The major issues raised in this session focused primarily on the topic of how to effectively promote the integration of basic science principles into the clinical curriculum. However, issues related to how to enhance the clinical relevance of basic science courses were also discussed. In order to promote discussion and involvement by all of the participants, four small breakout groups were designated and each of these groups was assigned a specific issue related to the broader topic. These specific issues included:1) recruiting faculty, 2) barriers, 3) curriculum issues and 4) outcomes. At the conclusion of this session each of these breakout groups reported back to the entire group and briefly summarized the major points they had discussed as well as potential solutions to perceived problems. 1) Recruiting faculty: Strategies used to recruit basic scientists to teach in clinical disciplines and clinicians to teach in basic science disciplines include: using salary support to buy “time” of clinical faculty to release them from revenue-generating activities so that they can teach basic science courses; encouraging clinical departments/deans or medical school foundations to endow chairs in basic science departments that will support the salary of a basic scientist to provide basic science instruction in the clinical years and/or support basic science faculty teaching in basic science courses; dissolving departments and teaching all basic science courses in an interdisciplinary fashion with centralized administration; and promoting the personal and professional relationships that will facilitate participation of clinical faculty in basic science teaching and basic science faculty in clinical teaching. Current barriers to faculty recruitment include: division directors/departmental chairs that prohibit or discourage clinical faculty from teaching in basic science courses; many basic science faculty are not trained/experienced in teaching medical students and hence do not feel comfortable participating in clinical courses/teaching; and new RRC rules for residents will require more active presence of faculty in inpatient/ambulatory clinics and this will make them less available for teaching in basic science courses. One possible solution to these problems is to empower medical students, who are paying steep tuition fees, to demand that both basic scientists and clinicians take more active roles in their education. 2) Barriers: Barriers to basic scientist-clinician interactions in terms of teaching include: both basic scientists and clinicians have compartmentalized mind sets and hence think only about teaching in their own area of expertise/specialty and not in terms of integration of basic and clinical sciences; rigid departmental boundaries often inhibit integration and interdisciplinary approaches to teaching and one solution would be to restructure departments along interdisciplinary lines; many basic scientists do not feel comfortable teaching clinical relevance or applications of their specific topic, but if they are self-motivated to accomplish this integration they can serve as excellent role models for junior faculty; and unequal financial compensation for basic science and clinical teaching may hinder interactions among faculty. With regard to the latter barrier, one possible solution would be to pay all teaching faculty (basic scientists as well as clinicians) the same base salary and allow them to supplement their incomes (working on wards). Attracting faculty who hold both MD and PhD degrees is also an effective way to promote integration of basic and clinical sciences. 3) Curriculum issues: Strategies to integrate basic and clinical sciences and foster learning. 1) Basic science and clinical faculty should collaborate on writing learning objectives. 2) Content experts should inform the course directors on the selection of curriculum content, but centralized oversight with input from basic science and clinical faculty will best integrate the appropriate content. 3) The relevance of basic science to medical practice and research should be transparent in all teaching efforts and learning experiences. 4) The learning of basic science is enhanced by developmentally appropriate clinical contexts. 5) Collegial and collaborative faculty relationships foster integration of basic and clinical and learning from disagreements that may arise in a community of committed educators. 4) Outcomes: Several outcomes that might reflect how effectively basic and clinical sciences have been integrated throughout the curriculum include: performance of students on USMLE Parts I and II, since many of the questions on these exams are integrative in nature; reports by clinicians concerning how well third year students are able to incorporate their basic science knowledge into everyday clinical situations; and graduation questionnaires that ask students to evaluate how well basic and clinical sciences were integrated during their medical school careers. In evaluating these outcomes it is extremely important to remain unbiased, since basic scientists and clinicians might be tempted to select the data or anecdotal stories that support their point of view concerning integration of basic and clinical sciences. In conclusion, integration of clinical material (Internal Medicine) into basic science courses (Physiology and Pharmacology) occurs in many curricula and is very well received by most students. Incorporation of basic principles of physiology and pharmacology into the clinical sciences is essential for vertical integration but is often more difficult to achieve. **** **** ****
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