, and some of the factors that may influence students attitudes towards biochemistry are given in Table 6. It is important to rationalise the medical curriculum and to decide what should be taught to undergraduates and what can be left to later years to be taught as part of chemical pathology. 10 It is necessary to reduce the factual load in terms of the chemical content of the course as well as details of metabolic pathways. There is a need for proper distribution between basic and clinically relevant biochemistry, and to orient biochemistry courses towards clinical problems. 3"7'm Isolated preclinical courses are inappropriate and if they are seen as unrelated to what is considered, rightly or wrongly, to be the requirements of a practising clinician. The result is likely to be the annhilation of students' enthusiasm and motivation for studying biochemistry and medicine and which are essential for progress in medical education and practice. The need for relevance must be accepted as far as possible and we make it clear to the students that the way in which each topic relates to the clinical situation at the Table 4 Students' suggestions for improving the biochemistry curriculum in the medical course Reduce the quantity of 'irrelevant' material taught Improve the quality of lectures and lecturers Highlight relevance to the practice of medicine
Table 5 Biochemistry course content: some points for consideration What is the role of biochemistry in medical education and the training of doctors? What are the areas of biochemistry which are of relevance to other medical disciplines and medical practice? How should the biochemistry course be taught?
19
Table 6 Factors that may influence students' attitudes towards biochemistry Motivation of students towards medicine and biochemistry. Perception of the relevance of biochemistry taught to the clinical subjects and the subsequent practice of medicine. Are students' lecture and study time overloaded? Are students too examination oriented?
Conclusions Anyone attempting to change the pattern of medical education is likely to face resistance from many quarters. Faculty and departmental staff consider such an action an encroachment on well established practices and a potential threat to academic autonomy and existing order. Any reforms in medical education, fundamental or not, to be effectively applied should not only follow other successful new models, but also fulfil local, social, cultural requirements and be economically feasible. Finally it must not be forgotten that biochemical knowledge must be seen as a means to an end in the study of medicine rather than as a subject which is satisfying by itself. Acknowledgement
time it is taught. It is not enough to assure them that it will be valuable later. It is difficult for students to appreciate the value of certain material if they do not witness its application soon thereafter.14
I would like to thank the many medical students, doctors and clinical colleagues for their comments and useful discussions, the officials of the Medical Society for permission to make use of some of their survey results.
References Role of the teaching staff Many innovative changes have taken place in the teaching of biochemistry. There are attempts to eliminate the sharp division which exists between the basic sciences and the clinical sciences. It is often assumed that we have the perfect teachers in biochemistry and so it is adequate to modify the curriculum - - or sometimes the students. A good teacher is one who is interested and prepared to work sufficiently hard to get to know his subject and its physiological and clinical applications. Adequate recognition needs to be given to good teachers, as judged by students. It must not be forgotten that the most effective judges of a good teacher are the students themselves. 1,10.15 The teacher must explain, in terms the students can understand, the complete concepts and principles. He must guide and direct the student to assume a greater responsibility for his own education. As an integrator of experiences, the teacher assumes a multidisciplinary approach with the major functions of co-ordinating, relating, harmonising and associating all aspects of academic life and study. Performing this role the teacher correlates knowledge, skills and behaviour with professional practice. Perhaps it should be realised that no educational system works better than that which is acceptable to both students and teachers. The main thing is to combine good teachers with good students. The medical profession has a strong lobbying potential and has taken considerable interest in postgraduate medical education. However, it has paid relatively little attention to the undergraduate medical curriculum. It must take an active interest and institute remedial measures in this long neglected area of medical education and emphasise the need for periodical review and change, and not allow those who have no interest or stake in the future of medical education and practice to influence professional training. BIOCHEMICAL EDUCATION 16(1) 1988
i Neame, R L B (1984) J Med Educ 59 699-707 2Muir, G G (1968) Lancet 1:632-633 3Wills, E D (1985) Biochemical Basis of Medicine Wright, Bristol, v-vi 4Candlish, J K, (1984) Lecture Notes on Biochemistry, Blackwell Scientific Publications, Oxford, (preface) 5perumal, R (1987) 'Problems in biochemical education', in Malaysian Biochemical Society Newsletter, 1-5 6Vella, F (1980) Innovations in the teaching of medical biochemistry, in Biochemical Education Bryce, C F A editor, Croom Helm, London, 81-94 7Montgomery, R A (1980) A Case oriented approach-design, implementation and results, in Biochemical Education Bryce, C F A editor, Croom Helm, London, 69-80 8Chandrasekharan, N (1985) The biochemistry course in the medical curriculum - - Trends and students' attitudes, Abstracts X1X Malaysia Singapore Congress of Medicine pp 132 9The Medical Society Survey on the medical curriculum, Faculty of Medicine, University of Malaya, Kuala Lumpur, 1979 1°General Medical Council Recommendations on basic medical education, GMC London, 1980 H Richardson, I M (1983) Med Educ 17, 8-10 ~2Dakshinamurthy, K (1980) Syllabi construction, curriculum content and relevance in medical biochemistry, in Biochemical Education Bryce, C F A editor, Croom Helm, London, 58-68 13Woods, A E, Learning in small groups, in Biochemical Education Bryce C F A editor, Croom Helm, London, 141-55 14Smith, A D (1983) Med Teacher 5, 56-93 15Veiga, S M G, Miller, M D, Hammock, J (1983) Med Educ 17, 87-9
Erratum Drawing a Porphyrin Formula In the article with the above title by H B F Dixon which appeared in Biochemical Education 15(4), 208, point (2) should have read 'Draw alternate double bonds round the porphyrin ring . . . . '. We apologise for any confusion this omission may have caused.
Biochemistry in the Medical Curriculum
Conclusions In a recent book by Weatherall (The New Genetics and Clinical Practice5) the author called attention to the need, in his opinion, for a new generation of doctor who has a foot firmly planted on both the clinical and the basic sciences. There was, he said, a need for not only education but also of discussion of the issues involved at all levels. Of course, I am not talking here solely about the education of medical people. These skills are required by all professional scientists. The tutorial can start the process of discussion. This is important not only as a way of helping the understanding of concepts but also of taking an active and informed part in discussing the issues. This is totally different from learning something and then of reproducing it in an examination or of learning intellectual and technical skills that might conceivably be of use in future professional practice. It is the start to making a contribution in science. To summarise, I believe that we should aim to develop, in students, such mental skills as critical and analytical thinking, interpretation and deduction, as well as communication skills. Tutorial teaching and group discussion, if properly organised, must be one of our major ways of achieving these. In addition, in the sciences, there is the need to integrate different facts, see overall patterns and discern general principles. In this respect, too, smallgroup teaching would seem to offer the enlightened teacher outstanding opportunities. Most important of all is that a properly run tutorial will demand active involvement of all the students. Active involvement means that knowledge must have been remembered, digested, corrected, correlated, and can now be used. It has been reported that we remember about 20% of what we hear, about 30% of what we see, about 50% of what we see and hear, and 90% of what we do, that is, of what we actively participate in. Lectures and laboratory classes obviously have their place. However, I believe that tutorial teaching, although it is the most expensive system in terms of staff time, has greater potential than any other for effective teaching and for the production of a fully developed individual by our educational systems.
Introduction During the last fifty years, biochemical principles, concepts and technology have become increasingly important for the understanding of disease, clinical treatment and medical research. Advances in biochemical sciences have led to progress in medicine, and this is entirely recognised by the medical profession. However there is dissatisfaction with the teaching of biochemistry in medical schools, especially in the preclinical years. Doctors and clinical students have often criticised the teaching of biochemistry, saying that the bulk of biochemistry taught to them in their preclinical course has been only of minor value to them in their clinical studies, investigation and treatment.l-3 Biochemistry is considered as a hurdle by many. A general prevalence of dislike for biochemistry has built up over the years amongst students and this is disheartening to teachers. It has been said that biochemistry is a difficult subject, not only for the student, but also for the teacher and this opinion is widespread. 4-6 The fact that many attempts have been made to change the emphasis on formal conventional teaching highlights the problem. There have been many attempts at developing curricula to make biochemistry more relevant to the study of medicine and textbooks have been written with this objective. 7 That those doctors who have been through a system may from experience be able to improve that system for their successors must be acknowledged by the teachers and authorities in universities as part of a developing evaluation of medical education.
References t Mehler, A H (1983) 'Strategies in Biochemical Education' Biochem Educ 11, 95-118 2Newble, D and Cannon, R (1983) 'A Handbook for Clinical Teachers' MTP Press, Lancaster, UK 3Wood, A E (1981) 'Learning in Small Groups' in 'Biochemical Education' edited by Bryce, C F A, pp 141-155, Croom-Helm, London 4Bion, W R (1968) 'Experiences in Groups', Tavistock Press, London 5Weatherall, D J (1986) 'The New Genetics and Clinical Practice' (Second Edition), Oxford University Press, Oxford
B I O C H E M I C A L E D U C A T I O N 16(1) 1988
N CHANDRASEKHARAN
Department of Biochemistry Faculty of Medicine University of Malaya Kuala Lurnpur, Malaysia
Feedback We must recognise the importance of inputs from students, past and present, as well as the medical profession in general, as their understanding will facilitate appropriate remedial measures towards improving the teaching of biochemistry to medical students. In order to get feedback information on the problems associated with the teaching of biochemistry in the preclinical years, a questionnaire was distributed to all students towards the end of the academic session. The areas covered included the lectures, tutorials, practicals and general aspects of the course. Information was also obtained through discussion with clinical students, doctors in teaching institutions and hospitals. Information gathered by the medical students' society in earlier years was also utilised, s'9 The responses from students were analysed and are discussed in the context of views expressed by other educationists on this subject. The information presented here gives some feedback on the success or failure of
17 instructional programmes and staff in biochemistry as well as on areas of concern (Tables 1-6).
Objectives The objectives of the biochemistry course were not clear to the majority of students: they could not appreciate the purpose or relevance of the bulk of the biochemistry taught to them (Table 1). Students enroi in the medical faculty to become doctors and their major objective is the acquisition of skills needed for medical practice. Our objective as teachers is to equip medical students with an adequate biochemical background for the study of medicine, ie to facilitate the study and understanding of other medical disciplines. It is a course which should also prepare medical students for future years of medical education. 10 Many students had difficulty in coping with the firstyear medical curriculum. Of the three preclinical subjects, biochemistry was ranked as the subject liked most by only 16% of the respondents. Students thought that biochemistry was taught excessively in terms of the amount of time devoted to the subject. It is pertinent to ask whether professional biochemists should decide what is important for a medical student? Universities decide how many hours shall be spent on
different subjects and they inevitably do so on the basis of tradition and estimates of importance. Views of consumers are generally not taken into account and so curricular subject time and therefore importance can be perpetuated in an authoritarian and empirical way. There is intense competition for curricular time, as the amount of subject matter to be learnt keeps growing. Factual overload continues, for it is easier to add new material to the course than to delete it. Some traditional physiological chemistry topics are often deleted.1 The basic sciences like biochemistry cover such a vast range of knowledge that it is difficult for the student to have a profound understanding of any part. It must also be appreciated that basic medical education is a continuing process. Biochemistry is only one of the several subjects in the medical curriculum, and other subjects both basic and clinical are equally important, t2 There have also been advances in other areas. We have to be realistic in the time allocated for biochemistry as well as in selecting what biochemistry needs to be included in the curriculum. One of'the major complaints of students and doctors was the irrelevance of substantial parts of the course to medicine (Tables 1 and 2). Often the student finds difficulty in relating biochemistry to other disciplines such
Table 1 Students' responses to a questionnaire on the biochemistry course in the medical curriculum
Table 2 Students' attitudes to biochemistry (at the end of the biochemistry course)
Respondents
Respondents
(%) A Objectives not clear
55
B Difficulty in coping with the 1st year medical curriculum
45
C Application of biochemistry (taught in 1st year) to clinical years: very often quite often sometimes hardly ever
1 4 50 45
D Retention of biochemistry (as taught in the first year) for application in clinical years: good fair amount very little E How well has the department of biochemistry prepared you for the clinical years? very well quite well satisfactory poor
BIOCHEMICAL EDUCATION 16(1) 1988
0 9 91
0 8 41 50
(%) A Ranking amongst the three pre-clinical subjects (Anatomy, Biochemistry and Physiology) 1st 2nd 3rd
16 39 45
B Interest nil very much average
16 39 45
C Knowledge learnt nothing learnt a lot average
10 4 86
D Enjoyment boring very much average
5 9 86
E Future application very useful not perceived average
12 5 83
18 as anatomy, physiology, pharmacology and to the functioning of the body as a whole and thus the application of these concepts to the disease process. Substantial parts of the biochemistry course are irrelevant to the future needs of contemporary medical practitioners and are presented when the student is ill prepared to grasp their relevance and significance to clinical practice. 1,3
Tutorials, practicais and exams Some of the comments made by students are worth consideration, even though they are not revolutionary (Table 3). The traditional aim of supplementation and reinforcement of didactic material is very often not attainable. Very often there is no correlation between the practical classes and the lecture topics. Often the equipment and methods used affect the quality of results. Dissatifaction with practical classes is nothing new. 6 Table 3 Some of the comments of students on practicals and tutorials in biochemistry Tutors have insufficient knowledge for conduct of practicals and tutorials Benefits of tutorials vary with the topics and tutors Often practicals have no correlation with lecture topics Insufficient emphasis placed on objectives and principles of the practicals Unsatisfactory discussion of results The value of many of the practicals to practising physicians is limited. Often people who conduct these practicals are isolated from developments in clinical chemistry. In this connection a clinical chemistry format may be useful, as clinical chemistry determinations and clinical correlations may be more meaningful. There is a global trend to reduce practical classes, with the hope that practical class time, if reduced, will be filled by more lectures and tutorials. A depressing tendency indeed! For maximum benefit, participation from both students and staff is essential at tutorials and this calls for adequate preparation before coming to tutorial classes. 13 At present the learning of biochemistry is oriented towards overcoming examination hurdles. Medical students will continue to be overloaded with masses of factual information, whilst examinations will continue to assess merely the ability to recall specific facts, rather than their competence to apply basic principles in problem solution. 3.1o The requirements for studying medicine vary considerably. In some countries a basic science degree is a prerequisite for the study of medicine and such students have a high level of academic achievement. Textbooks designed for such students are often also prescribed for students with inadequate knowledge of English as well as
B I O C H E M I C A L E D U C A T I O N 16(1) 1988
lower entry qualifications. Some books require knowledge of extensive clinical situations. 7 Books which are recommended are at times not accepted and students resort to books used by their seniors.
What biochemistry should a practising physician know? It is appropriate to ask: are we preparing students to be physician-scientists, or for a teaching/research oriented career, or of course clinicians.12 Perhaps it would not be presumptuous to say that we would like to have a better clinician. Any review of the teaching of biochemistry must also take into account, in addition to the course content and context in which it is taught, the students and most important the teachers. Some of the suggestions made by students for improving the biochemistry course are listed in Tables 4 and 5, and some of the factors that may influence students attitudes towards biochemistry are given in Table 6. It is important to rationalise the medical curriculum and to decide what should be taught to undergraduates and what can be left to later years to be taught as part of chemical pathology. 10 It is necessary to reduce the factual load in terms of the chemical content of the course as well as details of metabolic pathways. There is a need for proper distribution between basic and clinically relevant biochemistry, and to orient biochemistry courses towards clinical problems. 3"7'm Isolated preclinical courses are inappropriate and if they are seen as unrelated to what is considered, rightly or wrongly, to be the requirements of a practising clinician. The result is likely to be the annhilation of students' enthusiasm and motivation for studying biochemistry and medicine and which are essential for progress in medical education and practice. The need for relevance must be accepted as far as possible and we make it clear to the students that the way in which each topic relates to the clinical situation at the Table 4 Students' suggestions for improving the biochemistry curriculum in the medical course Reduce the quantity of 'irrelevant' material taught Improve the quality of lectures and lecturers Highlight relevance to the practice of medicine
Table 5 Biochemistry course content: some points for consideration What is the role of biochemistry in medical education and the training of doctors? What are the areas of biochemistry which are of relevance to other medical disciplines and medical practice? How should the biochemistry course be taught?
19
Table 6 Factors that may influence students' attitudes towards biochemistry Motivation of students towards medicine and biochemistry. Perception of the relevance of biochemistry taught to the clinical subjects and the subsequent practice of medicine. Are students' lecture and study time overloaded? Are students too examination oriented?
Conclusions Anyone attempting to change the pattern of medical education is likely to face resistance from many quarters. Faculty and departmental staff consider such an action an encroachment on well established practices and a potential threat to academic autonomy and existing order. Any reforms in medical education, fundamental or not, to be effectively applied should not only follow other successful new models, but also fulfil local, social, cultural requirements and be economically feasible. Finally it must not be forgotten that biochemical knowledge must be seen as a means to an end in the study of medicine rather than as a subject which is satisfying by itself. Acknowledgement
time it is taught. It is not enough to assure them that it will be valuable later. It is difficult for students to appreciate the value of certain material if they do not witness its application soon thereafter.14
I would like to thank the many medical students, doctors and clinical colleagues for their comments and useful discussions, the officials of the Medical Society for permission to make use of some of their survey results.
References Role of the teaching staff Many innovative changes have taken place in the teaching of biochemistry. There are attempts to eliminate the sharp division which exists between the basic sciences and the clinical sciences. It is often assumed that we have the perfect teachers in biochemistry and so it is adequate to modify the curriculum - - or sometimes the students. A good teacher is one who is interested and prepared to work sufficiently hard to get to know his subject and its physiological and clinical applications. Adequate recognition needs to be given to good teachers, as judged by students. It must not be forgotten that the most effective judges of a good teacher are the students themselves. 1,10.15 The teacher must explain, in terms the students can understand, the complete concepts and principles. He must guide and direct the student to assume a greater responsibility for his own education. As an integrator of experiences, the teacher assumes a multidisciplinary approach with the major functions of co-ordinating, relating, harmonising and associating all aspects of academic life and study. Performing this role the teacher correlates knowledge, skills and behaviour with professional practice. Perhaps it should be realised that no educational system works better than that which is acceptable to both students and teachers. The main thing is to combine good teachers with good students. The medical profession has a strong lobbying potential and has taken considerable interest in postgraduate medical education. However, it has paid relatively little attention to the undergraduate medical curriculum. It must take an active interest and institute remedial measures in this long neglected area of medical education and emphasise the need for periodical review and change, and not allow those who have no interest or stake in the future of medical education and practice to influence professional training. BIOCHEMICAL EDUCATION 16(1) 1988
i Neame, R L B (1984) J Med Educ 59 699-707 2Muir, G G (1968) Lancet 1:632-633 3Wills, E D (1985) Biochemical Basis of Medicine Wright, Bristol, v-vi 4Candlish, J K, (1984) Lecture Notes on Biochemistry, Blackwell Scientific Publications, Oxford, (preface) 5perumal, R (1987) 'Problems in biochemical education', in Malaysian Biochemical Society Newsletter, 1-5 6Vella, F (1980) Innovations in the teaching of medical biochemistry, in Biochemical Education Bryce, C F A editor, Croom Helm, London, 81-94 7Montgomery, R A (1980) A Case oriented approach-design, implementation and results, in Biochemical Education Bryce, C F A editor, Croom Helm, London, 69-80 8Chandrasekharan, N (1985) The biochemistry course in the medical curriculum - - Trends and students' attitudes, Abstracts X1X Malaysia Singapore Congress of Medicine pp 132 9The Medical Society Survey on the medical curriculum, Faculty of Medicine, University of Malaya, Kuala Lumpur, 1979 1°General Medical Council Recommendations on basic medical education, GMC London, 1980 H Richardson, I M (1983) Med Educ 17, 8-10 ~2Dakshinamurthy, K (1980) Syllabi construction, curriculum content and relevance in medical biochemistry, in Biochemical Education Bryce, C F A editor, Croom Helm, London, 58-68 13Woods, A E, Learning in small groups, in Biochemical Education Bryce C F A editor, Croom Helm, London, 141-55 14Smith, A D (1983) Med Teacher 5, 56-93 15Veiga, S M G, Miller, M D, Hammock, J (1983) Med Educ 17, 87-9
Erratum Drawing a Porphyrin Formula In the article with the above title by H B F Dixon which appeared in Biochemical Education 15(4), 208, point (2) should have read 'Draw alternate double bonds round the porphyrin ring . . . . '. We apologise for any confusion this omission may have caused.