Design and use of a proton pump inhibitor case to integrate physiology, pharmacology, and biochemistry

Abstract

THE USE OF DRUGS to integrate basic and clinical sciences is frequently used in a lecture format, but the availability of alternative pedagogical approaches that address higher-order learning are not widely available. The use of case studies and case-based projects to reinforce lectures can help link basic and clinical disciplines and promote knowledge retention (2). Casebased projects also help students with varying levels of background education see the applicability of topic material, and this may maintain engagement (5, 6). However, both the significant time and effort and the general breadth of knowledge across basic science content areas necessary to construct clinically relevant basic science cases may serve as hindrances to their development.To address this issue, over the course of ϳ2 mo, I designed an integrated case that uses proton pump inhibitors (PPIs) to connect basic pharmacological principles with basic gastrointestinal physiology and pathophysiology. The development of this case grew out of discussions with clinical faculty members and students regarding general confusion surrounding how and why drugs that act in the stomach on parietal cells are made as enterically coated prodrugs to protect them from destruction by stomach acid. Thus, in the process of searching the literature to resolve this paradox, it became apparent that this would be an excellent way to connect gastrointestinal physiology, pharmacology, and biochemistry (1).The first iteration of this case is presented in the first module of our curriculum (Fig. 1). This module covers basic biochemistry, cell biology, genetics, and pharmacological principles over the course of 8 wk. As part of this module, students are introduced to receptors and channels followed by lectures on pharmacokinetic principles including information on drug absorption, distribution, metabolism, and excretion. In these sessions, we discuss the principle of ion trapping, and this serves as the segue to the case. Normal anatomy and physiology content, including gastrointestinal physiology, is presented in the subsequent module. Thus, the case introduces students to the principles of gastric acid secretion and buffering in an applied manner together with pharmacology before their formal presentation in a physiological context in the second module. When the cases are administered, students work on the case first as individuals before assembling in groups, which consist of eight members. By doing this, students are afforded the opportunity for individual thought and expression without the pressures of a group. Upon the completion of the session, I collect both the individual answers and group answers for comparison. This is followed by a detailed discussion on the concepts addressed in the learning objectives and the answers to the questions.The PPI case is represented to students in the second year of the curriculum, when they cover gastrointestinal pathophysiology in the gastrointestinal, hepatic, and renal systems module. In this module, students must work through...