University of Pennsylvania SOM Integrating Basic Sciences and Patient Care in a Core Clerkship Curriculum: 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)

University of Pennsylvania SOM Yale SOM Curriculum 1875 Year 2 Dispensary Chemistry Practical Anatomy Embryology Physiological Chemistry Chemistry of Urine Chemical Laboratory Histology Pathology Theory and Practice Ophthalmology Obstetrics Surgery Year 3 Dispensary Surgery Clinic Eye Clinic Medical Clinic Hospital Toxicology Diseases of Women and Children Lectures on Insanity

University of Pennsylvania SOM Abraham Flexner

University of Pennsylvania SOM Flexner Report, 1908 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."

University of Pennsylvania SOM UCSF AnatomyBiochemistry HistologyPhysiologyGenetics EndocrinologyHuman BehaviorImmunology 2PathologyMicrobiologyPharmacologyHuman Sexuality Intro to Clinical Medicine Statistics Psychiatry 3Clerkships:SurgeryPediatricsNeurology Internal MedicineOB-GYNPsychiatry 4Electives Basic Science Selective Senior SurgeryAnaesthesia

University of Pennsylvania SOM Case Western NormalNeurologicMusculoskeletalCardiac PulmonaryHematology EndocrineRenal 2DiseasesNeurologicMusculoskeletalCardiac PulmonaryHematology EndocrineRenal 3Clerkships (12 months) SurgeryPediatricsNeurology Internal MedicineOB-GYNPsychiatry 4Electives

University of Pennsylvania SOM UCSF CURRICULUM (February 2003) Prologue Gross Anatomy Cell Biology Biochemistry General Pathology General Pharmacology Organs (heart, lungs, kidneys, GI) Anatomy review Physiology Histo-Pathology Pharmacology Clinical Inter- lude Cancer Oncology Hematology Genetics Biochemistry Histo-Pathology Pharmacology Brain, Mind, and Behavior Neurobiology Neuroanatomy Neurology Psychiatry Histo-Pathology Pharmacology Foundations of Patient Care YEAR 2 Immunology, Infection, and Inflammation Microbiology Immunology Rheumatology Histo-Pathology Pharmacology Metabolism and Nutrition Physiology Gastroenterology Nutrition Endocrinology Biochemistry Histo-Pathology Pharmacology Life Cycle Genetics Embryology Repro Physiology OB/GYN Pediatrics Geriatrics Dev..Psychol. Pharmacology Integra- tion and Review Foundations of Patient Care YEAR 1 Internal Medicine Obstetrics-Gynecology Surgery Pediatrics Family Comm. Med Surgical Specialties Psychiatry Neurology Anaesthesia INTERSESSIONS YEAR 3

University of Pennsylvania SOM Source: frommedskoll.com Student Perspective of Medical Biochemistry 8

University of Pennsylvania SOM AAMC Graduation Questionnaire: Basic Science Education “Basic science content was sufficiently integrated”

University of Pennsylvania SOM How well did these basic science courses prepare you for the clinical clerkships? Anatomy7985 Biochemistry4253 Biostats/Epi4051 Genetics4560 Immunology70 Histology5161 Microbiology7675 Neuroscience6874 Pathology8582 Pharmacology8066 Physiology83

University of Pennsylvania SOM 11 IAMSE Flexner Revisited: Defining the Role and Value of the Basic Sciences in Medical Education Goals: 1.Define and describe the sciences that constitute the foundation of medicine 2.Identify the role and value of the sciences and scientific thinking in medical education 3.Identify the best practices of when, where and how the foundation sciences should be incorporated into medical education

University of Pennsylvania SOM 12 Questions to be Addressed: 1.What are the sciences that constitute the foundation for medical practice of the future? 2.What is the value and role of the foundational sciences in medical education? 3.When and how should these foundational sciences be incorporated into the medical education curriculum? 4.What sciences could/should be pre-requisite components of the undergraduate medical curriculum (i.e. be part of the pre-medical requirements)? 5.What are examples of the best practices for incorporation of the foundational sciences in the medical education curriculum?

University of Pennsylvania SOM 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

University of Pennsylvania SOM 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

University of Pennsylvania SOM 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

University of Pennsylvania SOM 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

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

University of Pennsylvania SOM HOW? 18