Integrating Basic Sciences and Patient Care in a Core Clerkship Curriculum:

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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)

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Yale SOM Curriculum 1875
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Abraham Flexner
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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."

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UCSF 1980
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Case Western 1955
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UCSF CURRICULUM (February 2003)
YEAR 1
YEAR 2
YEAR 3
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Student Perspective of Medical Biochemistry
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Source frommedskoll.com
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AAMC Graduation Questionnaire Basic Science
EducationBasic science content was sufficiently
integrated
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How well did these basic science courses prepare
you for the clinical clerkships?
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IAMSE 2009-- Flexner Revisited Defining the
Role and Value of the Basic Sciences in Medical
Education

• Goals
• Define and describe the sciences that constitute
  the foundation of medicine
• Identify the role and value of the sciences and
  scientific thinking in medical education
• Identify the best practices of when, where and
  how the foundation sciences should be
  incorporated into medical education

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Questions to be Addressed

• What are the sciences that constitute the
  foundation for medical practice of the future?
• What is the value and role of the foundational
  sciences in medical education?
• When and how should these foundational sciences
  be incorporated into the medical education
  curriculum?
• What sciences could/should be pre-requisite
  components of the undergraduate medical
  curriculum (i.e. be part of the pre-medical
  requirements)?
• What are examples of the best practices for
  incorporation of the foundational sciences in the
  medical education curriculum?

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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

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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

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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

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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

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Designing a new basic science curriculum WHEN?
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HOW?
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