IAMSE 2003 Annual Meeting - Drs. Kevin Krane and Jack Strandhoy

WORKSHOP SESSION TITLE:	Strategies for Integrating Basic Science into the Continuum of Medical Education

SESSION LEADER(S):	Drs. Kevin Krane, Tulane University School of Medicine, New Orleans, Lousiana, USA and Jack Strandhoy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA

OTHER PRESENTERS:

HANDOUTS or SLIDES

This session had the following objectives. Participants were expected to:
1. Evaluate the pros and cons of incorporating basic science education into the continuum of medical education,
2. List topics and methods for incorporating science education into the continuum of medical education, and
3. Develop ways to create dialogues between basic science and clinical science faculty to facilitate medical student learning.

Issues raised:
The discussion leaders introduced several ways in which basic and clinical sciences are integrated into curricula, especially in the pre-clerkship years. Examples from Tulane and Wake Forest were summarized. Barriers to teaching and learning can reduce the perceived relevance of basic science teaching and limit its exposure in the clinical years. The question of how much basic science should be taught in the clinical years, or whether it is being taught relabeled as medicine, was a topic for discussion. The focus of the discussion centered on challenges and opportunities to integrative learning.

Focus of discussion:

Concerns:

Compartmentalization of knowledge
Lack of apparent retention and clinical application of concepts
Poor cooperation between faculty in teaching
Few opportunities for basic science teaching in clinical years
Uncertain need for basic science teaching in clinical years
Financial and time pressures on all faculty

Approaches:
Team teaching and exams, e.g., pathologist and nephrologist
Standardized patient or simulator exams with basic science mechanisms evaluated
Problem-based and case-based learning formats
Database access of teaching materials to permit collegial coordination of instruction
Scientist participation on clinical rounds as an observer or participant
Use of technology for distance learning and customized content delivery during all years of the curriculum
Use of retired physicians as volunteer faculty
Establishment of clear mechanistic objectives for clinical years to better evaluate if basic science is missing or relevant
Use of current medical literature such as the series on “Mechanisms of Disease” and “Medical Genomics” in the New England Journal of Medicine
Limited formal courses or introduction of new topics in the final phase of the curriculum, e.g., Clinical Pharmacology, genomics, pathophysiology concepts

Major outcomes:
Many of the participants already successfully incorporate clinical relevance into their basic science teaching. New opportunities were shared. Much of the discussion focused on basic science in the clinical years. The question of whether basic science teaching is really being taught as mechanisms of disease in medicine courses is unclear. Moreover, are basic scientists needed to do the teaching during clinical years? Major challenges to teaching in clinical years such as heterogeneity of experiences, diffusion of topics with reduced identity of fields, and individual patient care schedules of students mitigates against standard classroom teaching. We discussed the use of technology for individualized instruction in which basic scientists could play authorship roles, and in the use of technology to identify content elements in a diffuse curriculum.
In the end, taking advantage of the opportunities to integrate basic science into a profession based curriculum may provide clearer relevance to students, foster life long learning habits and curiosity, encourage some careers in academic medicine, and provide collegial research opportunities among faculty.

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