Medical School Programs
KeywordsBioastronautics Medical Schools Clinical Space Flight Risk USA Europe Health Sleep circadian disorders Behavioral Mental Physical Risks Physiology Solar Particle Radiation Gravity International Space Station Mars500 Cardiovascular Transcranial Doppler Head-down tilt
Medical school bioastronautics education is the multidisciplinary engagement of scientists, physicians, and space explorers to provide specialized training in bioastronautics science and to impact medical care on Earth by transferring the solutions to patients suffering from similar conditions, including osteoporosis, muscle wasting, shift-work-related sleep disorders, balance disorders, and cardiovascular system problems.
Few medical schools across the globe have structured bioastronautics research programs. Most bioastronautics research takes place among educational and research organizations, including national space agencies/centers/institutes, universities/institutes with specialized biology in space programs, space systems laboratories, astronaut/cosmonaut training centers, graduate schools offering research degree programs, and various corporate entities invested in space exploration.
Bioastronautics research programs in Canada and the United Kingdom (UK) are generally housed in physiology and life sciences graduate departments, national space agencies, and other corporate entities – rather than in medical schools. For example, King’s College London in the UK offers a masters’ degree in space physiology and health, which provides training for biomedical scientists and physicians; it is tailored to meet the needs of the space industry and to train individuals to do research in space physiology and medicine. The program is administered by the department of physiology in collaboration with the Space Medicine Office of the European Astronaut Centre. Similarly, there are no degree-granting bioastronautics programs in Canadian medical schools. Rather, the Canadian Space Agency (CSA), which coordinates all space-related policies and programs on behalf of the Government of Canada, collaborates with various research universities across the country to fund and conduct bioastronautics research and to support aerospace medicine medical electives for medical students or residents.
Medical schools that have been selected for this discussion are defined as having charters/accreditation to grant medical and bioastronautics research and are engaged in conducting research and training in bioastronautics science and space medicine. These medical schools uniquely engage medical specialties to examine the effects of spaceflight on humans, identify risks, and prevent problems that humans face while living in the extreme environment of space. These risks include exposure to the hazardous environments of space and medical challenges – including sleep and circadian disorders and behavioral, mental, and physical risks – that have potential to affect crew health and mission success (IOM 2014). Also, these risks vary based on the length of stay for long-duration missions on the International Space Station, the lunar surface, and the estimated 30-month round journey to Mars. In general, these medical bioastronautics programs utilize multidisciplinary teams of physicians, space scientists, and engineers to study the physical, mental, and social health of humans in space, on their return to Earth, and to spin off products for commercialization.
Below are descriptions of select medical school programs in Europe and the USA that meet these criteria and have dedicated bioastronautics research and education programs. These programs offer training and credentials that prepare bioastronautics professionals for careers in space agencies, space industries, educational systems, and research. Most US medical school programs collaborate with complementary graduate education research programs that broaden understanding of the systemic nature of spaceflight risk mitigation.
Medical School Programs in the USA and Europe
Medical School Programs in the USA
Baylor College of Medicine (BCM- Center for Space Medicine (CSMP): BCM-CSMP, instituted in 2008, offers a unique Space Medicine Track within Baylor College of Medicine. Touted as the “first of its kind in the world,” the CSMP offers elective courses and research opportunities throughout all 4 years of undergraduate medical education. CSM’s elective courses are taught by Baylor faculty, experts from other institutions across the country including faculty associated with the twelve-institution consortium, National Space Biomedical Research Institute (NSBRI), which was housed at BCM. The mission of the NSBRI, which was funded by the National Aeronautics and Space Administration (NASA), was to study health risks related to long-duration spaceflight and the development of technologies and countermeasures needed for human space exploration missions. The Institute’s science, technology, and career development projects were based at approximately 60 institutions across the USA. NSBRI Industry Forum partnered with the private sector to medical products for both space and Earth through commercialization activities and start-up funding (www.NSBRIforum.org).
Approximately 40% of first-year medical students at BCM enroll in the CSM’s spring semester, multidisciplinary elective course, Introduction to Human Space Exploration and Medicine, which introduces students to knowledge about biomedical risks and human adaptation associated with space travel and the unique environment of space, including reduced gravity and solar particle radiation, and provides an overview of scientific research, new technologies, and medical approaches to decrease risks for human space exploration and provides students with opportunities to learn how space medicine intersects with other areas of science, medicine, and engineering. The course Topics in Human Space Exploration and Medicine focuses on the use of Earth’s harsh environments as analogs to improve capabilities for space exploration and exposes students to technological and clinical care advances in space medicine and the countermeasures that mitigate human health risks in space. Also, the course introduces students to the role that the International Space Station (ISS) plays to promote space biomedical science and international collaborations and the opportunities that commercial sector for innovative partnerships to promote commercial space flight and research. A space medicine journal club and a course on research opportunities provide mentors for “hands-on” research experiences and opportunities for group discussions.
Harvard Medical School-Massachusetts Institute of Technology (MIT) Division of Health Sciences and Technology (HST): HST is a collaboration between Harvard University and MIT. It is one of the oldest and largest biomedical engineering and physician-training programs in the United States and enrolls approximately 300 students per year. This interdisciplinary curriculum combines engineering and physical and biological sciences that advance research knowledge and have applicability for patient care and advancement of science. A central tenet of this program is to educate students to integrate quantitative and molecular aspects of medicine and biological science through strong quantitative skills, hands-on experiences in clinical and/or industry settings, and completion of a focused interdisciplinary research project. The Program prepares its graduates for a broad range of possible career opportunities including medicine and basic bioastronautics sciences research and is integrated with MIT/Harvard University Graduate Education Program in Bioastronautics, which was developed in 2006 as a multidisciplinary program that integrates biology, medicine, engineering, and space research with emphasis on astronaut protection in space and provision of air, water, food, and telemedicine during space travel. Students must satisfy requirements of the Harvard-MIT PhD program in medical engineering and medical physics, which entails substantial coursework in preclinical medicine and an introduction to clinical practice conducted in Harvard hospitals. They take courses in aerospace biomedical and life support systems, human factors engineering, and space system engineering, as well as a journal seminar in bioengineering. In addition, students are required to choose one restricted elective from options including sensory-neural systems, spatial orientation, radiation biophysics, technology in healthcare and life sciences, strategic decision-making, and a detailed space systems analysis (a historical engineering course on the US Apollo mission that flew humans to the moon). Program students must complete a summer course at Baylor College of Medicine, followed by an internship, either at NASA’s Johnson Space Center or a commercial space-based laboratory. A thesis, under the tutelage of a Harvard-MIT faculty member, is required for completion of the PhD degree (www.hst.mit.edu/bioastro.edu).
The University of Texas Medical Branch (UTMB): The UTMB is a component of the University of Texas, which was established in 1891. UTMB’s Department of Preventive Medicine and Community Health, Division of Clinical Preventive Medicine, supports the Wyle Integrated Science and Engineering Group, which supports the National Aeronautics and Space Administration Johnson Space Center (NASA-JSC). UTMB’s bioastronautics research bolsters NASA-JSC medical operations, including behavioral health and medical monitoring of scientific research activities. This program provides certification for physicians in aerospace, develops medical operations procedures for the ISS, and supports research at NASA-JSC.
In addition, UTMB provides monitoring, safety oversight, and medical care for NASA astronauts and families and provides staff support for international programs such as the Yuri Gagarin Cosmonaut Training Center and Baikonur Cosmodrome. Psychiatrist and flight surgeons in the UTMB Behavioral Health and Performance Section support NASA-JSC’s Space Medicine’s Clinical Services unit and perform professional and scientific work including prevention, diagnosis, therapy, and referral in psychiatry and aerospace medicine (http://pmch.utmb.edu/residency/aerospace-medicine-program).
The University of Pennsylvania (UP)-Perelman School of Medicine: The UP-Perelman School of Medicine, Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, is a multidisciplinary collaboration that focuses on the nature of and dynamic changes in human physiological and neurobehavioral responses produced by sleep loss and circadian rhythmicity. Scientists and physicians use a variety of techniques (e.g., genetics, brain imaging, psychopharmacology) to identify biomarkers for vulnerability to sleep loss and identify differences under basal conditions. This unit conducts bioastronautics studies of sleep and performance in analog space environments such as the NASA Extreme Environment Mission Operations and the Russian 105-Day Mars mission simulation to develop technologies that prevent and treat neurobehavioral and physiological impairments from sleep loss and related stressors that adversely affect the health, behavior, and safety of space travelers. Many premed students work on these studies. This area of bioastronautics research is funded by grants from space biomedical research entities, including the US National Aeronautics and Space Administration (NASA) and the NSBRI, the US Federal Aviation Administration, and the European Union (http://www.med.upenn.edu/psych/news.html).
Wright State University-Boonshoft Medical School (BMS): The BMS Division of Aerospace Medicine was instituted as a unit of the Department of Community Health in 1978. It prepares aerospace medicine practitioners who graduate with a Master of Science degree in Aerospace Medicine and an aerospace medical certificate. This preventive medicine specialty focuses on the health of pilots, astronauts, and other flight crew members with special emphasis on discovering, preventing, and managing adverse physiological responses of healthy individuals to the hostile aerospace environment. Lecture and research topics include the effects of low barometric pressures and oxygen tension, rapid and sustained acceleration, short- and long-term effects of microgravity, cosmic radiation, and isolation. Common medical problems associated with exposures to this abnormal environment include hypoxia, decompression sickness, embolism, barotitis, spatial disorientation, G-induced loss of consciousness, desynchronosis, thermal stress, space adaptation syndrome, and microgravity-induced bone loss which are also covered in the curriculum.
University of Texas Southwestern Medical Center (UTSMC) Institute for Exercise and Environmental Medicine (IEEM): UTSMC-IEEM, instituted 20 years ago, has worked with Olympic athletes to improve their exercise capacity and to train mountain climbers and long-distance swimmers. The IEEM also has helped NASA understand how weightlessness affects the heart functions of astronauts after prolonged spaceflight by conducting experiments on four space shuttle missions and at the Mir and International Space Stations.
IEEM’s bioastronautics research is focused on understanding the cardiovascular limitations of a patient with heart failure, how weightlessness affects the heart, and discerning how sedentary lifestyles can lead to stiffening of the heart muscle, which is a looming health issue as rates of obesity and inactivity in the USA continue to increase and our population ages. The Institute – created by leaders of UT Southwestern and Texas Health Presbyterian Hospital Dallas in 1992 – includes 10 laboratories and is supported by 8 faculty members, 16 postdoctoral researchers, and more than 40 technical staff. The IEEM has one of the US’s largest human physiology clinical research programs, with hyperbaric chambers and other equipment engineered for cardiovascular, respiratory, and neuromuscular research on how altitude, heat, and stress affect the body and an Environmental Physiology/Hyperbaric Medicine Laboratory with a 1110-cubic-foot chamber that can replicate altitudes of up to 165 ft below sea level to treat patients with chronic non-healing wounds, diabetic foot wounds, bone infections, radiation soft tissue injuries, and failing skin grafts (http://www.ieemphd.org).
Medical School Programs in Europe
The Medical University – Graz, Austria – Institute of Physiology, Center of Physiological Medicine, University of Graz, Austria (MUGIPCPM): The MUGIPCPM has a research unit, Gravitational Physiology and Medicine (GPM), which is housed in the Institute of Physiology.
Measurements done at the Medical University of Graz include (1) beat-to-beat heart rate, stroke volume, cardiac output, and autonomic activity using heart rate variability and total peripheral resistance (using the Task Force Monitor, CNsystems, Graz); (2) volume-regulating hormone concentrations in plasma and novel neuropeptides such as galanin and adrenomedullin using serial blood samplings (Grasser et al. 2009); (3) cerebral autoregulation and splanchnic blood flow, using transcranial Doppler and portal vein ultrasound, respectively; and (4) assessment of blood flow in the lower limbs using near-infrared spectroscopy. It has recently been reported that presyncope in astronauts who return after 6–15 days of spaceflight may be related to a mismatch of cerebral blood flow with blood pressure (Hinghofer-Szalkay et al. 2011). The GPM research unit collaborates extensively with partners from the USA, Canada, Japan, China, Russia, and Europe (http://physiologie.medunigraz.at/research/gpm/).
Charité-Universitätsmedizin Berlin-Germany: Charité, a joint institution of the Free University of Berlin and Humboldt University, houses the Center of Space Medicine and Extreme Environments (CSMEE), which is one of the preeminent bioastronautics research centers in Germany. The CSMEE, established in 2000 as a joint initiative with the German Aerospace Center (DLR), coordinates six teams from the Medical Faculty of the Free University of Berlin and the Charité and Humboldt University. The mission of the Center is to investigate human adaptation in the weightless environment of space with research in the following areas: spaceflight, altitude medicine, lower body negative pressure, human centrifuge investigation, brain cognition, cardiovascular system, cold environments, immersion and diving, isolation and confinement, head-down tilt, microcirculatory observation, functional anatomy and cell biology, exercise in extreme environments, and anthropometry systems.
The Center works in partnership with European space companies and ten international space agencies, including the Russian Federation, Institute for Biomedical Problems of Roscosmos, and Russian Academy of Sciences to conduct the “Mars-500” project in a series of experiments on long-term isolation of the crew in conditions of the specially built ground-based isolation experiment facility (http://mars500.imbp.ru/en/index_e.html) and the NASA to conduct circadian rhythm research on the ISS.
- Hinghofer-Szalkay H (2010) Future human spaceflight: the need for international cooperation. International Academy of Astronautics, ParisGoogle Scholar
- Antunano MJ, Wade K (2014) Index of international publications in aerospace medicine, DOT/FAA/AM-14/7. Office of Aerospace Medicine, Washington, DCGoogle Scholar
- Basner M, Dinges DF, Mollicone DJ, Savalev I, Ecker AJ, DiAntonio A, Jones CW, Hyder EC, Kan K, Morukov BV, Sutton JP (2014) Psychological and behavioral changes during confinement in a 520-day simulated interplanetary mission to Mars. PLoS One. https://doi.org/10.1371/journal.pone.0093298CrossRefGoogle Scholar
- Dijk D, Neri DF, Wyatt JK, Ronda JM, Riel E, Ritz-De Cecco A, Hughes RJ, Elliott AR, Prisk GK, West JB, Czeisler CA (2001) Sleep, performance, circadian rhythms, and light-dark cycles during two space shuttle flights. Am J Physiol Regul Integr Comp Physiol 281(5):R1647–R1664. PMID: 11641138CrossRefGoogle Scholar
- Fu Q, Levine BD, Pawelczyk JA, Ertl AC, Diedrich A, Cox JF, Zuckerman JH, Ray CA, Smith ML, Iwase S, Saito M, Sugiyama Y, Mano T, Zhang R, Iwasaki K, Lane L, Buckey J, Cooke W, Robertson R, Baisch F, Blomqvist G, Eckberg DL, Robertson D, Biaggioni I (2002) Cardiovascular and sympathetic neural responses to handgrip and cold pressor stimuli in humans before, during and after spaceflight. J Physiol 544(2):653–664CrossRefGoogle Scholar
- Gunga HC (2014) Human physiology in extreme environments. Academic Press, ElsevierGoogle Scholar
- Health Standards for Long Duration and Exploration Spaceflight: Ethics Principles, Responsibilities, and Decision Framework (April, 2014) Institute of Medicine ReportGoogle Scholar
- Mallis MM, DeRoshia CW (2005) Circadian rhythms, sleep, and performance in space. Aviat Space Environ Med 76(Suppl 6):B94–B107Google Scholar
- Monk TH, Buysse DJ, Billy BD (2006) Using daily 30-min phase advances to achieve a 6-hour advance: circadian rhythm, sleep, and alertness. Aviat Space Environ Med 77(7):677–686. PMID: 16856351Google Scholar
- Prisk GK, West JB, Czeisler CA (2001) Sleep, performance, circadian rhythms, and light-dark cycles during two space shuttle flights. Am J Physiol 281:R1647Google Scholar
- Whitmire A, Leveton LB, Barger L, Brainard G, Dinges DF, Klerman E, Shea C (2009) Human health and performance risks of space exploration missions: evidence reviewed by the NASA Human Research Program. NASA SP-2009-3405. Washington, DC: National Aeronautics and Space AdministrationGoogle Scholar