The role of the flight surgeon through all mission phases, including training, medical exams, pre-launch suit-up, and post-landing recovery is discussed.
A Concept for Space Medicine Education in Medical School Nicholas G. Economos
1 B.S. ,
Michael Boyle
1 B.S. ,
Anusha Singh
1 B.S. ,
Mansur A. Ghani
1 B.S. ,
Josh Feler
1 M.S. ,
Paul Barash
1,2 M.D.
1. Yale School of Medicine, New Haven, CT 06510, USA 2. Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510, USA
Introduction Currently, modalities for space medicine education in the United States consist of undergraduate elective courses or clinical clerkship, residency, and fellowship programs at a select list of institutions.1-3 For the vast majority of American medical students without access to institutions with relevant faculty and resources, exposure to the field of space medicine is rare and challenging. Thus, there is a need to increase medical student exposure and access to topics in space medicine, particularly in the preclinical phase of medical education. The development of an elective preclinical curriculum for fundamental topics in space medicine, especially one that can be effectively delivered outside specialized institutions, can expand awareness and knowledge early in medical education. Such an initiative has the potential to broaden student access to the esoteric field of space medicine and encourage downstream interest and placement into clinical training opportunities.
Results
Conclusions
Main Curriculum
Class Sessions
Immunology Tissue Damage & Healing Rheumatology Immune System Microbiology
Sample Problem-Based Learning Session
Dec 1: Introduction to Space Science Here we describe the hazards that the space environment poses to humans, and how spaceflight affects the human body (where we are). We then review the historical context of human spaceflight (how we got there), and end with the challenges facing humans in space (where do we go from here).7
Dec 15: Space Biology Gravity provides a directional stimulus that plays an important role in basic life processes in the cell. It is likely that the growth and development of plants are determined by hormones, whose transport is also influenced by gravity. Here we review the fundamental questions raised in the space environment in the areas of gravitational biology, developmental biology, plant biology, and radiobiology.7
Jan 12: Operational & Life Support
Aims Create an adjunct curriculum to introduce students to the unique challenges and opportunities of space medicine while also furthering student understanding of general medical principles.
The role of the flight surgeon through all mission phases, including training, medical exams, pre-launch suit-up, and post-landing recovery is discussed. These doctors are so essential that they are always first on scene for landing. If crewmembers were not mentally and physically healthy, their nominal and emergency interactions with the vehicle might be fatally compromised.7
Neurology Central Nervous System Psychiatry Musculoskeletal Peripheral Nervous system
Feb 9: Psychological Issues of Space Flight Here we emphasize the importance of mental and social well being in the success of both short and long space missions. What are the psychological and sociological issues, which must be addressed, especially for international missions? This section reviews the factors that may have a critical impact on the success or failure of a space mission, in terms of interactions of the crewmember with his habitat, with the space environment, and with the other crewmembers.7
Methods Curricular Integration ● Medical curricula have increased integration between clinical and basic sciences in the pre-clerkship years. ● Integrated curricula reduce fragmentation of knowledge, reinforce the relatedness of medical topics, and improve teaching effectiveness. ● The integration of curricular elements can be described on a continuum ranging from isolated to transdisciplinary, with increasing requirement of communication and accomodation between instructors of various segments with increasing integration. ● In planning a new curricular element, the mode of integration must account for available resources and flexibility of partnered elements.4 Problem-Based Learning (PBL) ● Group-based learning in which students engage with realistic clinical scenarios with moderation by an instructor. ● Students prepare for content-area of a lecture beforehand with review of previously provided materials and self-selected extra material. We utilized chapters from the textbook Fundamentals of Space Medicine (2011), by Dr. Gilles Clément. ● Clinical scenarios are designed such that the solution requires use of skills and knowledge described in learning objectives for session. ● PBL enhances self-directed learning, increased interaction between students and faculty, and promotes robust learning. ● PBL is a mainstay of medical education in our institution and therefore a familiar format to students.5-6 Effectiveness Analysis ● A survey was administered to students who had completed the seminar to assess integration with their curriculum and pre- and post-exposure affinity for a career in aerospace medicine, and understanding of the field. ● Pre and post-exposure results were compared with a paired t-test (n = 10).
Case: A 33 y/o female astronaut who has been on the International Space Station for 6 months presents with diffuse lower abdominal pain. Discussion Questions ● What is the DDx and how might spaceflight environment affect our DDx? ● Development: Pt reports localization of pain to right side in line with umbilicus (not RLQ), begins to feel nauseous, and vomits. Question: How does this affect our DDx? ● How do considerations related to microorganisms change in a microgravity environment?
Here we review the effects of microgravity on the functioning of the sensory organs primarily used for balance and spatial orientation. The disorientation and malaise encountered during early exposure to microgravity and upon return to Earth are described. Theories and actual data regarding the role of the central nervous system in the adaptation of sensory-motor functions, including the control of posture, eye movements, and self-orientation, to changing environmental gravity levels are explored.7
Apr 12: Musculoskeletal System in Space Here we examine the effects of spaceflight on the structure and function of the musculoskeletal system, what the implications of such changes might be for long-duration exploration missions, and what countermeasures might be employed to prevent undesirable changes.7
References
May 10: Cardiovascular System in Space Cardiovascular deconditioning during spaceflight may significantly affect a crewmember’s ability to perform strenuous or prolonged tasks during and after a spaceflight mission, respond to an emergency situation, or assist a crewmate who might be incapacitated. Here we discuss the principles of cardiovascular fluid and electrolyte control to shed light on the symptoms typically reported by astronauts during and after spaceflight.7
Dr. Rachel Liu (Yale School of Medicine, Dept. of Emergency Medicine) instructs participants in ocular imaging using portable ultrasound.
Class Feedback Data drawn from an online survey administered to participants who had completed the seminar. N = 10.
Based on what I learned in my classes, I had adequate knowledge to participate in the problem-based learning in the space medicine seminar.
Next Steps ● Implement knowledge assessments to reinforce learning objectives and track student progress. ● Work with the Office of Medical Education to expand this seminar to become a formal elective that students can take for credit. ● Partner with other medical schools to share this educational model and facilitate its adoption at institutions nationwide. ● Implement surveys before and after participation in class to more accurately understand impact of class on participant perspectives and behaviors.
Mar 8: Neurosensory System in Space
Circulatory Systems Renal Cardiac Pulmonary
● The educational model described here provides medical students with a monthly problem-based learning (PBL) style seminar teaching space medicine and supplements traditional topics in the medical school curriculum. ● Students who participated in this seminar felt more likely to pursue a career as a provider or researcher in aerospace medicine and felt more familiar with its unique challenges. ○ There was a significant difference between the pre-seminar likelihood of pursuing a career in aerospace medicine (M=2.56, SD=1.13) and post-seminar (M=3.33, SD=1.00); t(9)=3.25, p < 0.05. ○ There was a significant difference between the pre-seminar familiarity with unique challenges of aerospace medicine (M=2.22, SD=0.83) and post-seminar (M=3.78, SD=0.67); t(9)=6.53, p < 0.05. ● This model is an effective and easily adoptable means of addressing the gap in space medicine education that exists at a majority of medical schools.
Prior to this seminar, how likely were you to pursue a career as a provider or researcher in aerospace medicine?
Prior to this seminar, how familiar did you feel you were with the unique aspects and challenges of aerospace medicine?
As of today, how likely are you to pursue a career as a provider or researcher in aerospace medicine?
As of today, how familiar do you feel you are with the unique aspects and challenges of aerospace medicine?
1. AsMA | Aerospace Medical Association. (n.d.). Retrieved May 6, 2018, from https://www.asma.org/aboutasma/careers/aerospace-medicine/residency-programs-related-courses 2. Education. (n.d.). Retrieved May 6, 2018, from https://www.bcm.edu/centers/space-medicine/education 3. Lewis, R. (2015, April 6). Aerospace Medicine Clerkship [Text]. Retrieved May 6, 2018, from http://www.nasa.gov/feature/aerospace-medicine-clerkship 4. Harden RM. The integration ladder: a tool for curriculum planning and evaluation. Medical Education 34, 551–557 (2000). 5. Wood, D. F. Problem based learning. BMJ 326, 328–330 (2003). 6. Albanese, M. A. & Mitchell, S. Problem-based Learning: A Review of Literature on Its Outcomes and Implementation Issues. Academic Medicine 68,52–81 (1993). 7. Clément, G. (2011). Fundamentals of Space Medicine. Springer Science & Business Media.
Acknowledgements We would like to acknowledge and thank the Office of Student Affairs and Department of Anesthesiology at Yale University School of Medicine, and Dr. Paul Barash, Professor Emeritus and former Chair of Anesthesiology, for their support.
Disclosures Strongly Disagree
Strongly Agree
Very Unlikely
Very Likely
Very Unfamiliar
Very Familiar
We have no financial relationships to disclose.
