IAMSE 2002 Annual Meeting - Dr. Deborah Klamen

FOCUS SESSION TITLE:	What is the Science Foundation Expected by Clinical Clerkship Directors?

SESSION LEADER(S):	Deborah Klamen, M.D., M.H.P.E., University of Illinois College of Medicine, Chicago, IL, U.S.A.
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OTHER PRESENTERS:

HANDOUTS or SLIDES

This topic, as might have been predicted, generated a lot of interest and debate. We had a healthy attendance, with good representation between basic scientists and clinicians. It quickly became apparent that no one, neither the discussion leader nor participants, had the "concrete details" for which all were hoping. It also was readily apparent that it was much easier to focus on the process of education or its outcome - a "responsible, knowledgeable, caring physician" - than deal with the enormous task at hand. With thanks to my colleagues who so actively participated, the following is a summary of the discussion that occurred.

Many interesting issues were raised by participants after data was presented that had been collected from a variety of sources (see hyperlinked handout of speaker's notes above). A recurring issue was "who exactly do we want to prepare?" Technicians versus those who can think outside the box? Pattern recognition experts who can think their way through a problem if the pattern falls apart? It was noted that the basic science needs of subspecialists are likely different from those of generalists (deeper in specific areas) but much of the basic science material needed had to be re-learned anyway (which was considered easier than learning it the first time in residency/fellowship).

Another theme to begin with was the issue of "what do clinicians know, use, and can articulate of basic science needs?" Repeatedly data within the gathered surveys alluded to abstract issues such as "width versus depth," "showing good clinical problem solving skills," "being professional" but rarely was there mention of any specific, concrete basic science knowledge. It was discussed that many clinicians do not ask the kinds of "why" questions on rounds, etc., and instead adhere to basic differential diagnosis questions - robbing students of the opportunity to put their basic science knowledge into active practice. It was suggested that inviting basic science faculty to participate in rounds would enrich the experience of all concerned. (Clinicians would receive renewed exposure to the basic science underpinnings of their work, students could put their basic science knowledge into context/practice, and basic scientists could see the realities of clinical work and clinical cases in action.)

Conclusions from this focus session were as follows:

Defining an appropriate basic science foundation upon which to base clinical training is a huge undertaking, and very few in this room have attempted, or would contemplate attempting to address this subject.

Students must be taught reasoning skills early, since all agreed the "pure technician" was not a desired outcome.

It might be possible to use pathophysiology as a core and "work backwards" to define details of a necessary science foundation. Two suggestions of where to begin were:

Using Dr. Henry Mandin's 125 +/- case presentation format.

Tracking cases seen in the course of a year by a large cohort of students throughout a medical school. These students would be asked to keep an electronic log of patients seen, complete with pathophysiologic issues raised and concepts learned. Such concepts might then form a nidus of the needed science foundation by clinical clerks.

Defining an appropriate basic science foundation would be impossible without clinicians and basic scientists working together, dividing the task into discrete units and rising above "turf issues" that frequently separate these two factions.
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