The Future of Basic Sciences in Undergraduate Medical Education Douglas L. Wood, D.O., Ph.D. President - AACOM

Will Discuss 1.Current Status of undergraduate medical education 2.Future status of undergraduate medical education - The role of the basic sciences in that future

We are not simply reactors in this system - we are active actors in it

Preclinical phase- First half of 20th Century 1.Basic Science departments organized by discipline 2.Taught basic science facts necessary to practice medicine 3.Teachers dominant - students passive

Preclinical phase- End of 20th Century 1.Basic science concepts defined by interdisciplinary groups 2.Problem solving skills less generalizable 3.Research in metacognition

Clinical phase - 1.Required clerkships use inpatient hospital services 2.Fragmentation of clinical experiences 3.Clerkships not educationally comparable 4.Inadequate attention to fundamental clinical skills

Curricular innovation since the late 1950s 1.Organ Systems Approach - assumptions: 1.1Integration maximized student learning 1.2Enables students to construct a rudimentary, clinically useful knowledge base 1.3Further integration achieved at beginning of clinical training

Curricular innovation since the late 1950s (cont.) 2.Problem-Based Learning Model - assumptions: 2.1Helps to make medical information more understandable and clinically useful 2.2Enhancement of student attitudes toward learning

Curricular innovation since the late 1950s (cont.) 2.3Active Learning enhances retention and recall 2.4Will develop students hypothetico-deductive reasoning

Curricular innovation since the late 1950s (cont.) 3.Clinical-Presentation Model - Assumptions: 3.1Borrows from and uses strengths of other curricular models 3.2Eliminates need for students to restructure knowledge upon entering clerkships

Curricular innovation since the late 1950s (cont.) 3.3Interrelationship between basic and clinical science concepts 3.4Schemata assist students

Health Care System of the Future 1.Increase concentration in areas of molecular medicine - molecular, cellular, structural and neural biology 2.Genetics 3.Increased emphasis on health promotion and disease prevention

Health Care System of the Future (cont.) 4.Practice of Evidence Based Medicine 5.Safe 6.Effective

Health Care System of the Future (cont.) 7.Patient Centered 8.Timely 9.Equitable

Medical Education of the Future 1.Obligation of medical education to prepare physicians who can provide services in a changing health care system 2.Purpose of medical education - Produce physicians who promote health and deliver curative services to all people

Medical Education of the Future (cont.) Goals of Basic Medical Science Education (Small and Suter) 1.Goal 1: Identify the competencies of the practitioner of the 21 st century and define the medical science base considered essential for understanding etiology and pathophysiology of disease, and the dynamics of management of illness

Medical Education of the Future (cont.) 2.Goal 2: Whenever possible, select instructional strategies that are derived from research results in the cognitive and neurophysiological sciences 3.Goal 3: Prepare students for the clinical problem-solving situation

Medical Education of the Future (cont.) 4.Goal 4: Increase the focus on the students professional development while learning basic science by adding ethical concerns and the development of interpersonal skills, especially communication skills

Medical Education of the Future (cont.) 5.Goals 5: Design ways by which students will acquire expertise in electronic information management as a basic tool for life-long learning and clinical decision-making

The Basic Sciences in Undergraduate Medical Education of the Future 1.Looking back in order to move forward 2.Status of science education in K-12 and colleges and universities 2.1Must determine most important concepts to emphasize

The Basic Sciences in Undergraduate Medical Education of the Future 2.2Science education liberates the human intellect 2.3Role of basic science educators

The Future 1.Integration of Cognitive Science concepts 1.1Organization of long term memory 1.1.1Information in isolation is inert and not helpful 1.1.2Inappropriate to teach clinical reasoning skills independent of clinical content

The Future (cont) 1.2Storage and retrieval from memory - Strategies to enhance memory 1.2.1Enhance meaning 1.2.2Reduce dependence on context 1.2.3Repeated practice in retrieving information

The Future (cont.) 1.3Problem solving 1.3.1Practice is essential 1.3.2Situation in which a certain particular problem - solving routine likely to be useful

The Future (cont.) 2.Mastery of only foundation knowledge 2.1New biology requires not mastery of facts by an understanding of principles 2.2Basic Science role 2.2.1Limit lectures

The Future (cont.) Exactly because contemporary medicine requires a scientifically sophisticated doctor, the science base of the medical curriculum must function to activate the student, and not simply perpetuate the passive role induced by obsolete didactic methods." Henry Walton, M.D., Ph.D.

The Future (cont) 2.2.2Small group teaching 2.2.3Integrate basic and clinical science

The Future (cont) 3.Ordering (structure) of medical education 3.1Do we need to teach basic science followed by clinical science?

The Future (cont) 3.2Basic Science (six to eight months) followed by clinical science with basic science integration 3.4Papa - …curricular organization does have an effect on students learning outcomes.

The Future (cont) 4.Integration of basic and clinical sciences 4.1Medical education as a system 4.2Packaging different sciences in separate departments - effect of 4.3NEED-Integrate interdisciplinary teaching horizontally and vertically

The Future (cont) 3.4Papa- "Investigators observed that students from integrated curricula had superior diagnostic performance as compared with students from programs where basic and clinical sciences were taught separately."

The Future (cont.) 5.Integration of the new basic science - molecular medicine 5.1Medical education slow to adjust 5.2Role of basic science 5.2.1Emphasize principles and universal concepts 5.2.2Create exciting environments for learning

The Future (cont.) 6.Lack of engagement in the sciences by medical students 6.1Serious problem 6.2Role of basic science 6.2.1Create exciting environments for learning 6.2.2Emphasize principles and universal concepts 6.2.3Evaluation

The Future (cont.) 7.Lack of Outcomes based education 7.1Instructional objectives and learning outcomes 7.1.1Detail of specification 7.1.2Level of specification where emphasis placed 7.1.3Classification adopted and interrelationships

The Future (cont.) 7.1.4Intent or observable result 7.1.5Ownership of outcomes 7.2Role of basic science 7.2.1Become a part of this approach 7.2.2Integrate basic science and clinical concepts

The Future (cont.) 8.Limited educational settings 8.1Learning environments and contemporary realities of practice 8.2Enhance settings - communities 8.3Basic science role 8.3.1Move basic science teaching 8.3.2Practice in novel situations

The Future (cont.) 9.Lack of medical teachers as educators 9.1Barrows quote - There is no place in medical education for faculty to teach by the seat of their pants, the way they were taught, not questioning what or how they should teach, any more than there would be a place for such an approach in research or patient care

The Future (cont.) Anyone with responsibility for educating students, residents, and physicians should be skilled and well informed about medical education - as preparing these learners to provide safe, humane, and effective care for the members of our society is a heavy responsibility

The Future (cont) 9.2Solution lies in educational leadership 9.3Basic Science Role 9.3.1Provide needed leadership

Best Evidence Medical Education (BEME)

Challenges to you 1.Integrate Cognitive Science concepts into medical education 2.Teach fundamental principles 3.Integrate basic and clinical science education 4.Become medical education experts 5.Lead