From traditional to problem-based learning: a case report of complete curriculum reform.

The Sherbrooke School of Medicine, Quebec, has restructured its entire curriculum to make problem-based learning (PBL) the main instructional format. This complete reform is explained both in terms of process and content. The curriculum problems were clearly identified and overcome by a major structural shift-over following the stages of a strategic planning of change. Implementation over a period of 7 years is described according to a four-stage framework: need for change; selection of the PBL solution; planning for implementation; and the full-scale adoption of the PBL method. The programme is described in relation to the congruence of goals, learning and evaluation activities. Initial impact on student learning and evaluation, attracting better quality students, academic staff roles, and on financing the operation are discussed. Changing the undergraduate programme has become an institutional project directed by the Office of the Dean.

Disopyramide phosphate effects on slow and depressed fast responses.

We studied the effects of disopyramide phosphate on explanted neonatal rat ventricle cells exhibiting depressed fast responses or naturally occurring slow response action potentials together with automatic activity. Disopyramide suppressed the spontaneous activity at a concentration of 2.5 micrograms/mL with a half-maximal value of 10 micrograms/mL. Before spontaneous activity was lost, there was an increase in beating rate possibly related to membrane depolarization. In depressed fast and slow response action potentials there was an increase in action potential duration (APD) which was consistently found both at the level of the plateau and at 90% repolarization. Comparison of the APD increase observed after disopyramide treatment and that after exposure to 20 mM tetraethylammonium suggested a block of a potassium conductance as a possible cause underlying the change in APD. The Vmax values of the depressed fast response decreased at constant membrane potential and this was attributed to the local anesthetic effect of the drug. In addition, we report two novel findings: (i) a decrease of Vmax of the slow response action potentials which may be secondary to membrane depolarization, and (ii) an increase in the duration of slow action potentials, possibly caused by inhibition of a potassium conductance.