Physiology belongs indisputably to the core of medicine. However, it is a continuous challenge for physiologists to emphasize its role in achieving medical competencies while new study programmes are designed, departmental structures reconstructed and budgets cut. In meeting the challenge, it is most important for teachers to know what the goals are in a form of concrete, attainable and assessable physiology learning outcomes. Since physiology is as content-loaded as natural sciences in general ("there is more to know than students can possibly learn", Michael et al. 2009), attainability includes not only that the quantity of physiology counted by credit points and number of instructional hours is sufficient, but also that the content knowledge of physiology is sensibly scaled to strain and expenditure of time.

Teaching physiology in an integrated curriculum means implementing problem based learning (PBL) and collaboration between basic and clinical sciences. The advantage of the integrated approach is, given that the learning outcomes fulfil the criteria, that physiology is repetitiously studied and learned in variable contexts. Thus, proceeding the studies in successive blocks (e.g. organ systems, "chest pain and dyspnea" etc.) strengthens the student comprehension about healthy and abnormal human function and behavior. On the other hand, physiology may smooth away if learning outcomes are not clear and transparent to all. Despite the curriculum design, all physiology learning seems to be confined to preclinical years. Should basic physiology be visible also in the clinic?

Higher education is based on research. In any academic discipline it implies not only science-based content knowledge, but also science-based teaching. Thus, physiology teachers should be both experts in physiology, by education and/or by experience, and in so-called pedagogical content knowledge (PCK). According to Shulman (1987) PCK combines content to various aspects of the learning process, such as the knowledge of learning methods and their effectiveness, knowledge of curriculum and assessment methods, and knowledge of the learners. Access of faculty members to continuing education in university pedagogics makes it possible to keep up with the PCK and thus, quality of teaching. Research on medical education is a growing science genre and there are several scientific journals that publish up-to-date papers on all aspects of teaching. Recently, Horton et al. (2012) in Advances in Physiology Education show that academic outcome is weakly correlated with lecture attendance emphasizing that in lecture-orientated physiology programmes the content of lectures should be reviewed and alternative and supportive learning methods should be obtainable. PBL has also been under intensive research due to its global popularity and aspiring learning outcomes. A recent paper by Cardozo et al. (2012) in Medical Teacher shows that structured approach in PBL increases student preparation, participation, and accountability in Harvard Medical School, where all the students are graduates. This result strongly supports our beliefs here in Helsinki where our students are mostly young high-school-graduates: to facilitate good learning of medical physiology we should strive for well-structured "package" of good-quality cases supported by key lectures and web-based learning, inspiring hands-on practicals, of sufficient amount of formative and summative assessement, and good teacher performance.

Michael et al. 2009. http://advan.physiology.org/content/33/1/10.full.pdf+html

Shulman, L. S. (1987). Knowledge and teaching: Foundations of the new reform.

Harvard Educational Review, 57(1), 1–22.

Horton et al. 2012. http://advan.physiology.org/content/36/2/108.full

Cardozo et al. 2012. http://informahealthcare.com/doi/pdf/10.3109/0142159X.2012.691187