The Future of Basic Sciences in Undergraduate Medical Education Douglas L. Wood, D.O., Ph.D. President - AACOM

The Future of Basic Sciences in Undergraduate Medical

Education

Douglas L. Wood, D.O., Ph.D.

President - AACOM

Will Discuss

1. Current Status of undergraduate medical education

2. Future status of undergraduate medical education - The role of the basic

sciences in that future

“We are not simply reactors in this system - we are active actors in it”

Preclinical phase- First half of 20th Century

1. Basic Science departments organized by discipline

2. Taught basic science facts necessary to practice medicine

3. Teachers dominant - students passive

Preclinical phase- End of 20th Century

1. Basic science concepts defined by interdisciplinary groups

2. Problem solving skills less generalizable

3. Research in metacognition

Clinical phase -

1. Required clerkships use inpatient hospital services

2. Fragmentation of clinical experiences

3. Clerkships not educationally comparable

4. Inadequate attention to fundamental clinical skills

Curricular innovation since the late 1950’s

1. Organ Systems Approach - assumptions:

1.1 Integration maximized student learning

1.2 Enables students to construct a rudimentary, clinically useful knowledge base

1.3 Further integration achieved at beginning of clinical training

Curricular innovation since the late 1950’s (con’t.)

2. Problem-Based Learning Model - assumptions:

2.1 Helps to make medical information more understandable and clinically useful

2.2 Enhancement of student attitudes toward learning


2.3 “Active Learning” enhances retention and recall

2.4 Will develop student’s hypothetico-

deductive reasoning


3. Clinical-Presentation Model - Assumptions:

3.1 Borrows from and uses strengths of other curricular models

3.2 Eliminates need for students to restructure knowledge

upon entering clerkships


3.3 Interrelationship between basic and clinical

science concepts

3.4 Schemata assist students

Health Care System of the Future

1. Increase concentration in areas of molecular medicine - molecular,

cellular, structural and neural biology

2. Genetics

3. Increased emphasis on health promotion and disease prevention

Health Care System of the Future (con’t.)

4. Practice of Evidence Based Medicine

5. Safe

6. Effective

Health Care System of the Future (con’t.)

7. Patient Centered

8. Timely

9. Equitable

Medical Education of the Future

1. Obligation of medical education to prepare physicians who can

provide services in a changing health care system

2. Purpose of medical education - Produce physicians who promote health and deliver curative services to all people

Medical Education of the Future (con’t.)

Goals of Basic Medical Science Education (Small and Suter)

1. Goal 1: Identify the competencies of the practitioner of the 21st century and define the medical science base considered essential for understanding etiology and pathophysiology of disease, and the dynamics of management of illness


2. Goal 2: Whenever possible, select instructional strategies that are

derived from research results in the cognitive and neurophysiological sciences

3. Goal 3: Prepare students for the clinical problem-solving situation


4. Goal 4: Increase the focus on the students professional

development while learning basic science by adding ethical concerns and the development of interpersonal skills, especially communication skills


5. Goals 5: Design ways by which students will acquire expertise in electronic information management as a basic tool for life-long learning and clinical decision-making

The Basic Sciences in Undergraduate Medical Education of the Future

1. Looking back in order to move forward

2. Status of science education in K-12 and colleges and universities

2.1 Must determine most important concepts to emphasize

The Basic Sciences in Undergraduate Medical Education of the Future

2.2 Science education liberates the human intellect

2.3 Role of basic science educators

The Future

1. Integration of Cognitive Science concepts

1.1 Organization of long term memory

1.1.1 Information in isolation is

inert and not helpful

1.1.2 Inappropriate to teach clinical reasoning skills independent of clinical content

The Future (con’t)

1.2 Storage and retrieval from memory - Strategies to enhance memory

1.2.1 Enhance meaning

1.2.2 Reduce dependence on context

1.2.3 Repeated practice in retrieving information

The Future (con’t.)

1.3 Problem solving

1.3.1 Practice is essential

1.3.2 Situation in which a certain particular problem -

solving routine likely to be useful


2. Mastery of only foundation knowledge

2.1 New biology requires not mastery of facts by an understanding of principles

2.2 Basic Science role

2.2.1 Limit lectures


“Exactly because contemporary medicine requires a scientifically sophisticated doctor, the science base of the medical curriculum must function to activate the student, and not simply perpetuate the passive role induced by obsolete didactic methods." Henry Walton, M.D., Ph.D.


2.2.2 Small group teaching

2.2.3 Integrate basic and clinical science


3. Ordering (structure) of medical education

3.1 Do we need to teach basic science followed by clinical science?


3.2 Basic Science (six to eight months) followed by clinical science with

basic science integration

3.4 Papa - “…curricular organization does have an effect on students’

learning outcomes.”


4. Integration of basic and clinical sciences

4.1 Medical education as a system

4.2 Packaging different sciences in separate departments - effect of

4.3 NEED-Integrate interdisciplinary teaching horizontally and vertically


3.4 Papa- "Investigators observed that students from integrated

curricula had superior diagnostic performance as

compared with students from programs where basic and clinical sciences were taught separately."


5. Integration of the new basic science - molecular medicine

5.1 Medical education slow to adjust

5.2 Role of basic science

5.2.1 Emphasize principles and universal concepts

5.2.2 Create exciting environments for learning


6. Lack of engagement in the sciences by medical students

6.1 Serious problem


6.2.1 Create exciting environments for learning

6.2.2 Emphasize principles and universal concepts

6.2.3 Evaluation


7. Lack of Outcomes based education

7.1 Instructional objectives and learning outcomes

7.1.1 Detail of specification

7.1.2 Level of specification where emphasis placed

7.1.3Classification adopted and interrelationships


7.1.4 Intent or observable result

7.1.5 Ownership of outcomes


7.2.1 Become a part of this approach

7.2.2 Integrate basic science and clinical concepts


8. Limited educational settings

8.1 Learning environments and contemporary realities of practice

8.2 Enhance settings - communities

8.3 Basic science role

8.3.1 Move basic science teaching

8.3.2 Practice in novel situations


9. Lack of medical teachers as educators

9.1 Barrows quote - “There is no place in medical education for faculty to teach by the seat of their pants, the way they were taught, not questioning what or how they should teach, any more than there would be a place for such an approach in research or patient care”


“Anyone with responsibility for educating students, residents, and physicians should be skilled and well informed about medical education - as preparing these learners to provide safe, humane, and effective care for the members of our society is a heavy responsibility”


9.2 Solution lies in educational leadership

9.3 Basic Science Role

9.3.1 Provide needed leadership

Best Evidence Medical Education(BEME)

Challenges to you

1. Integrate Cognitive Science concepts into medical education

2. Teach fundamental principles

3. Integrate basic and clinical science education

4. Become medical education experts

5. Lead

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The Future of Basic Sciences in Undergraduate Medical Education Douglas L. Wood, D.O., Ph.D. President - AACOM