Abstract
Integration of biomedical and clinical sciences has been a focus of curricular change in undergraduate medical education since the second half of the twentieth century. While clinical sciences have been successfully embedded throughout the preclinical curriculum of many schools, integration of biomedical science into clinical clerkships remains a challenge. Here, we describe our approach to create case-based learning modules that integrate infectious disease and pharmacology content into the third-year family medicine clerkship rotation to improve transfer of biomedical science knowledge to the clinical setting, and to enhance student recall and use of biomedical science knowledge within a clinical context. To assess student perceptions and experience of the learning event, students completed a voluntary questionnaire, the results of which revealed that the majority of students felt that the exercise focused on high-yield concepts in infectious disease, pharmacology, and family medicine. Students also indicated that integration of additional biomedical science disciplines into the family medicine rotation would be valuable, as would extending the approach into the other third-year clerkships.
Similar content being viewed by others
References
Hopkins R, et al. Integrating basic science without integrating basic scientists: reconsidering the place of individual teachers in curriculum reform. Acad Med. 2015;90(2):149–53.
Harden RM, Sowden S, Dunn WR. Educational strategies in curriculum development: the SPICES model. Med Educ. 1984;18(4):284–97.
Bandiera G, et al. Integration and timing of basic and clinical sciences education. Med Teach. 2013;35(5):381–7.
Brauer DG, Ferguson KJ. The integrated curriculum in medical education: AMEE guide no. 96. Med Teach. 2015;37(4):312–22.
Mann KV. Thinking about learning: implications for principle-based professional education. J Contin Educ Heal Prof. 2002;22(2):69–76.
Bordage G. Elaborated knowledge: a key to successful diagnostic thinking. Acad Med. 1994;69(11):883–5.
Vidic B, Weitlauf HM. Horizontal and vertical integration of academic disciplines in the medical school curriculum. Clin Anat. 2002;15(3):233–5.
Regehr G, Norman GR. Issues in cognitive psychology: implications for professional education. Acad Med. 1996;71(9):988–1001.
Burnett E, Phillips G, Ker JS. From theory to practice in learning about healthcare associated infections: reliable assessment of final year medical students’ ability to reflect. Med Teach. 2008;30(6):e157–60.
Grande JP. Training of physicians for the twenty-first century: role of the basic sciences. Med Teach. 2009;31(9):802–6.
Norman G. Teaching basic science to optimize transfer. Med Teach. 2009;31(9):807–11.
Wilkerson L, Stevens CM, Krasne S. No content without context: integrating basic, clinical, and social sciences in a pre-clerkship curriculum. Med Teach. 2009;31(9):812–21.
Dahle LO, et al. Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum: examples and experiences from Linkoping, Sweden. Med Teach. 2002;24(3):280–5.
Goldman E, Schroth WS. Perspective: deconstructing integration: a framework for the rational application of integration as a guiding curricular strategy. Acad Med. 2012;87(6):729–34.
Harden R, et al. Task-based learning: the answer to integration and problem-based learning in the clinical years. Med Educ. 2000;34(5):391–7.
Kulasegaram KM, et al. Cognition before curriculum: rethinking the integration of basic science and clinical learning. Acad Med. 2013;88(10):1578–85.
Malik AS, Malik RH. Twelve tips for developing an integrated curriculum. Med Teach. 2011;33(2):99–104.
Muller JH, et al. Lessons learned about integrating a medical school curriculum: perceptions of students, faculty and curriculum leaders. Med Educ. 2008;42(8):778–85.
Salmon M, Williams D, Rhee K. Refocusing medical education reform: beyond the how. Acad Med. 2015;90(2):136–8.
Schmidt H. Integrating the teaching of basic sciences, clinical sciences, and biopsychosocial issues. Acad Med. 1998;73(9 Suppl):S24–31.
Spencer AL, et al. Back to the basic sciences: an innovative approach to teaching senior medical students how best to integrate basic science and clinical medicine. Acad Med. 2008;83(7):662–9.
Functions and Structure of a Medical School, In Standards for Accreditation of Medical Education Programs Leading to the MD Degree. March 2017, Liaison Committee on Medical Education.
Cooke M, Irby DM, O'Brien BC. Educating Physicians: A Call for Reform of Medical School and Residency. Series on preparation for the professions. San Francisco: Jossey-Bass; 2010.
Marston RQ. The Robert Wood Johnson Foundation Commission on medical education. The sciences of medical practice, summary report. JAMA. 1992;268(9):1144–5.
Hirsh D, et al. Educational outcomes of the Harvard Medical School–Cambridge integrated clerkship: a way forward for medical education. Acad Med. 2012;87(5):643–50.
Bowe CM, Voss J, Thomas Aretz H. Case method teaching: an effective approach to integrate the basic and clinical sciences in the preclinical medical curriculum. Med Teach. 2009;31(9):834–41.
Dubois EA, Franson KL. Key steps for integrating a basic science throughout a medical school curriculum using an e-learning approach. Med Teach. 2009;31(9):822–8.
Finnerty EP, et al. Flexner revisited: the role and value of the basic sciences in medical education. Acad Med. 2010;85(2):349–55.
Report IV—Contemporary issues in medicine: basic science and clinical research. Medical School Objectives Project. 2001, the Association of American Medical Colleges (AAMC). Washington, DC: AAMC.
Sakles JC, Maldonado RJ, Kumari VG. Integration of basic sciences and clinical sciences in a clerkship: a pilot study. Med Sci Educator. 2006;61(1)
Wilkins, K.M., et al., Integration of basic and clinical science in the psychiatry clerkship. Acad Psychiatry, 2016.
Rajan SJ, Jacob TM, Sathyendra S. Vertical integration of basic science in final year of medical education. Int J Appl Basic Med Res. 2016;6(3):182–5.
Bahner I, Stevenson F, Zwygart K. Vertical integration of basic science: returning the basic sciences to the final medical school year using individuated, career-specific short courses. Med Sci Educ. 2015;25(4):481–2.
Harden RM, Stamper N. What is a spiral curriculum? Medical Teacher. 1999;21(2):141–3.
Bauler TJ, S. B, van Enk R, Lutwick L, Dickinson BL. Design and implementation of an integrated course to teach immunology and infectious disease to first year medical students. Med Sci Educ. 2016;26(4):701–7.
Harden RM. The integration ladder: a tool for curriculum planning and evaluation. Med Educ. 2000;34(7):551–7.
Anderson MB. Definitions and explanations of selected terms used in this supplement. Acad Med. 2010;85(9 Suppl):S646–8.
MedBiquitous Curriculum Inventory Working Group Standardized Vocabulary Subcommittee. MedBiquitous Curriculum Inventory Working Group Standardized Vocabulary Subcommittee. (2012). Curriculum Inventory standardized instructional and assessment methods and resource types (September 2012 version). 2012, Washington, DC: Association of American Medical Colleges.
Dussart C, et al. Optimizing clinical practice with case-based reasoning approach. J Eval Clin Pract. 2008;14(5):718–20.
Bransford JD, B.A., Cocking RR, How people learn. 2000, Washington, D.C.: National Academy Press.
KV, K.D.a.M., Teaching and learning in medical education: how theory can inform practice. Understanding medical education: evidence, theory and practice, ed. T. Swansick. 2010, West Sussex: Wiley-Blackwell.
Ambrose S, Bridges MW, DiPietro M, Lovett MC, Norman MK. How learning works: seven research-based principles for smart teaching. San Francisco, CA: Jossey-Bass; 2010.
Brown PC. Make it stick: the science of successful learning. Cambridge, Massachusetts: The Belknap Press of Harvard University Press. xi; 2014. 313 pages
Karpicke JD, Blunt JR. Retrieval practice produces more learning than elaborative studying with concept mapping. Science. 2011;331(6018):772–5.
Karpicke JD, Roediger HL 3rd. Expanding retrieval practice promotes short-term retention, but equally spaced retrieval enhances long-term retention. J Exp Psychol Learn Mem Cogn. 2007;33(4):704–19.
Karpicke JD, Roediger HL 3rd. The critical importance of retrieval for learning. Science. 2008;319(5865):966–8.
de Bruin AB, Schmidt HG, Rikers RM. The role of basic science knowledge and clinical knowledge in diagnostic reasoning: a structural equation modeling approach. Acad Med. 2005;80(8):765–73.
Loftus S. Understanding integration in medical education. Medical Science Educator. 2015;25(3):357–60.
Acknowledgements
The authors wish to thank Richard Brandt and Duncan Vos in the Division of Biostatistics and Epidemiology for their role in questionnaire data collection and analysis, and Jayme Salinas and Amber Tuner in the Department of Educational Affairs for their administrative role in this study. The authors also thank Drs. Barbara Bregman and Daniel Pratt for critical review of this manuscript. This study was developed by BLD as part of the Harvard Macy Program for Educators in Health Professions Education and presented as a seminar at the 2017 Society of Teachers of Family Medicine Annual Conference by Drs. VanDerKolk and Dickinson.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dickinson, B.L., VanDerKolk, K., Bauler, T. et al. Integration of Biomedical Sciences in the Family Medicine Clerkship Using Case-Based Learning. Med.Sci.Educ. 27, 815–820 (2017). https://doi.org/10.1007/s40670-017-0484-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40670-017-0484-3