Back from basics: integration of science and practice in medical education

Abstract

Context In 1988, the Edinburgh Declaration challenged medical teachers, curriculum designers and leaders to make an organised effort to change medical education for the better. Among a series of recommendations was a call to integrate training in science and clinical practice across a breadth of clinical contexts. The aim was to create physicians who could serve the needs of all people and provide care in a multitude of contexts. In the years since, in the numerous efforts towards integration, new models of curricula have been proposed and implemented with varying levels of success. Scope of Review In this paper, we examine the evolution of curricular integration since the Edinburgh Declaration, and discuss theoretical advances and practical solutions. In doing so, we draw on recent consensus reports on the state of medical education, emblematic initiatives reported in the literature, and developments in education theory pertinent to the role of integrated curricula. Conclusions Interest in integration persists despite 30 years of efforts to respond to the Edinburgh Declaration. We argue, however, that a critical shift has taken place with respect to the conception of integration, whereby empirical models support a view of integration as pertaining to both cognitive activity and curricular structure. In addition, we describe a broader definition of ‘basic science’ relevant to clinical practice that encompasses social and behavioural sciences, as well as knowledge derived from biomedical science.

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“…The other useful lesson is that mechanistic understanding in medicine does not need to be constrained to traditional basic science content domains. While it is often taken for granted that there are biochemical, anatomical, and physiological explanations for clinical signs and symptoms, virtually any form of knowledge that creates explanatory links within a network can have value in clinical judgement . Work by Lucey has identified “new basic and clinical sciences” that extend beyond the traditional formulations of relevant knowledge in medicine .…”

“…While it is often taken for granted that there are biochemical, anatomical, and physiological explanations for clinical signs and symptoms, virtually any form of knowledge that creates explanatory links within a network can have value in clinical judgement. 32 Work by Lucey has identified "new basic and clinical sciences" that extend beyond the traditional formulations of relevant knowledge in medicine. 33 Behavioural sciences such as psychology and economics can be used alongside biomedical sciences to form the critical conceptual understanding needed for clinical expertise.…”

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“…20 However, since the common curricular pattern in health professions education generally emphasizes didactic basic science education in the early years and patient care-based clinical education in the latter years, Bandiera et al noted that integration of basic and clinical sciences requires intentional efort. 21,22 The revision of the didactic medical curriculum away from content-speciic disciplines to a more systems-based model, according to Bandiera et al, attempts to integrate teaching of the basic sciences with clinical practice. As stated by Spencer et al, emphasizing the relevance of basic sciences to clinical practice throughout the curriculum will increase retention of knowledge, thus developing a more competent clinician who is able to luently identify critical links between the two.…”

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“…Previous research has highlighted that basic sciences can contribute to clinical reasoning through its connections with clinical knowledge (5,22,23). These links between basic sciences and clinical content should be strong within the minds of individual learners (27,28) for cognitive integration to happen (2). Studies have also reported that cognitive integration of knowledge, which helps in the application of basic science knowledge to clinical contexts, would not happen spontaneously (15,16) just by exposing students to an integrated curriculum (15).…”