Basic Sciences in the Medical Curriculum Tehran University of Medical Sciences April Professor John Hamilton University of Newcastle, Australia

The sciences basic to medicine Biological ‘Basic science’ Biological ‘Basic science’ Social Social Population Population Behavioural Behavioural

A clinical student: “If at the beginning of the course I had seen the role of the sciences in clinical medicine it would have made studying them so much easier and so much more relevant ” Relevance

A physiology graduate: “This is the first time I have been challenged to use my knowledge to explain and solve a problem” Competence

Australian Medical Council Guideline 3.2 Curriculum “Basic Biomedical Sciences should be sufficient to underpin clinical studies, be relevant to the overall aims of the course and their relevance should be apparent to students” [WFME Similar]

Basic sciences in relation to medicine Sciences relevant and used in clinical medicine Sciences relevant and used in clinical medicine Basic principles and clarity Basic principles and clarity Students to use their knowledge to solve problems Students to use their knowledge to solve problems Avoid excess detail Avoid excess detail But do not “dumb down” But do not “dumb down”

Case based study Traffic accident Traffic accident Chest pain and progressively short of breath Chest pain and progressively short of breath Respiratory rate 35/minute Respiratory rate 35/minute

Case 1a Pneumothorax (short case)

Key Concepts Mechanisms and clinical parameters of ventilation Pressure dynamics Impaired ventilation Anatomical structure of thoracic cage Anatomical and physiological basis of management

Group discussion

Related sessions: Clinical Skills based on surface anatomy Clinical Skills based on surface anatomy Anatomy demonstration based on pleural drain Anatomy demonstration based on pleural drain Clinical session in ED Clinical session in ED Animal demonstration if permitted Animal demonstration if permitted Paper exercise on intra-plural pressure Paper exercise on intra-plural pressure Physiology of impaired ventilation. Physiology of impaired ventilation.

Anatomy Practical classes – Dissection – Prosection – Living anatomy – Medical Imaging – Surgical anatomy

Durham UK: The story of Alfie

Comprehensive Integration Biomedical Biomedical Clinical Clinical Health service Health service Family Family Society Society Ethical Ethical

Alfie: Learning from mother and child ‘Case led: The real thing’ Mother’s narrative, year by year, her changing experience. Alfie’s development, medical problems and social integration. Chromosomes Chromosomes Epidemiology Epidemiology Screening, options Screening, options Health services Health services Clinical management Clinical management Professional duty and ethics Professional duty and ethics Communication Communication Family, schooling, Family, schooling, Disabled in society Disabled in society

Life Cycle Semester 1: Conception to birth Durham UK: Life Cycle Semester 1: Conception to birth Down Syndrome chromosomes, genetics Down Syndrome chromosomes, genetics Spina Bifida embryology Spina Bifida embryology Pregnancy physiology, anatomy Pregnancy physiology, anatomy Antenatal Care growth, hazards Antenatal Care growth, hazards Prematurity metabolic maturation, future Prematurity metabolic maturation, future

Life Cycle: % Positive Approval “Patient contact invaluable. Aspects of mental and social factors as part of a holistic approach to medicine is of importance to us being good doctors” “Patients make it much easier and more interesting to learn basic sciences, because you can see how they fit in and how they are used in clinical practice “Listening to Alfie’s story brought all our duties as doctors into one circle”

Assessment of Basic Sciences in an integrated curriculum Overall aim: Overall aim: – To think logically and critically – To understand general concepts and principles and mechanisms – To master knowledge – To apply their knowledge to new problems – To recognise when they need further information