Image by Kevin Reginald Parks, MOOC participant, alternative medicine specialist… and artist
Course: Medical Neuroscience
Instructors: Leonard White, PhD
The course provides students an understanding of the essential principles of neurological function, from cellular and molecular mechanisms of neural signaling and plasticity to the organization and function of sensory and motor systems. This course emphasizes the neural and vascular anatomy of the human brain and spinal cord, providing an anatomical framework for localizing lesions within the central nervous system. It also emphasizes the neurobiological foundation for understanding cognition, mental illness and disorders of human behavior.
The overall goal is to equip students in the health professions for interpreting impairments of sensation, action and cognition that accompany neurological injury, disease or dysfunction.
This was another of the three “killer moocs” I took concurrently – but I’m very glad I took the chance, in spite of the workload, and the warnings that this was intended for graduate medical professionals with solid grounding in biology, chemistry, and anatomy. I loved this course, and I highly recommend it to anyone who’s willing devote serious time and effort to covering a huge array of information about the nervous system. The materials were well-organized and clear, and included a variety of styles: text, video, animations, diagrams, anatomical photographs and specimens. Staff, both Duke staff and volunteer CTAs, were extremely involved and generous with their time and talents: one CTA created a fantastic website of study materials, and Dr. White held three live hang-outs during the twelve week session. And, by the way, fellow students (who range from practicing health science professionals to medical students to the curious, like me) were helpful, encouraging, and all-around delightful.
The course will migrate to the new Coursera platform in April or May, where it will be offered again on a more “on demand” schedule. I am (somewhat famously) not a fan of the new platform, so although staff has assured us changes will be minimal, I’m glad I got to take the last “session-based” run of the course. And yet, because it is such a great course, and because it involves a massive amount of fascinating material, I might just show up in that new session, just for fun.
What’s involved? Twelve intense weeks of detailed neurological anatomy, physiology, and biochemistry. Material was divided into six two-week units, each with its own quiz. There was also a series of short “functional anatomy” quizzes (identify locations on a cross-section with either a named structure, or a function), plus a comprehensive final. All of these exams were timed, but generously so; multiple attempts were allowed, but not only would you not know which questions you got wrong, you also got mostly different questions each time. Two peer-assessed assignments were also included, though they together only counted for 10% of the total grade. They were, however, extremely helpful in developing an understanding of the material covered.
Although no book was required, the course followed the extraordinary and comprehensive textbook used for the in-person course, available through Sinauer Publishers, whose site includes a variety of free animations and other materials. The text was edited by, among others, Dr. White and Dr. Purves, whose “Visual Perception” mooc I took a year ago. Many illustrations from this book were included in the videos, and I found them both aesthetically pleasing (come on, you know how many books have boring or just plain ugly illustrations) and very intuitive. Also in the videos were screen shots from the “interactive atlas” of neuroanatomy known as Sylvius 4, allowing us to see internal structures via stained cross-sections, arranged anatomically.
Anatomy was the first unit covered, and included both illustrative diagrams and detailed lab examinations of the surface and various cut views of a human brain. What are the different kinds of cells in the nervous system? What are the boundaries of the lobes? What are the important areas? What’s inside? Where are the cranial nerves? What about the spinal cord? What’s the blood supply to the brain? And what about the ventricles, the cerebrospinal fluid, how does that work? And by the way: depending on how it’s sliced (or isn’t), sometimes the nervous system looks like a butterfly, sometimes like an angry falcon, sometimes like a grinning skull, and sometimes like a prehistoric fertility icon. And that’s just for starters.
The first peer assessed assignment was connected with this unit: draw a picture of the brain, showing a specific level of detail. We were encouraged to be creative and use what was at hand – “draw in the dirt at your feet with a stick, if you wish” – and the assignment generated some of the most creative work I’ve seen in a mooc: not only beautifully drawn standard diagrams, but brains made from pills, from crumpled up trash bags, from flower petals, from pushpins on a bulletin board, from vegetables, brains drawn on the beach, on snow, and, my favorite, cats-on-the-brain, shown here (submitted by Romanian veterinary student – and talented artist – Iulia Cimpoieș).
The second two-week unit was all about neural signaling. This was the hardest part for me, since I have only the most elementary grasp of chemistry. I’m completely fascinated, when looking at the multitudinous and complicated steps involved in passing a signal along an axon, and then passing it across a synapse to another cell – which neurotransmitter, which receptor, which ion – that we’re able to do anything at all, let alone study how those things happen. Life really is a miracle. I’d like to be able to understand these processes better. Fortunately for me, a general understanding of the major classes of neurotransmitters and types of receptors was sufficient to cover the subsequent material.
The next two units were central: sensory and motor pathways, and recognizing how an interruption in the flow of information would affect various kinds of perception or function. This is what’s crucial to the medical professionals, the physical therapists, the physiatrists, the nurses, and to the primary care practitioners. What does it mean if someone has a slowly-reacting pupil on one side? If someone has weakness in one leg, but can’t feel touch on the other, where is the most likely site of the problem? What does it mean if they can feel touch but not pain? if they can’t tap their fingers to their thumb in succession? and one of the most interesting tidbits: the difference between the emotional smile, and the forced smile. Different pathways are involved. We also learned more than you’d ever want to know about urination. Again, I’m amazed anyone can pee, given all that has to happen. And by the way, maybe I’m highly suggestible, but there’s something about listening to someone talk about peeing, even when phrased as muscle contractions, nerve inputs, and signals to sphincters, that made me want to pee over and over. These pathways were the focus of the second peer-assessed assignment, also a drawing task. I found this to be extremely helpful. I probably should’ve done more drawing, until I could keep all the pathways straight.
Then we looked at the development of the nervous system over the lifespan, including embryonic development, recovery from damage, and the aging process. Here’s where I discovered a neurotransmitter called Sonic Hedgehog and its two protein helper pals, Patched and Smoothened. It’s also where I discovered the “pinwheel” organization of visual cortex neurons favoring various orientations, and how those pinwheels, as yet inexplicably, seem to have a density of π across species. Makes the hair stand up on the back of your neck, doesn’t it?
The final unit covered aspects of cognition, memory, and sleep. I discovered that, just like there’s nothing like a lecture on peeing that makes you need to pee, there’s also nothing like someone talking about different kinds of sleep, different wavelengths involved, different purposes and effects, that makes me want to take a nap.
The “killer” aspect wasn’t in the difficulty of the material; nothing was that confusing. Everything was very well explained in multiple forms, there were plenty of materials available, and the assignments were beautifully designed to aid in learning what was most important. What made it difficult was simply the volume of material: nearly a dozen different neural pathways, scores of anatomical locations with varied functions, and a vocabulary full of words like “dorsomedial” as opposed to “anterolateral”, all of which are crucial to identifying what’s happening. I was lucky I had a good deal of the vocabulary going in, but I still didn’t have fluency in many instances, so I had to keep thinking, Where is dorsolateral? before I could move on. It’s just a lot to keep straight.
But it’s doable. I know, because I did it. I wouldn’t say I’m an expert on the nervous system, and I had to check my notes frequently on all the tests, but I think I passed (the grading system is complex – 40% for quizzes, 25% for the final, etc – so I won’t be sure until grades are released). What I’d like to do is be able to pass without notes. Then again, I’m not a medical student or a health practitioner; this is all just out of curiousity – for fun. And it was. But hard work, definitely. I put a lot of time into this – and loved every minute.
I’ve been reading general-readership medical nonfiction all my life. It started in the 60s when I was a fifth grader devouring anything readable, including my family’s issue of Reader’s Digest: William Nolen’s description of his surgical training, the “I am Joe’s [organ of the month – they started with the famous ones like heart and stomach then moved on to lungs and kidneys, eventually arriving at the pancreas, IIRC], jeremiads about what were then called venereal diseases, phrased in such oblique terms that it years before I realized syphilis had anything to do with sex. I have shelves of these books: tours through medical school and residency, as well as patient accounts of struggles with cancer and heart disease. Some are fictionalized. Some are hilarious (House of God and Calling Dr. Horowitz. Some made me angry. All were fascinating. Of course, the writings of neurologist Oliver Sacks stand at the pinnacle.
But they aren’t textbooks. Sure, I learned a few of the obscene mnemonics, but I never learned the bones or nerves that went with them. I know them now. I learned the bones of the wrist corresponding to “Scared lovers try positions that they can’t handle” in the Upper Limb course last year, and now, thanks to Neuroscience, I know all about the cranial nerves memorialized in “Oh oh oh to touch and feel a girl’s vagina, ah, heaven”. The mnemonics have been cleaned up (in the case of the cranial nerves, necessarily so, since the acoustic nerve is really the vestibulochochlear nerve, and the accessory nerve is better referred to as the spinal accessory nerve.
Of course, now that the internet is here, anatomy and medicine isn’t the mystery it was in the 60s. Anyone with a cell phone can find materials for pretty much any medical topic, from simplest explanations to actual course materials. But I still do far better in a course, where material is structured and presented, rather than just groping my way through Youtube and pdfs. I’m incredibly grateful that this course is available to anyone who wants to take it – even me.