Educating the educators: a key to curricular integration

Using a boundary crossing lens to understand basic science educator and clinical educator collaboration in instructional design

PURPOSE

Collaborations between basic science educators (BE) and clinical educators (CE) in medical education are common and necessary to create integrated learning materials. However, few studies describe experiences of or processes used by educators engaged in interdisciplinary teamwork. We use the lens of boundary crossing to explore processes described by BE and CE that support the co-creation of integrated learning materials, and the impact that this work has on them.

MATERIALS AND METHODS

We conducted qualitative content analysis on program evaluation data from 27 BE and CE who worked on 12 teams as part of a multi-institutional instructional design project.

RESULTS

BE and CE productively engaged in collaboration using boundary crossing mechanisms. These included respecting diverse perspectives and expertise and finding efficient processes for completing shared work that allow BE and CE to build on each other's contributions. BE and CE developed confidence in connecting clinical concepts with causal explanations, and willingness to engage in and support such collaborations at their own institutions.

CONCLUSIONS

BE and CE report the use of boundary crossing mechanisms that support collaboration in instructional design. Such practices could be harnessed in future collaborations between BE and CE.

Professional Identity Formation of Medical Science Educators: An Imperative for Academic Medicine

Medical schools increasingly seek the expertise of talented medical science faculty to engage in the educational mission of the school; yet, the professional identity of these individuals is in flux. As courses and departments have become more integrated and less discipline-based, faculty with doctorates in biomedical science disciplines who primarily teach may suffer a loss of connection to their discipline, either in the courses they are teaching or in their home departments. Recent reports suggest that most medical science educators transitioned from the laboratory to the classroom by happenstance-not the most ideal way to build this key segment of the faculty. This article addresses the importance of foundational sciences in medical training, highlights the unique contributions of science educators in medical schools, and makes a case for why the professional identity of medical science educators should be studied. An imperative for academic medicine is to understand the factors that underpin the professional identity formation of medical science educators and to invest in training and nurturing this group of faculty members that are vital to educating the next generation of health professionals.

Professional Identity Formation of Basic Science Medical Educators: A Qualitative Study of Identity Supports and Threats

PURPOSE

Basic science medical educators (BSME) play a vital role in the training of medical students, yet little is known about the factors that shape their professional identities. This multi-institutional qualitative study investigated factors that support and threaten the professional identity formation (PIF) of these medical educators.

METHOD

A qualitative descriptive study was conducted with a purposive sample of 58 BSME from 7 allopathic medical schools in the U.S. In-depth semi-structured interviews of individual BSME were conducted between December 2020 and February 2021 to explore the facilitators and barriers shaping the PIF of BSME. Thematic analysis was conducted.

RESULTS

Factors shaping PIF were grouped into 3 broad domains: personal, social, and structural. Interrelated themes described a combination of factors that pushed BSME into teaching (early or positive teaching experiences) and kept them there (satisfaction and rewards of teaching, communities of like-minded people), as well as factors that challenged their PIF (misunderstanding from medical students, clinical, and research faculty, lack of formal training programs, and lack of tenure-track educator positions). The structural environment was reported to be crucial for PIF and determined whether BSME felt that they belonged and were valued.

CONCLUSIONS

This study shows that although most BSME derive a sense of fulfillment and meaning from their role as medical educators, they face considerable obstacles during their PIF. Structural change and support are needed to increase recognition, value, promotion, and belonging for BSME to improve the satisfaction and retention of this important group of faculty.

Models of clinical integration into basic science education for first-year medical students

While medical education continues to evolve away from a two-stage model of preclinical basic science education followed by clinical rotations, medical schools have struggled with how best to integrate basic science education with clinical application in the early educational curriculum. As Course Directors for the entire first year of medical student education at a new medical school, we review three models for the clinical application of basic science education that we utilized in the first year, including clinical retrofitting, parallel session development, and session co-creation.

Transfer of anatomy during surgical clerkships: an exploratory study of a student-staff partnership

OBJECTIVES

This qualitative study aims to explore how fourth-year medical students on the surgery course perceived a clinical anatomy workshop organised by near-peer student teachers in partnership with faculty.

METHODS

Forty-seven medical students participated in a workshop on clinical anatomy in the dissection laboratory. A voluntary response sampling method was used. The students' perceptions of the workshop were explored through a thematic content analysis of transcribed, semi-structured group interviews and written comments.

RESULTS

A majority of the students had not revisited the dissection laboratory since their second year, and all students described the workshop as a unique opportunity to vertically integrate anatomical knowledge. Four main themes were identified as most valuable for the students' learning experience, namely that the workshop 1) was taught by knowledgeable and friendly near-peer tutors (NPTs), 2) consisted of highly relevant anatomical content, 3) offered a hands-on experience of cadavers in the dissection laboratory, and 4) was taught in a focused session in the middle of the surgery course.

CONCLUSIONS

 This study shows how hands-on workshops in clinical anatomy, developed in student-staff partnerships and taught by NPTs, can enable senior medical students to recall and vertically integrate anatomical knowledge during surgical clerkships. The results have implications for curriculum design, giving voice to senior students' wishes for spaced repetition and vertical integration of pre-clinical anatomy knowledge during their clinical training. Moreover, this study may inspire other students and faculty to develop similar near-peer teaching activities through student-staff partnerships.

Integration of Clinical and Scientific Principles in the Teaching of Drug-Drug Interactions

Evaluation of drug-drug interactions (DDIs) is an integral part of pharmacy practice worldwide. An understanding of the scientific mechanisms behind and the clinical implications of DDIs is important for proper management of pharmacotherapy. Here, we describe an integrated approach to teaching both aspects of DDIs as a standalone module in diverse course settings. These include on-campus and online delivery to international and local audiences in small and large classes. We describe the scientific, clinical, and integrated learning objectives of the module, and we show how these can be achieved through group projects based on published DDI case reports.

Is it time for transition from the subject-based to the integrated preclinical medical curriculum?

In the 60s of the last century, a number of new universities in the world began to apply an integrated program of medical education, the cornerstone of which was problem-oriented education. Thus, the Flexner model of higher education adopted by that time in most countries of the world, with its characteristic segregation of teaching of the theoretical and clinical disciplines, which had ceased to satisfy the needs of modern healthcare, was gradually replaced by a new system that put the student in the center of the educational process and opened the way to active methods of teaching being focused on the end result – training of graduates whose qualifications most fully satisfy the needs of society. Over the half-century history of its existence, this system has been adopted by most medical universities in different countries of the world, in many of which it has undergone significant modifications in accordance with the needs of national educational standards. Many medical universities in Russia and other countries of the former Soviet Union showed interest in this system, some of the medical faculties of our country accepted certain elements of it. However, up to date no integrated preclinical medical education program has been applied in any of the Russian universities. Hereby we are undertaking an attempt to analyze the reasons and assess the possible perspectives for the transition of medical universities in Russia to teaching of fundamental and biomedical disciplines using the integrated curriculum.

Integrating the basic sciences in medical curricula: focus on the basic scientists

Basic science educators are not trained as clinicians, yet are expected to adjust their content to mesh appropriately with its clinical application. While achievable, this is a challenge that requires intentional effort on the part of the basic science educators. A practical solution to facilitate curricular integration is to create experiential opportunities for basic scientists to observe the clinical application of their content and to pair these initiatives with training in effective medical education practices.

A critical narrative review of transfer of basic science knowledge in health professions education

CONTEXT

'Transfer' is the application of a previously learned concept to solve a new problem in another context. Transfer is essential for basic science education because, to be valuable, basic science knowledge must be transferred to clinical problem solving. Therefore, better understanding of interventions that enhance the transfer of basic science knowledge to clinical reasoning is essential. This review systematically identifies interventions described in the health professions education (HPE) literature that document the transfer of basic science knowledge to clinical reasoning, and considers teaching and assessment strategies.

METHODS

A systematic search of the literature was conducted. Articles related to basic science teaching at the undergraduate level in HPE were analysed using a 'transfer out'/'transfer in' conceptual framework. 'Transfer out' refers to the application of knowledge developed in one learning situation to the solving of a new problem. 'Transfer in' refers to the use of previously acquired knowledge to learn from new problems or learning situations.

RESULTS

Of 9803 articles initially identified, 627 studies were retrieved for full text evaluation; 15 were included in the literature review. A total of 93% explored 'transfer out' to clinical reasoning and 7% (one article) explored 'transfer in'. Measures of 'transfer out' fostered by basic science knowledge included diagnostic accuracy over time and in new clinical cases. Basic science knowledge supported learning - 'transfer in' - of new related content and ultimately the 'transfer out' to diagnostic reasoning. Successful teaching strategies included the making of connections between basic and clinical sciences, the use of commonsense analogies, and the study of multiple clinical problems in multiple contexts. Performance on recall tests did not reflect the transfer of basic science knowledge to clinical reasoning.

CONCLUSIONS

Transfer of basic science knowledge to clinical reasoning is an essential component of HPE that requires further development for implementation and scholarship.

Integration of Basic and Clinical Sciences: Faculty Perspectives at a U.S. Dental School

Although dental education has traditionally been organized into basic sciences education (first and second years) and clinical education (third and fourth years), there has been growing interest in ways to better integrate the two to more effectively educate students and prepare them for practice. Since 2012, The University of Texas School of Dentistry at Houston (UTSD) has made it a priority to improve integration of basic and clinical sciences, with a focus to this point on integrating the basic sciences. The aim of this study was to determine the perspectives of basic and clinical science faculty members regarding basic and clinical sciences integration and the degree of integration currently occurring. In October 2016, all 227 faculty members (15 basic scientists and 212 clinicians) were invited to participate in an online survey. Of the 212 clinicians, 84 completed the clinician educator survey (response rate 40%). All 15 basic scientists completed the basic science educator survey (response rate 100%). The majority of basic and clinical respondents affirmed the value of integration (93.3%, 97.6%, respectively) and reported regular integration in their teaching (80%, 86.9%). There were no significant differences between basic scientists and clinicians on perceived importance (p=0.457) and comfort with integration (p=0.240), but the basic scientists were more likely to integrate (p=0.039) and collaborate (p=0.021) than the clinicians. There were no significant differences between generalist and specialist clinicians on importance (p=0.474) and degree (p=0.972) of integration in teaching and intent to collaborate (p=0.864), but the specialists reported feeling more comfortable presenting basic science information (p=0.033). Protected faculty time for collaborative efforts and a repository of integrated basic science and clinical examples for use in teaching and faculty development were recommended to improve integration. Although questions might be raised about the respondents' definition of "integration," this study provides a baseline assessment of perceptions at a dental school that is placing a priority on integration.

Extending the theoretical framework for curriculum integration in pre-clinical medical education

INTRODUCTION

Curriculum integration is widely discussed in medical education but remains ill defined. Although there is plenty of information on logistical aspects of curriculum integration, little attention has been paid to the contextual issues that emerge from its practice and may complicate students' knowledge integration. Therefore, we aimed to uncover how curriculum integration is manifested through context.

METHODS

We collected data from the official curriculum and interviewed ten participants (including curriculum designers, facilitators, and students) in the bachelor's medical program at Aalborg University. We observed various learning activities focused on pre-clinical education. Inspired by grounded theory, we analyzed the information we gathered.

RESULTS

The following theoretical constructs emerged after the inductive analysis: 1) curriculum integration complexity is embedded in the institutional learning perspectives; 2) curriculum integration is used to harmonize conflicting learning perspectives in curriculum practice; 3) curriculum integration creates tensions that self-organize its structure; and 4) curriculum integration becomes visible in collaborative learning spaces.

DISCUSSION

These constructs provide a framework for analyzing curriculum integration in the context in which it is meant to appear, which may assist educationalists to gain a more specific understanding of the term. This may enable effective curriculum integration since contextual issues are addressed in addition to the goals specified in the official curriculum.

Institutional factors affecting participation in national faculty development programs: a nation-wide investigation of medical schools

BACKGROUND

Medical schools have used faculty development programs as an essential means to improve the instruction of faculty members. Thus far, however, participating in such programs has been largely voluntary for individuals even though a certain degree of participation is required to achieve practical effectiveness. In addition, the learning behaviors of faculty members are known to be influenced by organizational contexts such as a hidden curriculum. Therefore, this study explored the organizational characteristics of medical schools affecting attendance at faculty development programs.

METHODS

Forty medical schools in South Korea were included in this study. In total, 1,667 faculty members attended the faculty development programs at the National Teacher Training Center for Health Personnel between 2007 and 2015. For independent variables, information on the basic characteristics and the educational states was collected from all the medical schools. Themes were identified from their educational goals and objectives by inductive content analysis.

RESULTS

The number of nine-year cumulative attendees from medical schools ranged from 8 to 104. The basic characteristics of the medical schools had little influence on faculty development program attendance, while several themes in the educational goals and objectives, including "cooperation", "serving various societies", and "dealing with a changing future" showed a significant difference in participation. The number of full-time faculty showed a significant positive correlation when it was smaller than the median, and the proportion of alumni faculty showed a significant negative correlation when it was higher than 50%.

CONCLUSIONS

This study adds to existing knowledge on factors affecting attendance at faculty development programs by identifying related institutional factors that influence attendance. While the variations depending on the basic characteristics were minimal, the organizational environment surrounding medical education significantly contributed to attendance. Addressing institutional as well as individual factors could contribute to improving participation by faculty members in faculty development programs.

Integration of Basic and Clinical Science Courses in US PharmD Programs

Objective. To determine the current status of and faculty perceptions regarding integration of basic and clinical science courses in US pharmacy programs. Methods. A 25-item survey instrument was developed and distributed to 132 doctor of pharmacy (PharmD) programs. Survey data were analyzed using Mann-Whitney U test or Kruskal-Wallis test. Thematic analysis of text-based comments was performed using the constant comparison method. Results. One hundred twelve programs responded for a response rate of 85%. Seventy-eight (70%) offered integrated basic and clinical science courses. The types of integration included: full integration with merging disciplinary contents (n=25), coordinated delivery of disciplinary contents (n=50), and standalone courses with integrated laboratory (n=3). Faculty perceptions of course integration were positive. Themes that emerged from text-based comments included positive learning experiences as well as the challenges, opportunities, and skepticism associated with course integration. Conclusion. The results suggest wide variations in the design and implementation of integrated courses among US pharmacy programs. Faculty training and buy-in play a significant role in successful implementation of curricular integration.

Integrated Medical Curriculum: Advantages and Disadvantages

Most curricula for medical education have been integrated horizontally and vertically--vertically between basic and clinical sciences. The Flexnerian curriculum has disappeared to permit integration between basic sciences and clinical sciences, which are taught throughout the curriculum. We have proposed a different form of integration where the horizontal axis represents the defined learning outcomes and the vertical axis represents the teaching of the sciences throughout the courses. We believe that a mere integration of basic and clinical sciences is not enough because it is necessary to emphasize the importance of humanism as well as health population sciences in medicine. It is necessary to integrate basic and clinical sciences, humanism, and health population in the vertical axis, not only in the early years but also throughout the curriculum, presupposing the use of active teaching methods based on problems or cases in small groups.

Faculty Development for a New Curriculum: Implementing a Strategy for Veterinary Teachers within the Wider University Context

Faculty development in veterinary education is receiving increasing attention internationally and is considered of particular importance during periods of organizational or curricular change. This report outlines a faculty development strategy developed since October 2012 at the University of Bristol Veterinary School, in parallel with the development and implementation of a new curriculum. The aim of the strategy is to deliver accessible, contextual faculty development workshops for clinical and non-clinical staff involved in veterinary student training, thereby equipping staff with the skills and support to deliver high-quality teaching in a modern curriculum. In October 2014, these workshops became embedded within the new University of Bristol Continuing Professional Development scheme, Cultivating Research and Teaching Excellence. This scheme ensures that staff have a clear and structured route to achieving formal recognition of their teaching practice as well as access to a wide range of resources to further their overall professional development. The key challenges and constraints are discussed.