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The Future of Basic Sciences in Undergraduate Medical Education

The Future of Basic Sciences in Undergraduate Medical Education. Douglas L. Wood, D.O., Ph.D. President - AACOM. Will Discuss. 1. Current Status of undergraduate medical education 2. Future status of undergraduate medical education - The role of the basic sciences in that future.

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The Future of Basic Sciences in Undergraduate Medical Education

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  1. The Future of Basic Sciences in Undergraduate Medical Education Douglas L. Wood, D.O., Ph.D. President - AACOM

  2. Will Discuss 1. Current Status of undergraduate medical education 2. Future status of undergraduate medical education - The role of the basic sciences in that future

  3. “We are not simply reactors in this system - we are active actors in it”

  4. Preclinical phase- First half of 20th Century 1. Basic Science departments organized by discipline 2. Taught basic science facts necessary to practice medicine 3. Teachers dominant - students passive

  5. Preclinical phase- End of 20th Century 1. Basic science concepts defined by interdisciplinary groups 2. Problem solving skills less generalizable 3. Research in metacognition

  6. Clinical phase - 1. Required clerkships use inpatient hospital services 2. Fragmentation of clinical experiences 3. Clerkships not educationally comparable 4. Inadequate attention to fundamental clinical skills

  7. Curricular innovation since the late 1950’s 1. Organ Systems Approach - assumptions: 1.1 Integration maximized student learning 1.2 Enables students to construct a rudimentary, clinically useful knowledge base 1.3 Further integration achieved at beginning of clinical training

  8. Curricular innovation since the late 1950’s (con’t.) 2. Problem-Based Learning Model - assumptions: 2.1 Helps to make medical information more understandable and clinically useful 2.2 Enhancement of student attitudes toward learning

  9. Curricular innovation since the late 1950’s (con’t.) 2.3 “Active Learning” enhances retention and recall 2.4 Will develop student’s hypothetico-deductive reasoning

  10. Curricular innovation since the late 1950’s (con’t.) 3. Clinical-Presentation Model - Assumptions: 3.1 Borrows from and uses strengths of other curricular models 3.2 Eliminates need for students to restructure knowledge upon entering clerkships

  11. Curricular innovation since the late 1950’s (con’t.) 3.3 Interrelationship between basic and clinical science concepts 3.4 Schemata assist students

  12. Health Care System of the Future 1. Increase concentration in areas of molecular medicine - molecular, cellular, structural and neural biology 2. Genetics 3. Increased emphasis on health promotion and disease prevention

  13. Health Care System of the Future (con’t.) 4. Practice of Evidence Based Medicine 5. Safe 6. Effective

  14. Health Care System of the Future (con’t.) 7. Patient Centered 8. Timely 9. Equitable

  15. Medical Education of the Future 1. Obligation of medical education to prepare physicians who can provide services in a changing health care system 2. Purpose of medical education - Produce physicians who promote health and deliver curative services to all people

  16. Medical Education of the Future (con’t.) Goals of Basic Medical Science Education (Small and Suter) 1. Goal 1: Identify the competencies of the practitioner of the 21st century and define the medical science base considered essential for understanding etiology and pathophysiology of disease, and the dynamics of management of illness

  17. Medical Education of the Future (con’t.) 2. Goal 2: Whenever possible, select instructional strategies that are derived from research results in the cognitive and neurophysiological sciences 3. Goal 3: Prepare students for the clinical problem-solving situation

  18. Medical Education of the Future (con’t.) 4. Goal 4: Increase the focus on the students professional development while learning basic science by adding ethical concerns and the development of interpersonal skills, especially communication skills

  19. Medical Education of the Future (con’t.) 5. Goals 5: Design ways by which students will acquire expertise in electronic information management as a basic tool for life-long learning and clinical decision-making

  20. The Basic Sciences in Undergraduate Medical Education of the Future 1. Looking back in order to move forward 2. Status of science education in K-12 and colleges and universities 2.1 Must determine most importantconcepts to emphasize

  21. The Basic Sciences in Undergraduate Medical Education of the Future 2.2 Science education liberates the human intellect 2.3 Role of basic science educators

  22. The Future 1. Integration of Cognitive Science concepts 1.1 Organization of long term memory 1.1.1 Information in isolation is inert and not helpful 1.1.2 Inappropriate to teach clinical reasoning skills independent of clinical content

  23. The Future (con’t) 1.2 Storage and retrieval from memory - Strategies to enhance memory 1.2.1 Enhance meaning 1.2.2 Reduce dependence on context 1.2.3 Repeated practice in retrieving information

  24. The Future (con’t.) 1.3 Problem solving 1.3.1 Practice is essential 1.3.2 Situation in which a certain particular problem - solving routine likely to be useful

  25. The Future (con’t.) 2. Mastery of only foundation knowledge 2.1 New biology requires not mastery of facts by an understanding of principles 2.2 Basic Science role 2.2.1 Limit lectures

  26. The Future (con’t.) “Exactly because contemporary medicine requires a scientifically sophisticated doctor, the science base of the medical curriculum must function to activate the student, and not simply perpetuate the passive role induced by obsolete didactic methods." Henry Walton, M.D., Ph.D.

  27. The Future (con’t) 2.2.2 Small group teaching 2.2.3 Integrate basic and clinical science

  28. The Future (con’t) 3. Ordering (structure) of medical education 3.1 Do we need to teach basic science followed by clinical science?

  29. The Future (con’t) 3.2 Basic Science (six to eight months) followed by clinical science with basic science integration 3.4 Papa - “…curricular organization does have an effect on students’ learning outcomes.”

  30. The Future (con’t) 4. Integration of basic and clinical sciences 4.1 Medical education as a system 4.2 Packaging different sciences in separate departments - effect of 4.3 NEED-Integrate interdisciplinary teaching horizontally and vertically

  31. The Future (con’t) 3.4 Papa- "Investigators observed that students from integrated curricula had superior diagnostic performance as compared with students from programs where basic and clinical sciences were taught separately."

  32. The Future (con’t.) 5. Integration of the new basic science - molecular medicine 5.1 Medical education slow to adjust 5.2 Role of basic science 5.2.1 Emphasize principles and universal concepts 5.2.2 Create exciting environments for learning

  33. The Future (con’t.) 6. Lack of engagement in the sciences by medical students 6.1 Serious problem 6.2 Role of basic science 6.2.1 Create exciting environments for learning 6.2.2 Emphasize principles and universal concepts 6.2.3 Evaluation

  34. The Future (con’t.) 7. Lack of Outcomes based education 7.1 Instructional objectives and learning outcomes 7.1.1 Detail of specification 7.1.2 Level of specification where emphasis placed 7.1.3Classification adopted and interrelationships

  35. The Future (con’t.) 7.1.4 Intent or observable result 7.1.5 Ownership of outcomes 7.2 Role of basic science 7.2.1 Become a part of this approach 7.2.2 Integrate basic science and clinical concepts

  36. The Future (con’t.) 8. Limited educational settings 8.1 Learning environments and contemporary realities of practice 8.2 Enhance settings - communities 8.3 Basic science role 8.3.1 Move basic science teaching 8.3.2 Practice in novel situations

  37. The Future (con’t.) 9. Lack of medical teachers as educators 9.1 Barrows quote - “There is no place in medical education for faculty to teach by the seat of their pants, the way they were taught, not questioning what or how they should teach, any more than there would be a place for such an approach in research or patient care”

  38. The Future (con’t.) “Anyone with responsibility for educating students, residents, and physicians should be skilled and well informed about medical education - as preparing these learners to provide safe, humane, and effective care for the members of our society is a heavy responsibility”

  39. The Future (con’t) 9.2 Solution lies in educational leadership 9.3 Basic Science Role 9.3.1 Provide needed leadership

  40. Best Evidence Medical Education(BEME)

  41. Challenges to you 1. Integrate Cognitive Science concepts into medical education 2. Teach fundamental principles 3. Integrate basic and clinical science education 4. Become medical education experts 5. Lead

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