Core History of Medicine for Queen's medical students with Learning Objectives

History for medical students at Queen's is an integral part of the undergraduate curriculum. Students are introduced to the history of each discipline as they study it. Every examination has one or two questions generated by the history of medicine component. Students who are particularly interested in history are given opportunities to explore it further in several different venues. Many Elective possibilities are also available.

Overall Learning Objectives of this Program
1. to raise awareness of history (and the humanities as a whole) as a research discipline that can enrich our understanding of the medical present.
2. to instill a sense of skepticism with regard to the "dogma" of the rest medicine.

Phase I

1. Heroes and Villains in the History of Medicine/Information Literacy Assignment No. 1: Monographs (to follow the first Information Literacy sessions in Library by one or two days)

Learning Objectives of this session
to distinguish the various types of monographs (single author, edited volume, posthumous collection, translation, facsimile etc.)
to search Q-Cat for maximum effectiveness (author, subject, key-word)
the basics of controlled vocabularies
the meaning of primary sources (books by) and secondary source (books about).
all history (even medical history) is a process of interpretation strongly influenced by the present.

Phase I

2. The History of Anatomy (structure) near beginning of Phase I

Learning Objectives of this session
To understand that
· anatomy has not always been important to medicine.
· dissection has been viewed with ambivalence by many societies.
· anatomical knowledge was applied first to physiology, then to medicine.
· even today not all diseases can be linked to a physical change.

To recognize reasons for
· the relationship between art and anatomy.
· the importance and impact of De Humani Corporis Fabrica (1543) (The Structure of the Human Body) by Andreas Vesalius.

To know that
· to overcome sanctions against dissection students and professors resorted to crime.

Phase I

3. The History of Physiology (function)
Learning Objectives of this session

To understand
· that functional explanations of disease vary with culture and time.
· the meaning of the terms vitalism, mechanism, empiricism, and teleology.
· the reasons for and significance of William Harvey's discovery of the circulation of blood.
· how positivism influences modern methods of experimental physiology.

To recognize
· the role and limitations of chance in scientific discovery.

History of Population Health (intro to CHE) CANCELLED IN 2009

Learning Objectives of this session

The student will learn
-bias of medical model against collective health
-that clinical medicine can serve collectives
-of a few clinicians whose "patients" were entire populations

4. History of Genetics and Notions of Heredity (joint with Genetics)
The student will learn
Some ancient and modern notions of heredity, their rise and fall
Rise in genetics follows a molecular agenda
Adaptation implies that not all bad things need to be treated
(Once again) science can be used for political ends

PHASE IIA

5. The History of Pathology (concepts of disease) middle to late Phase I
Learning Objectives of this session
To understand
· how pathology links medicine to science.
· the potential distinction between "disease" as an idea, and "illness" as suffering.
· two theories of disease relating to perceived sufferer: organismic (individual); and non-organismic (population).
· two theories of disease relating to perceived cause: physiological (disease from within the patient) versus ontological (disease as a separate entity from outside the patient).
· how 18th-century nosologists thought of diseases as constellations of symptoms.
· that anatomy was not useful to pathology, until diseases had been linked to organic change.
· the 19th-century change in disease concepts: from subjective symptoms described by the patient to objective organic changes detected by the doctor.
· the advent and impact of germ theory (Pasteur, Lister, Koch).
· the meaning of social construction of disease.
· criticisms of the medical model that react against its lack of subjectivity and the apparent exclusion of the patient's feelings.

6. The History of Pharmacology (to be given as pharm unit starts)
Learning Objectives of this session
To understand that
· most therapies have been discovered by empirical methods.
· social factors play an important role in perceived need for remedies.
· most therapeutic "discoveries" have non-scientific precursors.
· the impact and problems of "magic bullets."

7. Why is Blood Special: A History of Hematology (during Heme block)

Learning Objectives of this session

To understand that
· blood has always been awarded special status in anthropological, social, mystical, and intellectual terms.
· blood has always related to theories of disease: e.g., the Greek theory of humors; modern theories of immunity and tissue typing.
· transfusion was promoted in response to wartime needs.
· red cells were linked to oxygen and to respiration through hemoglobin.
· the hemophilia of the European royal families may have had an impact on the political history of the west.
· the identification of clotting-factor deficiencies depended on simple mixing studies.

To know that
· mismatch, clotting, and infection have been (and continue to be) the main dangers of transfusion.
· work on hematological problems has been awarded a disproportionately large number of Nobel prizes.

8. Plagues and Peoples: A History of Epidemics and their Impact (during ID block)

Learning Objectives of this session
To know that
· epidemics have made major impacts on populations and on economic, social, intellectual, and political aspects of life.
· panic and breakdown of social order typify human reactions to epidemic disease.
· smallpox was the first human disease to be eradicated by medical methods.
· incidence of infectious disease can be related to changes in wealth, hygiene, and nutrition.
· "new" diseases are rarely as new as they first seem to be.
· the meaning of social construction of disease (also Chap. 5)
· the role of germ theory and antibiotics in control of epidemics.
· the implications of the term "innocent victim."

To understand that
· public health measures are product and legacy of prior epidemics.
· legislated controls are influenced by current notions of disease transmission and can incorporate social prejudice.
· public health measures have not always been effective; in some instances, they have been detrimental.
·

knowledge of a microbial cause is not essential for the prevention of infectious disease.

9. Community Based Project-History Option (CPB) : 10-12 hr seminar, research project, presentation and essay. Part of class. Students choice.

Learning Objectives of this seminar and research project

To understand

Research questions and methods in history
aspects of the medical past which corresponds to the students interest.
The impact of social, political and economic factors on health and disease

To develop skills in

Historical research methods
Presentation methods in oral and written communication

Phase IIB

10. The History of Psychiatry
Learning Objectives of this session
To know that
· ancient words for diseases of the psyche, such as melancholia, hysteria, and mania, still have currency in our time.
· understanding mental disturbances often relies on a conceptual separation of mind and body.
· lunatic asylums resembled prisons.
· concepts of madness have incorporated prejudicial notions of race, gender, culture, morality, and class.
· psychiatric patients have been blamed for their condition.
· the introduction of humane measures to care for the insane was a conscious project of the late eighteenth and early nineteenth centuries.
· Charcot's studies of hysteria are now considered to have been problematic.
· many attempts have been made to link disorders in thought and behaviour to physical change.
· physical treatments for mental disorders have been and are used with benefit (e.g., ECT, phenothiazines, Lithium).
· some physical treatments for mental disorders are now considered to be ineffective and unethical (e.g.. ECT, ovariotomy, insulin shock, lobotomy).
· "decarceration" movements are product of medical discoveries, financial concerns, and changes in social attitudes.
· the classification of mental diseases is dependent on an analysis of symptoms felt by the spatient or behaviours observed by others.

To understand
· the pervasive impact of Freud's theories of the unconscious.
· the origins and continued impetus of anti-psychiatry movements.

Phase IIC

11. William Harvey and the Circulation of Blood (lecture and video) (in cardiology block)

Learning Objectives of this session

To understand
The nature of one great scientific discovery
The reason for Harvey's use of live animals in experimentation
The complex nature of discovery in general
That any discovery is influenced by social, cultural, financial and intellectual concerns

Phase IIC

12. The Stethoscope and the Birth of Physical Diagnosis (in respiratory block)
Learning Objectives of this session
To know that
· technological inventions, like Laennec's invention of the stethoscope, depend on
1. changing concepts (e.g., anatomical disease);
2. prior technology (e.g., percussion);
3. social factors (e.g., the French Revolution).
· Laennec's discovery also depended on his knowledge of anatomy, pathology, and clinical medicine, and on his personal skills as an observer and a musician.
· Laennec identified most breath sounds recognized today; however, his interpretation of the heart sounds was different.
· the use of auscultation and X-rays spread quickly.
· technology has been intended to introduce diagnostic acumen and objectivity.
· technology tends to distance the patient from the doctor.

To understand how
· technologies emerge from changes in disease concepts: for example, the stethoscope was part of a shift in disease concepts from a basis in subjective symptoms to a basis in objective organic lesions.
· established technologies, in turn, can alter disease concepts by creating new possibilities for the definition of disease.

Phase IIC

Phase IID

13 Critical Enquiry Elective (8 wks) occasional students

Learning Objectives of this elective
To understand
Research methods in history
aspects of the medical past which correspond to the students interest.

Phase IIE

14. The History of Obstetrics
Learning Objectives of this session

To understand that
· history is about the present as well as the past.
· the past may have a variety of interpretations.
· the reasons for the introduction of midwifery in Canada.

To know that
· for most of history, birthing was the domain of non-medical women.
· birthing women die of bleeding and infection.
· obstetrical forceps may have been used in antiquity, but their use was kept secret by the Chamberlen family.
· Ambroise Paré's description of podalic version was intended to save both mother and child.
· eighteenth-century atlases contributed to understanding of the normal anatomy and function of the pregnant uterus.
· doctors could transmit childbed fever to birthing mothers via instruments, but acceptance of this notion was slow.
· the use of anesthesia in birthing was controversial.
· birth control methods were (and in some situations still are) controversial.
· modern reproductive technology raises many questions.
· women were initially allowed to enter the medical profession with the expectation that they would care for other women.

Phase II E

15. The History of Surgery
Learning Objectives of this session

To know that
· surgical practices in the care of trauma can be traced to prehistory.
· some surgical techniques have been developed to deal with trauma of war.
· trephination and circumcision are elective procedures of great antiquity.
· some ancient and folk recipes for wound dressing are beneficial.
· early methods of healing conceived of a need for "laudable" pus and burning oil, and that Paré's accidental discovery altered that perception.
· pain and infection were major obstacles to the development of surgical techniques.
· anesthesia was promoted by dentists before it was adopted by surgeons.
· anesthesia was adopted after a long prehistory in the late 1840s.
· two decades after anesthesia, Lister contributed to the development of surgical antisepsis and related it to germ theory.
· the advent of antisepsis and anesthesia brought a period of tremendous surgical innovation.
· surgical practices are modified by economic and epidemiological factors.

Phase III

16. Medical Grand Rounds: My current research topic
Learning Objectives of this session

To understand
an aspect of the medical past
research methods in history

Phase III

17. Clerkship selective (4 wks) occasional students.
Learning Objectives of this unit

To understand

Research methods in history
an aspect of the medical past which corresponds to the student's interest.

To develop
Skills in critical thinking