Integrating Basic Sciences and Patient Care in a Core Clerkship Curriculum:

1. 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) Integrating Basic Sciences and Patient Care in a Core Clerkship Curriculum:

2. Yale SOM Curriculum 1875

3. Abraham Flexner

4. 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." Flexner Report, 1908

5. UCSF 1980

6. Case Western 1955

7. UCSF CURRICULUM (February 2003) YEAR 1 YEAR 2 YEAR 3

8. Student Perspective of Medical Biochemistry 8 Source: frommedskoll.com

9. AAMC Graduation Questionnaire: Basic Science Education“Basic science content was sufficiently integrated”

10. How well did these basic science courses prepare you for the clinical clerkships?

11. IAMSE 2009-- Flexner Revisited: Defining the Role and Value of the Basic Sciences in Medical Education Goals: Define and describe the sciences that constitute the foundation of medicine Identify the role and value of the sciences and scientific thinking in medical education Identify the best practices of when, where and how the foundation sciences should be incorporated into medical education 11

12. Questions to be Addressed: What are the sciences that constitute the foundation for medical practice of the future? What is the value and role of the foundational sciences in medical education? When and how should these foundational sciences be incorporated into the medical education curriculum? What sciences could/should be pre-requisite components of the undergraduate medical curriculum (i.e. be part of the pre-medical requirements)? What are examples of the best practices for incorporation of the foundational sciences in the medical education curriculum? 12

13. 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

14. 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

15. 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

16. 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

17. Designing a new basic science curriculum: WHEN? Clinical Sciences Basic Sciences Clinical Sciences Basic Sciences Year 1    Year 4 Year 1    Year 4 See Milbank Report 17

18. HOW? 18