Back to the Basic Sciences: An Innovative Approach to Teaching Senior Medical Students How Best to Integrate Basic Science and Clinical Medicine

Abstract

Abraham Flexner persuaded the medical establishment of his time that teaching the sciences, from basic to clinical, should be a critical component of the medical student curriculum, thus giving rise to the "preclinical curriculum." However, students' retention of basic science material after the preclinical years is generally poor. The authors believe that revisiting the basic sciences in the fourth year can enhance understanding of clinical medicine and further students' understanding of how the two fields integrate. With this in mind, a return to the basic sciences during the fourth year of medical school may be highly beneficial. The purpose of this article is to (1) discuss efforts to integrate basic science into the clinical years of medical student education throughout the United States and Canada, and (2) describe the highly developed fourth-year basic science integration program at the University of Pittsburgh School of Medicine. In their critical review of medical school curricula of 126 U.S. and 17 Canadian medical schools, the authors found that only 19% of U.S. medical schools and 24% of Canadian medical schools require basic science courses or experiences during the clinical years, a minor increase compared with 1985. Curricular methods ranged from simple lectures to integrated case studies with hands-on laboratory experience. The authors hope to advance the national discussion about the need to more fully integrate basic science teaching throughout all four years of the medical student curriculum by placing a curricular innovation in the context of similar efforts by other U.S. and Canadian medical schools.

How do medical students in their clinical years perceive basic sciences courses at King Saud University?

“…To diminish these problems, some have suggested altering the curriculum to ensure vertical integration, by initially teaching only clinically-oriented basic science subjects and then providing additional learning experiences in these subjects during the clinical years 7–9. The results showed a paradoxical association between students’ perception of receiving overloaded courses, being able to recall information, and receiving information that was applicable to clinical practice.…”

Seeking the Optimal Time for Integrated Curriculum in Jinan University School of Medicine

“…However, one question we have to face is to hunt for the optimal point-in-time for the integrated course. Some schools implement the integrated curriculum at the first-year students (Pipas, Peltier, Fall, Olson, Mahoney, Skochelak, & Gjerde, 2004), while some at the third-year or fourth-year students (Spencer, Brosenitsch, Levine, & Kanter, 2008). So far, there has not been evidence showing what time is the best to begin the integrated curriculum for medical students.…”

“…Croen reported that the program of integration of basic science and clinical medicine for year 3 students at Albert Einstein College was successful since the students are able to apply basic science concepts and principles to clinical problems well (Croen, Lief, & Frishman, 1986). The reform program at University of Pittsburgh School of Medicine was to integrate basic science knowledge into clinical teaching during the fourth year of medical school, and the authors also thought that senior medical students are better able to appreciate the relevance of basic science concepts to clinical medicines (Spencer, Brosenitsch, Levine, & Kanter, 2008). The two reports are generally consistent with our observation in this study although they did not optimal time for open the integrated curriculum to the senior students with the junior students.…”

“…Concerning about the timing for the integrated curriculum, it was arranged at the students of grade 1 or 2 to after students studied human anatomy in University of Wisconsin, University of Pittsburgh and Dartmouth Medical School (see e.g., Pipas et al, 2004). Nevertheless, some American and Canadian universities integrate some aspects of basic sciences into clinical medicines at year 3 or 4 medical students (Spencer, Brosenitsch, Levine, & Kanter, 2008;Croen, Lief, & Frishman, 1986). It is noteworthy that little attention has been paid to the optimal time for the integrated curriculum in different medical schools, in other word, what time is the best for kicking off the integrated curriculum, so that students learn medical knowledge more efficiently.…”

“…McGill University was the first university to implement integrated basic sciences and clinical knowledge for medical students in the 1970s (Patel, & Dauphinee, 1984). More than dozens of medical schools offered the integrated courses in U.S. and Canada in the 1980s (Spencer, Brosenitsch, Levine, & Kanter, 2008). A few Chinese and Japanese medical schools have begun the integrated curricula in recent years (see e.g., Huang et al, 2014;Rao, & Rao, 2007).…”