A total of 57 participants attended this two-hour session in the Washington, DC Hilton Hotel on November 13, 1991. Roger Koment, Ph.D. opened the meeting with a welcome and overview of this year’s theme Basic Sciences in the Clinical Years. This relates to the broader topic of Curriculum Integration which is one of four major topics determined at the Third Annual Meeting to be priority issues for BSEF consideration.
Following a report on current membership, recruitment progress, regional chapter activities, and a description of the newly created newsletter, Dr. Koment introduced Richard Hyde, Ph.D., Southern Regional Director of the BSEF. Dr. Hyde led the remainder of the meeting, introducing our six speakers and guided audience discussion following each presentation.
Abstracts of the six presentations are printed on the following page.
A RETURN TO THE BASIC SCIENCES
John T. Hansen, Ph.D. (Acting Chair of Neurobiology and Anatomy) and Sharon K. Krackov, Ed.D. (Director, Curriculum Development Office), University of Rochester School of Medicine and Dentistry, Rochester, NY 14642.
A major curricular objective at the University of Rochester School of Medicine is to provide for our students a broad understanding of the sciences basic to the practice of clinical medicine. Implicit in this broad objective is a thorough integration of basic and clinical science, not just for students moving forward through the curriculum but also for advanced students who wish to return to the science basic to their clinical study. Consequently, a formalized approach that specifically “reintroduces” students and residents to the basic sciences is an evolving part of our curricular planning.
Currently, our fourth-year students and selected residents, depending upon the program, may return to the basic sciences by participating as small group facilitators in case-based clinical exercises. Additionally, students and residents may return as teaching assistants in our more laboratory intensive courses such as human anatomy or histology. Finally, fourth-year students may select basic elective courses that offer opportunities for in-depth study in a basic science discipline. These experiences have been very positive both for the advanced students and residents as well as for the first? and second-year students. Especially noteworthy is the way in which the more advanced students act as positive role models for the junior students. Moreover, these opportunities provide a chance for first? and second-year students to gain an appreciation for the importance of basic science material as it relates to clinical practice.
Further implementation of programs targeted toward a return to the basic sciences at Rochester will include the following initiatives: (a) Each clinical department will develop a written set of educational goals that deal with basic sciences and this material will be included in clerkship syllabi; (b) Clinical pathophysiological conferences will be jointly developed by basic and clinical science departments; (c) Basic scientists will be included in clinical rounds and clinical case-based teaching; and (d) We will continue to train fourth-year students as facilitators for small group case-based exercises and laboratory teach.
(Portions of these efforts were supported by a Planning Grant from the Robert Wood Johnson Foundation)
A SURVEY OF BASIC SCIENCE COURSES WITHIN THE CLINICAL YEARS
Richard M. Hyde, Ph.D., Department of Microbiology & Immunology, University of Oklahoma College of Medicine, Oklahoma City, OK 73190.
A survey was conducted in the fall of 1991 to determine the extent to which basic, Science courses are currently being taught during the Clinical years of undergraduate medical education. A questionnaire was mailed to all medical schools in the U.S. Of the 30 responses, 24 had one or more such courses, while 4 schools had required courses that varied in length from two weeks to three months. The most frequently covered subjects were Anatomy (8 schools had courses), Pharmacology, Biostatistics/Epidemiology, and Pathology (3 schools each). A research experience in a Basic Science was reported in 6 institutions. The number of students participating in Basic Science electives varied from a handful to as much as 75-80% of the class.
Microbiology is offered in 2 of the responding schools. The number of students electing to participate is small (two to four per year). The courses offered included Directed Readings in advanced topics such as Microbial Genetics and laboratory based experiences, either in a specific research area or in clinical microbiology. In our institution (University of Oklahoma College of Medicine in Oklahoma City) we normally have two to four students each year who take a one month elective in “Problems in Diagnostic Microbiology” or in “Bactermia”.
PROPOSAL FOR A CLINICAL PHARMACOLOGY ELECTIVE FOR FOURTH YEAR MEDICAL STUDENTS
Charles D. Puglia, Ph.D., Department of Pharmacology, Medical College of Pennsylvania, Philadelphia, PA 19129.
The goal of the proposed elective course is to prepare students to utilize current information about pharmacokinetic and pharmacodynamic characteristics of drugs to safely and effectively institute therapy and manage patients receiving those drugs.
The elective in clinical pharmacology will be conducted over a 2 week period. During that time, students will use case descriptions in a small group, problem-based learning format to enable students to identify areas where more information and understanding is needed. Students will then develop strategies and identify resources necessary to answer key questions concerning drug action and kinetics. They will evaluate a variety of drug information available from a wide variety of sources (manufacturers, texts, and reviews, as well as original articles) during unstructured time blocks following small group meetings. Students will integrate information regarding drug action and kinetic properties into clinical decision making.
Resource faculty will be available to answer questions during a scheduled consult time.
Each focus area will end with a faculty-guided patient rounds which will demonstrate examples of key issues related to each covered area. The focus will be on drug classes which have been identified as having broadest relevance to students entering a variety of residency programs.
NEW BASIC SCIENCE TEACHING OPPORTUNITIES
William R. Galey, Ph.D., Department of Physiology, University of New Mexico School of Medicine, Albuquerque, NM 87131.
Several strong trends in medical education have elicited concern from Basic Scientists that the sciences on which medical practice is based will not be adequately learned by medical students. The trends which elicit these concerns include: 1) increased emphasis on clinical problem based learning, 2) decreased number of basic science lectures, 3) increased emphasis on non-classroom learning, and 4) integrating of basic science learning into the clinical environment.
The challenge presented by new curricular designs is to insure that students are exposed to the clinically useful aspects of the basic sciences. Some opportunities for insuring basic science learning are as follows:
In Problem Based Learning Tutorials—make sure Basic Science faculty are: 1) involved in the development of the problem, and 2) are active as tutors.
In Clinical Skills courses—integrate the learning of relevant basic sciences, (I.e., anatomy, physiology, pathology) into the learning of particular maneuvers or skills.
In Ambulatory Clinics—develop post-clinic tutorials where clinic patients seen by students are used to learn basic sciences, as well as clinical medicine.
In Ward-Round teaching—have Basic Scientists present to bring up basic science learning issues relevant to patient management issues.
In Rural or Non-Medical School learning environments—work to insure basic science learning is one of the educational goals and make sure Basic Scientists are involved in monitoring student activities in such settings.
In-depth experiences for students to participate in basic science research can be devised for traditional vacation and holiday periods to further stimulate basic science learning.
In Graduate Training (residency programs) – advanced courses in basic sciences may be very important and appreciated by house officers and programs.
THE DEMISE OF A POPULAR PHARMACOLOGY ELECTIVE
Joanne I. Moore, Ph.D., Department of Pharmacology, University of Oklahoma College of Medicine, Oklahoma City, OK 73190
Prior to 1985, basic science departments at the University of Oklahoma College of Medicine offered only research electives for medical students. In 1985 the Department of Pharmacology introduced a three week elective Directed Readings in Pharmacology which could be paired with a three week clinical elective to complete a rotation period. The Pharmacology elective was relatively non-structured, non-stressful and was tailored to meet each student’s interests. Initial references were provided by the faculty to get students started with their literature review. Although Individual faculty differed in their conduct of the elective, most met with students to discuss the readings, prepared take-home essay questions specifically to direct readings into special or controversial issues, and asked for new references to update the readings lists. Students interviewing for residencies often selected this elective as they could keep up with their readings while traveling. The curriculum again was modified in 1990 by changing rotations from six weeks to one month and reducing the total curricular time in the fourth year. The most drastic reduction occurred in elective time which was cut from 1440 to 522 hours. The Pharmacology elective was cut from three to two weeks to accommodate the new rotation schedule. Although more than 75% of fourth year students previously enrolled in the pharmacology elective, after the curriculum was changed rarely elected our course and usually only after a Dean requested special arrangements for a student. Although several factors probably contribute, the most likely cause for the demise of our popular Pharmacology elective is that there are no other two week clinical or basic sciences courses which students can select to fill out a monthly rotation.
Murray Saffran, Ph.D., Department of Biochemistry & Molecular Biology, and Roberto Franco-Saenz, M.D., Department of Medicine, Medical College of Ohio, Toledo, OH 43699.
In most programs of the return to the basic sciences in the clinical years, the students come to the basic science departments for lectures and seminars. Our program differs in that a basic scientist goes to the hospital and participates in clinical teaching rounds in the medical clerkships. Generally a session begins with the presentation of a case by one of the students. The basic scientist participates in the discussion and draws attention to the basic science aspects of the case, usually by questions-and answers. This functions as a recall of the pertinent basic science material as well as an opportunity to add new information that was not taught or not available when the students studies the basic sciences. We have found that most clinical problems illustrate biochemical principles that are relearned in a practical setting with more understanding and much less resistance than in a formal lecture setting. Some examples include sickle cell disease and hemoglobin structure, diabetes mellitus and intermediatry metabolism, cardiac infarct and muscle structure, as well as clotting reactions and lipids, etc. The sessions are given once in every medical rotation. Faculty requirements for each group of 6-10 students in this program are a physician and a basic scientist who is comfortable in the clinical setting and who is not afraid to say “I don’t know. Let’s look it up together.?
BIBLIOGRAPHY: Basic Sciences in the Clinical Years.
1. Bedside Biochemistry. M. Saffran and R. Franco-Saenz. Biochemical Education. January 1975, pp. 11-12.
2. Integrating Basic Science and Clinical Teaching for Thrid-Year Medical Students. L.G. Croen, P.D. Lief, and W.H. Frishman. Journal of Medical Education. 61:444-453, June 1986.
3. Clinical Anatomy for Surgical Residents: A 10-Week Course. J.R. Osuch, K.B. Dean, R.E. Carrow, and R.E. Dean. Clinical Anatomy, 1:205-211, 1988.
4. One Day Review of Surgical Anatomy for Third-Year Medical Students: Improved Knowledge Acquisition and Retention. F.M. Ilgenfritz, J.R. Osuch, R.E. Carrow, J.B. Babel, V. Bonet, and J.C. Gruenberg. Current Surgery, 47(6): 407-410, 1990.
5. Integrative Virology for Senior Medical Students. R.W. Koment. Academic Medicine 66:139-140, 1991.