Clinical Physiology Research Articles

Refuting misconceptions in medical physiology

BackgroundIn medical physiology, educators and students face a serious challenge termed misconceptions. Misconceptions are incorrect ideas that do not match current scientific views. Accordingly, they have shown to hamper teaching and learning of physiological concepts. Conceptual Change Theory forms the basis of new teaching and learning practices that may alleviate misconceptions and facilitate critical thinking skills that are essential in becoming knowledgeable, self-regulated health professionals. In this study, we examined if such an intervention named refutation texts, could enhance medical students’ cognition and metacognition.MethodsFirst-year medical students (N = 161) performed a pre-test and post-test on cardiovascular physiology concepts, including a self-perceived confidence rating. In between, students read either a standard text with an explanation of the correct answer, or a refutation text which additionally refuted related misconceptions.ResultsIn both groups, average performance scores (refutation: + 22.5%, standard: + 22.8%) and overall confidence ratings (refutation: Δ0.42 out of 5, standard: Δ0.35 out of 5) increased significantly (all p < .001), but a significant effect of the specific refutation element was not found. Initially incorrect answers were corrected less frequently in cases of high confidence (35.8%) than low confidence (61.4%).ConclusionsOur results showed that refutation texts significantly increased students’ knowledge, however, the refutation element did not have a significant additional effect. Furthermore, high confidence in incorrect answers negatively affected the likelihood of correction. These findings provide implications for teaching practices on concept learning, by showing that educators should take into account the key role of metacognition, and the nature of misconceptions.

Predictive Value of Markers of Adiposity in Carpal Tunnel Syndrome: A Clinical and Electrophysiological Evaluation.

To determine the association of total and segmental body composition adiposity indices with electrophysiological indicators of CTS. Observational cross-sectional study. Departments of Medicine and Clinical Physiology at King Saud University Medical City, King Saud University, Riyadh from August 2018 to December 2019. Total and segmental body composition analyses were performed by a bio-impedance body composition analyser. All the patients were grouped according to body mass index [BMI], total body fat % [TBF%], total fat mass [TFM], arm fat % [AF%], arm fat mass [AFM], and visceral fat rating [VFR] scores. Nerve conduction studies (NCS) were performed according to the standard protocols. CTS clinical severity score and CTS by NCS correlated significantly with BMI, TBF%, TFM, VFR, AF% and AFM. In ROC analysis, it was revealed that adiposity indices including BMI, TFM, VFR and AFM were significant predictors of abnormal NCS with area under the curve (AUC) of 0.824, 0.795, 0.795, and 0.803, respectively. VFR was a significant independent predictor of CTS severity (β coefficient=0.613, p<0.001) and delayed median nerve latency (β coefficient=0.317, p=0.017). Total and segmental body composition adiposity indicators are significantly associated with clinical severity of CTS and electrophysiological markers; especially, visceral adiposity. Large scale studies are required to explore the true predictive value of body composition in CTS. Key Words: Body mass index, Body composition, Adipose tissue, Body fat distribution, Carpal tunnel syndrome, Nerveconduction, Mediannerveentrapment, Visceralfat, Bioelectricalimpedance, ROCanalysis.

Precision-based exercise as a new therapeutic option for children and adolescents with haematological malignancies

Children and adolescents with haematological malignancies (PedHM) are characterized by a severe loss of exercise ability during cancer treatment, lasting throughout their lives once healed and impacting their social inclusion prospects. The investigation of the effect of a precision-based exercise program on the connections between systems of the body in PedHM patients is the new frontier in clinical exercise physiology. This study is aimed at evaluating the effects of 11 weeks (3 times weekly) of combined training (cardiorespiratory, resistance, balance and flexibility) on the exercise intolerance in PedHM patients. Two-hundred twenty-six PedHM patients were recruited (47% F). High or medium frequency participation (HAd and MAd) was considered when a participant joined; > 65% or between 30% and < 64% of training sessions, respectively. The “up and down stairs'' test (TUDS), “6 min walking” test (6MWT), the “5 Repetition Maximum strength” leg extension and arm lateral raise test (5RM-LE and 5RM-ALR), flexibility (stand and reach), and balance (stabilometry), were performed and evaluated before and after training. The TUDS, the 5RM-LE and 5RM-ALR, and the flexibility exercises showed an increase in HAd and MAd groups (P < 0.05), while the 6MWT and balance tests showed improvement only in HAd group (P < 0.0001). These results support the ever-growing theory that, in the case of the treatment of PedHM, ‘exercise is medicine’ and it has the potential to increase the patient’s chances of social inclusion.

Move your mind: embedding accredited exercise physiology services within a hospital-based mental health service.

Despite support for the role of exercise in improving physical and mental health for various psychiatric disorders, few service implementation evaluations within diverse hospital environments exist. This study presents the feasibility and implementation of a clinical exercise physiology service within a hospital mental health service. Feasibility and service data were collected from databases and self-report (consumer and staff) for 6 months from the commencement of new exercise services (gym and group sessions) for community and inpatients (one secure and three open wards). One hundred and twenty consumers engaged with exercise services with 70 direct referrals over the 6-month audit period (mean age 40 ± 13 years (19-69); 41% male). The overwhelming reason for referral was related to weight loss/management (65.7%), with the majority of patients (51%) presenting with schizophrenia spectrum and other psychotic disorders. Further, 549 exercise service interactions were delivered and 78% gym attendees and 69% group session attendees rated the exercise sessions as 'Good' or 'Great', and intention to return ranged from 78% for inpatient gym sessions to 91% for community gym sessions. Embedding exercise physiology into a mental health service is feasible and well accepted and the evaluation of long-term consumer outcomes in 'real-world' will serve as a crucial step.

Counterpoint: Investigators should not control for menstrual cycle phase when performing studies of vascular control that include women.

Observed sex differences in the epidemiology of cardiovascular disease incidence and the efficacy of clinical intervention strategies, coupled with recent mandates from the National Institutes of Health (NIH), and its international counterparts to consider sex as a biological variable in all preclinical and clinical work (15), have led to increased enrollment of women in human physiology studies of vascular function with the goal of improving external validity and clinical applicability of the findings. However, standard practice in these studies is to test women during the early follicular phase (~days 1-5) of the menstrual cycle, during which estrogen and progesterone concentrations are lowest, and either exclude or limit testing of women who use hormonal contraceptives to the placebo phase. This approach seeks to control for, or limit, differences in circulating hormone concentrations between men and women and is based on the dogmatic theory that cyclic changes in estrogen and progesterone concentrations lead to greater variability in study outcomes and uninterpretable datasets. Contrary to this common approach, we propose that limiting testing of women to this single phase 1) decreases external validity of the findings, 2) obfuscates potential physiological differences contributable to differences in sex hormone concentrations between men and women, and 3) is, in many instances, contradicted by literature that demonstrates limited or no variability in vascular measurements across the menstrual cycle.

CARDIORESPIRATORY FITNESS AND VASCULAR HEMODYNAMICS IN MIDDLE-AGED AND OLDER ADULTS

Clinical Exercise Physiology, Ball State University, Muncie, IN, USA Cardiovascular disease-related (CVD) mortality with older age is in part attributable to altered vascular hemodynamics including increased central and peripheral blood pressure (BP) and augmentation index (AIx). Cardiorespiratory fitness (CRF) is inversely associated with CVD mortality independent of traditional risk factors. It is unknown, however, if CRF is inversely related to vascular hemodynamics. PURPOSE: To investigate the relationship between CRF and vascular hemodynamics in an apparently healthy middle-aged and older adult population. METHODS: Apparently healthy males and females (N=101; 54 M, 47 F; Age: 63.5 ± 8.5) from the Ball State Adult Fitness Longitudinal Lifestyle Study (BALL ST) were studied. All participants underwent assessment of vascular hemodynamics, which included non-invasive central and peripheral BP, central and peripheral pulse pressure (systolic minus diastolic BP), AIx (%), AIx normalized to HR 75 (AIx% HR75) and directly-measured CRF (VO2max ; ml/kg/min). Age- and sex-adjusted CRF percentiles where calculated based on the Fitness Registry and Importance of Exercise National Database (FRIEND). Data were analyzed via Pearson correlations. RESULTS: CRF was inversely related with central systolic BP (cSBP, r = -0.330), central pulse pressure (cPP, r = -0.255), AIx %( r = -0.366), AIx% HR75 (r = -0.474), brachial systolic BP (bSBP, r = -0.227), and brachial pulse pressure (bPP, r = -0.172) (all, p<0.05). cSBP (r = -0.412), cPP (r = -0.249), AIx % (r = -0.202), AIx % HR75 (r = -0.292), and bSBP (r = -0.320) were correlated with FRIEND percentiles (all, p<0.05) whereas bPP (r = -0.131) was not (p> 0.05). CONCLUSION: Our findings demonstrate that more ideal measures of vascular hemodynamics are correlated with higher CRF in middle-age and older adults. These data support the notion that vascular hemodynamics may be a potential modulator in the inverse relationship between CRF and CVD in apparently healthy adults.

In Memorium: Burton Rose, 1942–2020

In Memorium: Burton Rose, 1942–2020

An Update to the Present Carpal Tunnel Syndrome (CTS) Nerve Conduction Grading Tool

The aim of this research is to establish, using best available evidence, a clinically appropriate revision of the current CTS nerve conduction grading tool and to evaluate its effectiveness (in terms of acceptability and usability as a tool for intervention prediction). The revised scale is designed from a clinical physiology perspective and is based on numerical values of nerve conduction findings.

Post Exercise Change in Peak Expiratory Flow Rate and its Relation with Body Adiposity in Nepalese Settings

Background: The Queens College Step Test is used to determine aerobic fitness. Peak Expiratory Flow Rate (PEFR) is the maximum rate of forceful exhalation following full inspiration. PEFR primarily reflects bronchial airflow and depends on the voluntary effort and muscular strength of the individual. Studies that correlate ventilatory capacity with body fat percentage are rare in published literature in Nepalese settings. Body fat percentage is regarded as a better indicator of obesity recently. Hence, this study aims to find an association between post-exercise change in PEFR and body adiposity in the context of Nepal.&#x0D; Methods: A cross-sectional study was carried out from 20th July 2019 to 15th November in the laboratory of Clinical Physiology of Maharajgunj Medical Campus. Body fat percentage was measured by using OMRON BF 214. Pre-exercise PEFR of each subject was recorded by using Wright’s peak flow meter. Post-exercise PEFR was also recorded after three minutes of Queen’s College step test, which is the submaximal exercise test, and change in PEFR was calculated and correlated with body fat percentage.&#x0D; Result: The study showed a negative correlation of change in PEFR with body fat percentage (r=-0.324; P&lt;0.001). A significant difference (P = 0.002) was observed between different quartiles of body fat percentage. A highly significant difference (P = 0.003) was noted with the first and fourth quartiles.&#x0D; Conclusion: Less ventilatory adjustment in response to exercise was noted in subjects with more body fat percentage compared to those with less body fat percentage.

Differentiating COVID-19 Pneumonia From Acute Respiratory Distress Syndrome and High Altitude Pulmonary Edema: Therapeutic Implications.

Differentiating COVID-19 Pneumonia From Acute Respiratory Distress Syndrome and High Altitude Pulmonary Edema: Therapeutic Implications.

Board Relevance of an Osteopathic Medical Physiology Course Introductory, Cardiovascular and Respiratory Sections

Physiology has been a foundational course in medical curriculums for several decades. As the discipline that integrates multiple other disciplines into a functional framework, medical physiology used to be a driving force of preclinical education complete with laboratory components. In recent years, medical education has begun to shift away from the traditional model. Organ system‐based curricula are becoming the standard and medical physiology is increasingly marginalized losing its laboratory component and receiving less and less contact time. As board scores remain a primary factor determining residency placement, students increasingly focus on board relevance in courses. Last year, our second‐year class identified Boards &amp; Beyond as an exceptionally useful study tool not just for board preparation, but also to help prioritize course materials and revisit concepts with regularity. We at WCUCOM want to give our students every opportunity to succeed. Incoming first year students and teaching faculty were provided with Boards &amp; Beyond access. Our overall goal was to map our Medical Physiology I and II courses to the Boards &amp; Beyond review resources. We started with mapping the blocks in the fall semester Medical Physiology I course, namely: Introductory (general physiology concepts), Cardiovascular and Respiratory physiology blocks. We used topic key words established by Boards &amp; Beyond for their physiology videos and added keywords of our own for topics not covered in Boards &amp; Beyond videos. The first‐year (OMS‐1) Medical Physiology I course has 54 lectures. There are 19 introductory lectures which include membrane and muscle physiology, as well as an introduction to regulatory systems. The cardiovascular section has 26 basic physiology lectures and respiratory physiology is taught in 9 basic physiology lectures. We mapped the content of these 54 lectures to Boards &amp; Beyond video contents. We found that except for the first 4 introductory lectures on homeostasis and the history and scope of physiology, even the introductory physiology lecture topics were at least 40% covered in Boards &amp; Beyond videos. The overlap increased in the cardiovascular and respiratory physiology lecture topics, but never reached 100%. We conclude that our osteopathic medical physiology course introductory, cardiovascular and respiratory sections are highly board relevant. We also conclude that Boards &amp; Beyond materials may be useful study tools to help prioritize topics is medical physiology, however they cannot replace the medical physiology course in our osteopathic medical curriculum.

Threshold Concepts in Medical Physiology

INTRODUCTIONThreshold concepts are those ideas that learners often find difficult, but must understand in order to master the discipline. In order for a concept to be defined as a threshold concept, it must meet at least three out of five characteristics: transformative, irreversible, integrative, bounded, and troublesome. In the realm of threshold concepts research, there has been very little conducted in regards to medical school curriculum specifically. Medical physiology has often been a challenging core topic for medical students. The goal of this study is to better understand what students considered to be threshold concepts in physiology so medical school curricula can better address the needs of students and ensure that they have a strong foundation.METHODSVolunteers from a medical school were recruited and three focus groups were conducted during the preclinical years. Each focus group consisted of 7–8 students. The focus groups began with a brief introduction of what threshold concepts are followed by the presentation of a brief clinical case. The students were given a case that integrated knowledge that had been taught in organ system courses prior to the focus groups. Students were asked to come up with a differential diagnosis and suggestions for underlying pathophysiology. After this, they were allowed to ask questions to gather a history and explain the underlying physiological concepts that led them to their differential diagnoses. A fourth focus group was conducted in the early weeks of the clinical years and after USMLE Step 1 examination. Following all focus groups, the audio was transcribed and thematic analysis was conducted.RESULTSBased on the four focus groups conducted, several potential candidate threshold concepts emerged including secondary messenger pathways, Starling forces, preload and afterload, and cell membrane potentials.CONCLUSIONThis study identified a set of candidate threshold concepts in medical physiology from the students’ perspective. Further characterization of these candidate threshold concepts can be used as a foundation for designing an effective and powerful physiology curriculum.Figure 1

Incorporating Retrieval Into Classroom Activities: Setting Good Habits

Retrieval is a learning strategy in which the student attempts to recall concepts from memory without consulting course notes, a textbook or the internet. Classical studies of retrieval support retrieval as an effective study technique. However, when students have had previous success with storage techniques such as listening to videos, reading textbook, or re‐reading course notes, it is difficult to convince students to use evidence‐based techniques.Three instances of introducing retrieval to students in clinical physiology are presented. In all three cases, students heard about the classical experiments of Karpicke and Roediger. In addition, the instructor shared her own retrieval success. In the first instance, students were exposed to retrieval practice questions throughout class time activities, mainly power point lectures interspersed with active learning exercises. Students completed an anonymous survey about their attitudes about retrieval as part of their final exam. In the second instance, students in a systems physiology course were given retrieval exercises at the beginning of each of a series of 5 lectures on endocrine physiology. After student completed the exam on this material, students were invited to complete an online survey of their use of and attitudes toward retrieval. In the third instance, student in a clinical physiology course worked to answer a series of short answer questions without the benefit of any course resources. After 30 minutes of work, the instructor led a discussion of the activity in terms of retrieval and confidence.These three classroom experiences provide evidence that there is an association between positive attitudes towards and use of retrieval and exam performance. For example, in a sample of 200 physiology students, agreement with the statement I used retrieval methods as I studied for this exam, is significantly correlated with exam performance (r= 0.33, p &lt; 0.00001). However, there was no significant correlation between agreement with the statement, I think retrieval is an effective study technique supported by evidence and exam performance. In addition, student comments indicate that students may require multiple opportunities to learn about and practice retrieval before they are ready to incorporate retrieval into their regular study habits.

Collaborative group testing increases intrinsic motivation but does not impact competition in medical students

It is increasingly recognized that the practice of medicine is a “team sport” with different medical professionals working together toward the common goal of providing health care. Collaborative group testing, where students work together to answer test questions models this team environment. The act of collaborating to achieve a challenging task may be intrinsically rewarding because one feels like they contributed to the “greater good”, which for the same reason may reduce competition. Therefore, we hypothesized that prolonged participation in collaborative group testing in first and second year medical students would increase intrinsic motivation and decrease competition. We assessed intrinsic motivation and competition via administration of the Intrinsic Motivation Inventory and the Competitive Attitude Scale, respectively. Students completed the surveys at baseline and after participating in thirteen collaborative group tests in a medical physiology course over a time‐period of 10 months. We found that all measures of intrinsic motivation were significantly increased after participation in collaborative group testing, while levels of competition were not changed. We conclude that medical student participation in collaborative group testing provides the opportunity to address the core psychological needs required to increase intrinsic motivation. Further studies are needed to understand why there was no effect on competition.

Revisitation of the Work of A Forgotten Comparative Physiologist, Homer W. Smith

The death of renowned renal physiologist Homer William Smith in 1962 brought an end to what some have called the “Smithian Era of renal physiology.” Although Dr. Smith’s contributions to renal physiology have been acknowledged most recently in a 2015 article in Physiology Reviews, there has been very little written over the past 50+ years about his extraordinary life. Dr. Smith spent most of his career at the New York University College of Medicine and therefore focused much of his academic energy on human health and disease, but as any reader of his various books knows, Dr. Smith’s research interests involved far more than mammals, and were filled with adventure. That he lucidly communicated his deep knowledge and appreciation of geography, geology, evolution, and physiology brings great meaning not only to his work, but to the discipline of physiology. The purpose of this presentation is to revisit his extraordinary career with an emphasis on his contributions to comparative physiology, as documented through his various research articles and in his most celebrated book, From Fish to Philosopher. His other more philosophical works, including Kamongo and Man and His Gods, will also be discussed. Many physiologists today, similar to Dr. Smith, are tasked with teaching physiology to medical students who lack both the time and interest in learning the evolutionary history of the system under study. Consequently, professors—even those with academic roots in comparative physiology (present author included)—are apt to not enrich their physiology sessions with discussion about how animals other than Homo sapiens “work”, let alone any discussion of who made this knowledge available. There are rich histories to explore to help put the “biology” back into medical physiology. As printed books are disappearing from our medical school libraries, the time is ripe to dig a bit deeper and resurrect the contributions of great biologist storytellers like Homer W. Smith, leading to an enrichment of our students’ learning experiences.Support or Funding InformationNone

TRAF3IP2 ablation protects against obesity‐associated glycemic dysregulation, elevated blood pressure, and endothelial dysfunction

Obesity and type 2 diabetes (T2D) are leading independent risk factors for cardiovascular disease morbidity and mortality. However, the precise molecular mechanisms underlying the development of cardiometabolic dysfunction in obesity and T2D remain largely elusive. The recently identified cytoplasmic adapter molecule TRAF3 Interacting Protein 2 (TRAF3IP2) is known to regulate various pathological stress pathways, including inflammation and oxidative stress, associated with obesity and T2D. Accordingly, we tested the hypothesis that TRAF3IP2 mediates metabolic and vascular dysfunction associated with chronic high fat/high sucrose (HFHS) feeding. The results show that HFHS feeding for 16 weeks (starting at 5 weeks of age) increased body weight and impaired glucose tolerance in wild‐type (WT) male and female mice relative to control chow‐fed mice (P&lt;0.05). Notably, glucose intolerance was attenuated in HFHS‐fed male and female homozygous TRAF3IP2 knockout (KO) mice (P&lt;0.05) compared to WT counterparts despite greater weight gain. Interestingly, male TRAF3IP2‐KO mice exhibited protection against HFHS feeding‐induced elevations in blood pressure (tail cuff plethysmography) and ex vivo aortic endothelial dysfunction (P&lt;0.05). However, female mice fed HFHS were protected against increases in blood pressure and impairments in aortic endothelial function and, thus, deletion of TRAF3IP2 was inconsequential (P&gt;0.05). In summary, our data show that TRAF3IP2 plays a causal role in obesity‐associated glucose intolerance, elevated blood pressure and endothelial dysfunction. These findings implicate TRAF3IP2 as a promising therapeutic target in cardiometabolic dysfunction associated with obesity.Support or Funding InformationDept. of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USADalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA Dept. of Biological Engineering, University of Missouri, Columbia, MO, USA Division of Endocrinology and Metabolism, Department of Medicine, University of Missouri, Columbia, MO, USA Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO, USA Laboratory of Immunoregulation, NIAID/NIH, Bethesda, MD, USA Dept. of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA Division of Cardiovascular Medicine, Department of Medicine, University of Missouri, Columbia, MO, USA

Editorial: Biographical Memoirs , Volume 68

Editorial: <i>Biographical Memoirs</i> , Volume 68

Histamine‐mediated regulatory loop in mesenteric perilymphatic mast cells

Lymphatic vessels play a critical role in mounting a proper immune response by trafficking peripheral immune cells to draining lymph nodes. Mast cells (MCs) are well known for their roles in type I hypersensitivity reactions but little is known about their secretory regulation in the lymphatic niche. MCs, as innate sensor and effector cells, reside close to mesenteric lymphatic vessels (MLVs) and their activation and ability to release histamine influences the lymphatic microenvironment in a histamine‐NF‐kB‐dependent manner. Using an established experimental protocol involving surgical isolation of rat mesenteric tissue segments, including MLVs and surrounding perilymphatic tissues, we tested the hypothesis that perilymphatic mesenteric MCs possess histamine receptors (HRs) that bind and respond to histamine released from these same MCs. Under various experimental conditions, including inflammatory stimulation by LPS, we measured histamine in mesenteric perilymphatic tissues, evaluated expression of histidine decarboxylase in MCs along with the degree of MC degranulation, assessed the functional status of HRs in MCs, and evaluated the ability of histamine itself to induce MC activation. Finally, we evaluated the importance of MCs and HRs 1 and 2 for MLV‐directed trafficking of CD11b/c‐positive cells during acute tissue inflammation. Our data indicate the existence of a functionally potent MC‐histamine autocrine regulatory loop, the elements of which are crucially important for acute inflammation‐induced trafficking of the CD11b/c‐positive cells towards MLVs. Our previously published data suggest that MLVs‐released histamine can also trigger the MC‐histamine loop during development of inflammation. Therefore, this MC‐histamine loop serves as a first‐line cellular servo control system, playing a key role in the innate and adaptive immune response as well as NF‐κB‐mediated maintenance of body homeostasis.Support or Funding InformationNIH/NIA R56 AG061097‐01; NIH/NIDDK R01 DK110035; NIH/NHLBI 1U01HL123420; funds from TAMU HSC COM and Dept. of Medical Physiology.

Loss of Caveolin‐1 Increases Macromolecule Transport Across Lymphatic Endothelium

Transport of fluid and macromolecules from the interstitium into lymphatic vessels is necessary for maintaining tissue homeostasis. Lymphatic capillary structure suggests that passive, paracellular transport would be the predominate route of macromolecule entry into lymphatics. Active transcellular transport, however, was recently identified to be equally important to solute flux across lymphatic endothelium in vitro. To specifically test if loss of caveolar transport impacted lymphatic transport, lymphatic conductance and permeability were measured in mice with a global deletion of caveolin‐1 (“CavKO”), the scaffolding protein necessary for caveolae formation, and in mice with a lymphatic endothelial cell‐specific deletion of caveolin‐1 (Lyve1‐Cre x Cav1flox/flox; “LyCav”). In each mouse line, lymphatic capillary architecture was largely unchanged. Using a quantitative microlymphangiography model, lymphatic conductance (mm3 fluid uptake/mm3 tissue/time) was measured to be significantly higher in CavKO mice. Increased lymphatic conductance was also measured in CavKO mice following nitric oxide synthase inhibition and in LyCav mice with lymphatic‐specific loss of caveolae. The permeability to 70kDa dextran was significantly increased in monolayers of lymphatic endothelial cells isolated from CavKO mice. These findings confirm that macromolecule transport is increased with loss of caveolar trafficking. Interestingly, macromolecule transport within the lymphatic system, measured by transit rate of dextran to a sentinel lymph node, was significantly reduced in CavKO and LyCav mice and isolated vessel studies identified increased permeability of CavKO collecting lymphatic vessels resulting in macromolecule loss from the lumen. These studies identify lymphatic caveolar biology as a key regulator of active lymphatic transport functions.Support or Funding InformationThis research was supported by the Texas A&amp;M University College of Medicine and Department of Medical Physiology.

Using Curriculum Mapping to Evaluate Physiology Core Competency Coverage in an Integrated Medical School Curriculum

Curriculum mapping is the process of indexing or diagramming a curriculum for purposes of improving the overall coherence and effectiveness of a course of study. A well‐designed curriculum map should ensure appropriate coverage of content, align teaching and learning with curriculum goals, improve integration across the curriculum, and facilitate demonstration of outcomes to stakeholders and accrediting agencies. The University of South Florida developed a novel electronic curriculum management database through process workflows that allows us to map entrustable professional activities, program objectives, course objectives, session objectives, keywords, hours per session, and assessments across our integrated medical school curriculum. In addition, we mapped national discipline‐specific core competencies to each session. The overall goal was to determine how well and to what extent we are matching content that students are actually taught with the academic expectations described in the learning objectives. The aims of mapping at this granular level were to: 1) identify gaps and redundancies; 2) evaluate horizontal and vertical integration of content; and 3) identify how much content is covered vs national core competencies. Once all course data for academic year 2017–2018 was entered by course/clerkship directors into the database, 11 integration directors specializing in 16 disciplines reviewed the session objectives for 942 sessions within 20 required courses in parallel with reviewing posted PowerPoint slides or other teaching material. Each session was tagged with national core competencies ("content objectives") for each discipline. For physiology, we based national core competencies on the Medical Physiology Learning Objectives developed by the American Physiological Society/Association of Chairs of Departments of Physiology. A total of 1002 physiology content objectives were entered into the database, of which 754 (75%) were mapped to sessions and 248 (25%) were unmapped (i.e. not covered in the curriculum). Of the mapped content objectives, physiology competencies were addressed in 274 sessions (30%) within 15 courses (75%). As expected, physiology competencies were covered predominantly in pre‐clerkship basic medical science courses and doctoring. However, physiology competencies were also identified in all 5 clerkships (adult medicine, psychiatry/neurology, surgical care, primary care, and maternal‐newborn pediatrics). These analytics allowed us to demonstrate that even though physiology competencies may not be part of course or session objectives per se, faculty are teaching and reviewing physiology concepts across the entire curriculum. For the 248 unmapped content objectives, the next step will be to evaluate why they are not being taught (e.g. why are only 7 of the 17 core competencies in integration &amp; exercise physiology mapped?). In conclusion, incorporating discipline‐specific competencies into the curriculum map is a useful tool to identify gaps and redundancies and evaluate integration of content. It also fostered communication between faculty, course/clerkship directors and administrators to really think about what is being taught and how to improve our curriculum.