In the fall of 1994, Saint Louis University (SLU) School of Medicine was visited by the Liaison Committee for Medical Education (LCME) for its routine reaccreditation of our medical curriculum. Remarkably, SLU's entire second-year medical class had recently passed Step 1 of the United States Medical Licensure Exam (USMLE) boards on their first attempts the preceding summer. Such an outcome can powerfully reinforce the status quo: If it's not broken, why fix it? Despite that auspicious showing, we were confronted by the LCME criticism that our traditional discipline-based curriculum must be redesigned so that it would be governed by a cross-disciplinary committee of practicing physicians. The LCME's operational hypothesis seemed to be that such top-down management would free curricular content from the pedagogical constraints exerted by powerful academic departments in charge of individual courses like biochemistry, physiology, pathology, and medicine. We soon learned that other medical schools were hearing this same message.
To this institution's credit, its teaching faculty reinvented all four MD years over the next 18 months. When our new year one rolled out in the fall of 1997, it resembled the old only by starting with Gross Anatomy (now a 2-month introduction), followed by 7 months of what I came to call "one cell and less" biology, with short courses in intermediary metabolism, genetics, cell biology and cell pathology, and introductions to immunology, microbiology, and pharmacology. Our second MD year became all about "two cells and more" biology, in what has emerged as a common paradigm: organ system modules that at SLU follow the sequence of neural, cardiovascular, respiratory, renal, gastrointestinal, endocrine/reproduction, and skin/bone/joint. Then comes Step 1.
At this writing, SLU's Respiratory Module has grown through 13 years of trial and error, field-tested annually over 5 weeks each November and December on an increasingly sophisticated student body. The module syllabus has grown from <400 pages of mostly outlines to twice that length, now mostly full text. Because we cover all erythrocyte biology within Respiratory, the module includes 50 one-hour lectures and nine labs and/or small group activities, all team-taught to utilize the breadth and expertise of >20 devoted faculty members. This book represents our current state-of-art for at least the formal course content on the lung, if not all ancillary activities. Each chapter represents the material we cover in a 50-minute lecture. The book's associate editors Drs. George Matuschak and David Brink, my collaborators and friends for 20+ years, have very capably guided the module's design and implementation of its clinical presentations and pathology.
During the module's evolution, I was privileged to serve two "tours of duty" on the Physiology Test Item committee of the National Board of Medical Examiners that produces the questions for USMLE Step 1. That experience reinforced the importance of writing clear test items that are vignette-driven, have parallel answer foils, and evaluate higher learning skills beyond rote memorization. Each chapter here includes sample questions that we consider of the right depth for medical students at this level of training. We hope our student audience will use these items for structured self-testing, and will let us know when items need repair because they are ambiguous or incorrect.
The book is organized into subsections that reflect the general flow used with our students, but most chapters can be read out of sequence without difficulty once the introductory section is completed. Although there is not universal agreement on common phrases, terms, abbreviations, and acronyms, we have adopted those which we consider the most accepted in the fields of respiratory physiology and pulmonary medicine. The Glossary should help novices to decipher this sometimes bewildering array of terminology. Likewise, we are committed to a worthwhile Index so that readers can quickly identify the extent of coverage on topics of particular importance to them; textual phrases in bold font are indexed and usually represent their first appearances in the book or section. At our institution, the Respiratory Module has assumed "ownership" of specific multi-system diseases, such as cystic fibrosis, the systemic inflammatory response syndrome, and masses of the neck. Consequently, such topics achieve coverage here that others might consider more extensive than strictly necessary. Pedagogically, we also favor introducing medical students to contemporary methods of diagnosis in pulmonary medicine, both at the patient's bedside and in the clinical laboratory. Hence, specific chapters here on the basic chest exam, pulmonary function testing, lung imaging, interpreting blood gases, and diagnostic bronchoscopy may exceed another course director's desire for their inclusion. Be reassured that this material is well within the ability of medical students to learn, integrate, and master.
Among all the diagrams, tables, equations, and images in this book, we hope that students can still perceive the love of this subject and the passion to teach it well that characterize our mission. The lungs are among the most beautiful and complex organs in our bodies, but beauty and complexity should not be impediments that prevent every physician for understanding their many functions and treating their numerous ailments.
Although the primary audience for this book is likely to be the second-year medical student, we believe that interns, residents, junior attendings, and even seasoned practitioners will find the text useful as a refresher of pulmonary histology, physiology, pathology, and pharmacology. We admire and want to encourage our students' willingness to learn more about a subject for which we care deeply. Love your lungs.
To our faculty peers, forgive our errors of omission and commission, and let us know your thoughts on how we might improve this first effort in the future. We also want to extend an invitation to those of you whose own institutions are wrestling with similar curricular innovation. My colleagues and I would be happy to share specific details about successful implementation, including suggested course calendars, core lab and clinic facilities, and the requisite expertise and team size needed to achieve your goals.
—Dr. Andy Lechner, Editor