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Integrating Basic Sciences and Patient Care in a Core Clerkship Curriculum:
Why do we care about integrating basic science into the clinical years?
Frazier Stevenson, M.D.Director of Education Devt. UC Davis SOM
President, IAMSE (Intl. Assn. of Medical Science Educators)
Yale SOM Curriculum 1875Year 2
•Dispensary•Chemistry •Practical Anatomy•Embryology •Physiological Chemistry•Chemistry of Urine •Chemical Laboratory •Histology •Pathology •Theory and Practice•Ophthalmology •Obstetrics•Surgery
Year 3
•Dispensary•Surgery Clinic•Eye Clinic•Medical Clinic•Hospital•Toxicology•Diseases of Women and Children•Lectures on Insanity
Flexner Report, 1908
• Admission to a medical school should require, at minimum, a high school diploma and at least two years of university study, primarily devoted to basic science.
• The length of medical education be four years, 2 years of basic science and 2 years of clinical practice
• Proprietary medical schools should either close or be incorporated into existing universities, because a stand-alone medical school would have to charge too much in order to break even.
• Medical schools should appoint full-time clinical professors--"true university teachers, barred from all but charity practice, in the interest of teaching."
UCSF 1980
1 Anatomy Biochemistry
Histology Physiology Genetics
Endocrinology Human Behavior Immunology
2 Pathology Microbiology Pharmacology Human Sexuality
Intro to Clinical MedicineStatistics
Psychiatry
3 Clerkships: Surgery Pediatrics Neurology
Internal Medicine OB-GYN Psychiatry
4 Electives
Basic Science Selective
Senior Surgery Anaesthesia
Case Western 1955
1 Normal Neurologic Musculoskeletal Cardiac
Pulmonary Hematology
Endocrine Renal
2 Diseases Neurologic Musculoskeletal Cardiac
Pulmonary Hematology
Endocrine Renal
3 Clerkships (12 months)
Surgery Pediatrics Neurology
Internal Medicine OB-GYN Psychiatry
4 Electives
UCSF CURRICULUM (February 2003)
Prologue
Gross Anatomy Cell Biology BiochemistryGeneral PathologyGeneral Pharmacology
Organs (heart, lungs, kidneys, GI)
Anatomy reviewPhysiologyHisto-PathologyPharmacology
Clinical Inter-lude
Cancer
OncologyHematologyGeneticsBiochemistryHisto-PathologyPharmacology
Brain, Mind, and Behavior
NeurobiologyNeuroanatomyNeurologyPsychiatryHisto-PathologyPharmacology
Foundations of Patient Care
YEAR 2 Immunology, Infection, and Inflammation
MicrobiologyImmunologyRheumatologyHisto-PathologyPharmacology
Metabolism and Nutrition
PhysiologyGastroenterologyNutritionEndocrinologyBiochemistryHisto-PathologyPharmacology
Life Cycle
GeneticsEmbryologyRepro PhysiologyOB/GYNPediatricsGeriatricsDev..Psychol.Pharmacology
Integra-tionand
Review
Foundations of Patient Care
YEAR 1
Internal Medicine Obstetrics-Gynecology Surgery PediatricsFamily Comm. Med Surgical Specialties Psychiatry Neurology Anaesthesia
INTERSESSIONS
YEAR 3
AAMC Graduation Questionnaire: Basic Science Education“Basic science content was sufficiently integrated”
0.0 2.5 5.0 7.5 10.0 12.530
35
40
45
50
55
60
65
70
75
80
UCD
Allschools
1998 2008
% r
espo
ndin
g ag
ree
orst
rong
ly a
gree
How well did these basic science courses prepare you for the clinical clerkships?
1998 2008
Anatomy 79 85
Biochemistry 42 53
Biostats/Epi 40 51
Genetics 45 60
Immunology 70 70
Histology 51 61
Microbiology 76 75
Neuroscience 68 74
Pathology 85 82
Pharmacology 80 66
Physiology 83 83
11
IAMSE 2009-- Flexner Revisited: Defining the Role and Value of the Basic Sciences in
Medical Education
Goals:1. Define and describe the sciences that constitute
the foundation of medicine
2. Identify the role and value of the sciences and scientific thinking in medical education
3. Identify the best practices of when, where and how the foundation sciences should be incorporated into medical education
12
Questions to be Addressed:
1. What are the sciences that constitute the foundation for medical practice of the future?
2. What is the value and role of the foundational sciences in medical education?
3. When and how should these foundational sciences be incorporated into the medical education curriculum?
4. What sciences could/should be pre-requisite components of the undergraduate medical curriculum (i.e. be part of the pre-medical requirements)?
5. What are examples of the best practices for incorporation of the foundational sciences in the medical education curriculum?
What are the sciences that constitute the foundation for medical practice of the
future?
• All basic sciences taught currently will remain important for the future.
• Normal structure and function are the basis for understanding pathophysiology
• Depth/detail may vary considerably
– must be informed by clinical relevance– a moving target requiring diligent monitoring and
assessment
13
How to assess clinical relevance?
• Key vocabulary
• Basis for understanding disease– Common diseases algorithms, practice guidelines– Complex or unusual diseases deeper learning and
understanding required
• Changing clinical practice creates a persistent and dynamic relationship between basic and clinical sciences
14
Designing a new basic science curriculum: WHAT?
• ability to access basic science mechanisms to solve clinical problems
• critical thinking skills, problem solving skills
• group interaction and communication skills
• ability to formulate research questions and hypotheses
• ability to find and use information to answer these questions
15
Designing a new basic science curriculum: WHEN?
• When – all years– A USMLE mandate
• Rather than a bolus of “ghettoized” information once, distribute content across the continuum
• Revisit science cyclically (upward spiral)
• Use opportunities to build upon previous learning
16
Designing a new basic science curriculum: WHEN?
17
Basic Sciences
Clinical Sciences
Year 1 Year 4See Milbank Report
Basic Sciences Clinical Sciences
Year 1 Year 4