Integrating Basic and Clinical Sciences Presentation by: Amy L. Wilson-Delfosse, Ph.D. James Bruzik, Ph.D. Case Western Reserve University School of Medicine

Why Did Case Change? The Western Reserve curriculum designed in the 1950s continued with only minor revisions despite enhancements in computer technology and unprecedented changes in the health care system Classrooms with ~30% of students attending Watching lectures online double time Paper syllabus boundaries Students not preparing for class Teacher-centered

Why Did Case Change? Course silos “I don’t know if you’ve had this yet but” Multiple choice tests –nothing else counted, binge and purge approach to learning Difficult to get faculty to teach – clinical and research productivity Dean’s Vision – research and scholarship block and MD thesis

Principles of Western Reserve 2 : Building on Western Reserve 1 Integration of health and disease (normal and abnormal) – systems biology Experiential learning, scholarship, critical thinking, lifelong learning Active interchange of ideas between students and faculty Graduate school environment – independent study and self- directed learning Weave scientific foundations and clinical medicine throughout the 4 year curriculum

Principles of Western Reserve 2 : Building on Western Reserve 1 Integration of health and disease (normal and abnormal) – systems biology Experiential learning, scholarship, critical thinking, lifelong learning Active interchange of ideas between students and faculty Graduate school environment – independent study and self- directed learning Weave scientific foundations and clinical medicine throughout the 4 year curriculum

Year IYear IIYear IIIYear IV Foundations of Medicine and Health (20 months, including vacation) Core Clinical Rotations IQ+ Program (48 weeks, flexible scheduling) Research & Scholarship (16 week block + electives, flexible scheduling) Advanced Clinical and Scientific Studies Areas of Concentration Electives (10 months, flexible scheduling) Western Reserve 2 Curriculum

Reflection, Integration & Assessment July Year 1 March Year 2 HomeostasisHost Defense and Host Response Cognition, Sensation, and Movement Food to Fuel (Host Defense, Microbiology, Blood, Skin, Auto-immune) (Endo, Repro, Development, Genetics, Mol Biol, Cancer Biology) (GI, Nutrition, Energy, Metabolism, Biochemistry) (Neuro, Mind Musculoskeletal, Cellular Neurophysiology (CV, Pulm, Renal, Cell Regulation, Pharmacology, Cell physiology) The Human Blueprint Reflection, Integration & Assessment 1 Week Clinical Immersion BOARD REVIEW BLOCKBOARD REVIEW BLOCK (Medical Error, Public Health, Inequities, Bioethics, Professionali sm Epi/Biostats) Becoming a Doctor (5 wk) Reflection, Integration & Assessment Structure (Anat., Histo-Path, Radiology) Foundations of Clinical Medicine WR 2 Foundations of Medicine and Health

Case Inquiry Group (IQ) Student-centered small groups with a faculty facilitator Case-based Self-directed learning Team work Quality improvement – “check out”

August to December Year 1 January (Year 1) to December (Year 2) January Year 2 Introduction to clinical skills Advanced Clinical Skills RAMP ( Rotating Apprenticeships in Medical Practice) Clinical Preceptorships FCM Seminars Health Policy, Leadership and Advocacy, Professionalism, Ethics Web Resources Integration and Assessment WR 2 : Eary Patient Experiences

Core and Advanced Clinical Experiences: Core Clinical Rotations Core 1 (16 weeks): Internal Medicine and Surgery + Peri-Op and Acute Pain Core 2 (16 weeks): Pediatrics, OB-Gyn, Family Medicine (Prevention/Wellness) Core 3 (8 weeks): Neuroscience and Psychiatry + Chronic pain Advanced Cores (4 weeks each): Undifferentiated and Emergent Care Aging and Society: Geriatrics, Chronic Disease, Palliative Care, Health Systems

4 hours Friday afternoon in group of students Reinforce importance of basic science and emerging basic science knowledge in the practice of clinical medicine Continue to use a team-based, learner-centered small group to enhance professional growth and development Practice advanced skills in communication, physical exam, clinical reasoning, evidence based medicine

Reflection Case discussion – DDX and learning objectives Research and discussion with experts (basic science and clinical faculty) Skills practice Checkout

Example Case: HLHS Check-in: Debrief, possible directed reflections on dealing with a sick child or the parent of a sick child. Go through the case in step by step – starting with a “blue baby”– generate a differential diagnosis, discuss the perinatal changes in the circulation Come up with a list of learning objectives and questions for the experts.

Expert session - paired basic scientist & neonatologist meet with larger group. Mini-didactics + Q+A – focusing on emerging science on the heritable nature of this problem + clinical insights. HLHS continued …

Skills practice – Students interview the standardized parent of this baby – script calls for integration of recently learned information + focus on delivering bad news and communicating with families. Check out HLHS continued …

Assessment Attendance Facilitator assessment Case development/presentation (teams) Students write cases and run the IQ+ afternoon Opportunities for scholarship Opportunities for peer teaching

Acknowledgements The faculty, staff and students of CWRU School of Medicine