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

Abraham Flexner

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

Source: frommedskoll.com

Student Perspective of Medical Biochemistry

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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

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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

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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

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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

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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

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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

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Designing a new basic science curriculum: WHEN?

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Basic Sciences

Clinical Sciences

Year 1 Year 4See Milbank Report

Basic Sciences Clinical Sciences

Year 1 Year 4

HOW?

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