Back to the basic sciences: an innovative approach to teaching senior medical students how best to integrate basic science and clinical medicine

Planning, implementation and revision of the longitudinal scientific curriculum at the Medical School Brandenburg

Objectives

The aim of this paper is to present the development of a longitudinal curriculum for medical students that is rooted in the particularity of the medical sciences and that aims to build and strengthen medical students' scientific skills and use thereof in clinical practice.

Methods

The curriculum development was initiated based on students' feedback on the initial curriculum. To improve and expand the curriculum appropriately, a needs assessment, a literature review to define science specific to the medical sciences and practice, and an analysis of national and international curricula were performed. The curriculum development followed the PDCA cycle (Plan-Do-Check-Act).

Results

The curriculum extends across the entire medical study programme from semesters 1 to 10. It consists of the seminar series on basic conduct and the epistemological groundings of science, scientific methods in medical research and health sciences, statistics and the scientific internship. Up to the sixth semester, the focus is on the acquisition of skills and abilities to work on and carry out a concrete research project; starting in semester seven, the critical evaluation and application of research results in everyday clinical practice are introduced. The curriculum is taught by epidemiologists, anthropologists, statisticians and public health scholars. Starting in semester seven, seminars are generally taught together with clinicians as tandem teaching. The curriculum is regularly assessed and adjusted.

Conclusions

The Brandenburg Scientific Curriculum can be seen as a model of a longitudinal curriculum to teach scientific thinking and acting. One that is at the same time highly integrated in the medical curriculum overall. A central coordination point seems to be necessary to coordinate the teaching content and to ensure that teachers are interconnected. Furthermore, a complex curriculum in scientific methodology requires a set of teachers from a range of disciplinary backgrounds. To ensure equally high-quality education, the variability of research projects and faculty must be taken into account by establishing generally applicable evaluation criteria and fostering faculty development, and providing all students supporting courses throughout the research project.

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.

Development of an Orthopedic Surgery Anatomy Curricular Model for Fourth Year Medical Students Using a Modified Delphi Method

OBJECTIVE

The purpose of this study was to develop anatomy-focused learning outcomes that can be used to design a fourth-year elective for students matriculating into orthopedic surgery residencies.

DESIGN

A series of proposed learning outcomes (N=72) was developed using the ACGME Orthopedic Milestones 2.0 as a framework. In 2021, these were converted into a survey asking participants to rate the importance of each outcome on a 5-point Likert scale. The modified Delphi Method was used to refine the list of outcomes until group consensus was achieved. The consensus was defined using a conservative 3-tier approach.

SETTING

Eighteen academic centers with an associated orthopedic surgery residency.

PARTICIPANTS

Twenty-six orthopedic surgeons (ranging from 1 to 42 years in practice).

RESULTS

Of the 72 learning outcomes from the first-round survey, 25 met consensus criteria. Of the 62 learning outcomes from the second-round survey, 45 met consensus criteria. All learning outcomes that met consensus criteria after the second-round survey were stratified into low-yield (n = 8), intermediate-yield (n = 34), and high-yield (n = 28) categories.

CONCLUSION

Using a modified Delphi Method, this study elicited feedback from experts in the field of orthopedic surgery to develop a framework for a fourth-year elective focused on anatomical concepts important for students applying to residencies in orthopedic surgery. The product of this process affords a great deal of flexibility when utilizing the results of this study in institution-specific curricular development.

Integration of anatomy and physiology into nursing practice as perceived by undergraduate students and registered nurses: a scoping review

OBJECTIVE

The current study aimed to determine perceptions of registered and student nurses regarding the integration of anatomy and physiology into nursing practice.

METHODS

This scoping review was conducted following the checklist provided in the Reporting Items for Systematic reviews and Meta-Analysis extension for scoping reviews. Articles published in PubMed, ERIC, and CINAL from January 1, 2002 to September 30, 2022 were included.

RESULTS

A literature review of 20 articles that matched the indicative criteria revealed that both undergraduate student and registered nurses recognized knowledge of anatomy and physiology as important to nursing practice. Student nurses recognized that such knowledge is related to understanding patient pathophysiology, patient observation, treatment selection, and patient safety and forms the basis for nursing practice. Registered nurses who were confident in their knowledge of anatomy and physiology also reported that they were able to explain the rationale for their nursing practice. They also reported that this knowledge is necessary for communication with multiple professions, which promotes patient/family trust in nurses and is the basis for building trusting relationships with patients and their families.

CONCLUSIONS

Although undergraduate student and registered nurses recognized the importance of learning anatomy and physiology, the integration of anatomy and physiology into nursing practice was not the same for all student and registered nurses. This suggests the need to investigate the overall perceptions of nurses regarding the integration of anatomy and physiology into nursing practice and for faculty to discuss how to facilitate critical thinking among students.

Integration of respiratory physiology and clinical reasoning in the early years of a medical curriculum: engaging with students in a large classroom setting

Medical graduates are expected to apply scientific principles and explain the processes underlying common and important diseases. Evidence shows that integrated medical curricula, which deliver biomedical science within the context of clinical cases, facilitate student learning in preparation for practice. However, research has also shown that the student's perception of their knowledge can be lower in integrated compared to traditional courses. Thus the development of teaching methods to support both integrated learning and build student confidence in clinical reasoning is a priority. In this study, we describe the use of an audience response system to support active learning in large classes. Sessions, delivered by medical faculty from both academic and clinical backgrounds, were designed to build on the knowledge of the respiratory system in both health and disease through the interpretation of clinical cases. Results showed that student engagement was high throughout the session and students strongly agreed that the application of knowledge to real-life cases was a better way to understand clinical reasoning. Qualitative free text comments revealed that students liked the link between theory and practice and the active, integrated method of learning. In summary, this study describes a relatively simple but highly effective way of delivering integrated medical science teaching, in this case respiratory medicine, to improve student confidence in clinical reasoning. This educational approach was applied within the early years of the curriculum in preparation for teaching within a hospital setting, but the format could be applied across many different settings.NEW & NOTEWORTHY The development of teaching methods that support integrated learning and build student confidence is a priority. An audience response system was used to engage early year medical students in large classes in preparation for teaching within a hospital setting. Results showed high levels of student engagement and a greater appreciation for the link between theory and practice. This study describes a simple, active, and integrated method of learning that improves student confidence in clinical reasoning.

Histology as a paradigm for a science-based learning experience: Visits by histology education spirits of past, present, and future

The term "histology" was coined a little over 200 years ago and the subject has always relied on microscopy as its defining technology. Microscopy was and still is an essential approach for the description of cellular components and their arrangements in living organisms. For more than a century and a half, histology or microanatomy has also been part of the basic science education for biomedical students. Traditionally, it has been taught in two major components, a didactic transfer of information, either in a lecture or self-learning format, and in active-learning laboratory sessions. These two modes of histology instruction conform with the dual-processing theory of learning, one being more automatic and depending mainly on rote memorization, whereas the other is analytical, requiring more advanced reasoning skills. However, these two components of histology education are not separate and independent, but rather complementary and part of a multi-step learning process that encourages a scientific analysis of visual information and involves higher-level learning skills. Conventional, as well as modern electronic instruction methods (e-learning) have been used in complementary ways to support the integrated succession of individual learning steps as outlined in this manuscript. However, as recent curricular reforms have curtailed instructional time, this traditional format of teaching histology is no longer sustainable and a reflective reassessment of the role of histology in modern biomedical education is a timely necessity.

Research in orthopaedic trauma surgery: approaches of basic scientists and clinicians and the relevance of interprofessional research teams

BACKGROUND

An increasing clinical workload and growing financial, administrative and legal burdens as well as changing demands regarding work-life balance have resulted in an increased emphasis on clinical practice at the expense of research activities by orthopaedic trauma surgeons. This has led to an overall decrease in the number of scientifically active clinicians in orthopaedic trauma surgery, which represents a serious burden on research in this field. In order to guarantee that the clinical relevance of this discipline is also mirrored in the scientific field, new concepts are needed to keep clinicians involved in research.

METHODS

Literature review and discussion of the results of a survey.

RESULTS/CONCLUSION

An interdisciplinary and -professional team approach involving clinicians and basic scientists with different fields of expertise appears to be a promising method. Although differences regarding motivation, research focuses, funding rates and sources as well as inhibitory factors for research activities between basic scientists and clinicians exist, successful and long-lasting collaborations have already proven fruitful. For further implementation of the team approach, diverse prerequisites are necessary. Among those measures, institutions (e.g. societies, universities etc.) must shift the focus of their support mechanisms from independent scientist models to research team performances.

Basic medical sciences should be mainly taught by the clinicians for a tightly integration of basic and clinical sciences in medical education

Medical education today faces many problems. But the most serious problem is the inability to integrate basic and clinical sciences. For this reason, students alienate from basic sciences and also clinicians are leaving sciences to basic scientists every day. The basic medical sciences learned in the preclinical term are remembered less by the students and cannot be sufficiently associated with clinical reality. Because a basic scientific knowledge learned without clinical framework is a low-value data that the student does not know how to use. Therefore, all reform initiatives in the medical education curriculum stick to the obstacle of basic sciences. Now is the time to take bold steps. The first step should be to removed the preclinical term from medical education. Medical education should only consist of clinical education term. This will gain the student and clinician a lot more time for clinical training. The second step should be to take basic sciences education from basic scientists and place it under the responsibility of clinicians. Clinician can decide much better how much of a basic sciences knowledge is clinically relevant. As a component of clinical education, it is best for the students to internalize the basic sciences during classroom, bedside and other clinical practices under the clinician's authority. Thus, students may be graduated as academic clinicians who have internalized the basic sciences and integrated the basic sciences with the clinical reality.

A scientific methodology course for advanced medical students: an eight-year perspective

Background: Exponential increases in the development of medical knowledge, the expansion of areas where medicine develops its activities, the emergence of new pathologies (e.g., COVID-19), novel diagnostic methods and therapeutic strategies, together with the appearance of multiple communication and information technologies, determined that the education of future physicians required targeted training in scientific methodology. Methods: The design and execution of a course in scientific methodology in the curriculum of Facultad de Medicina, Universidad de la República, Uruguay, is described. The course is carried out at an advanced stage of the medical studies for all the students, in which they develop a 10-month research project supervised by the medical school faculty. Students undergo all stages of a research endeavor: generation of hypothesis or general aim, elaboration of a research protocol, submission to the Research Ethics and Animal Welfare Committees, data recollection, analysis, interpretation and publication of the results. Results: The course is undertaken at the Facultad de Medicina, Universidad de la República, Uruguay, the main university of the country, with high numbers of students enrolled. The course involves the participation of 600 students and up to 300 professors per year, which implies a huge institutional effort. Conclusions: The scientific methodology course resulted in one of the most important incorporations of the current 2008 curriculum. Local students, faculty and international evaluators have qualified this activity as an educational breakthrough, being a gratifying and productive experience. The course represented the first exposure of medical students to the research methodology, scientific literature and publication rules, and emphasized the dynamic nature of medical knowledge within modern medical education. Moreover, for some students it constituted the onset of academic research careers. An additional positive outcome was the reactivation of some faculty research projects, in a way that largely exceeded the boundaries of the course.

Advanced Integrated Science Courses: Building a Skill Set to Engage With the Interface of Research and Medicine

Scientific research has been changing medical practice at an increasing pace. To keep up with this change, physicians of the future will need to be lifelong learners with the skills to engage with emerging science and translate it into clinical care. How medical schools can best prepare students for ongoing scientific change remains unclear. Adding to the challenge is reduced time allocated to basic science in curricula and rapid expansion of relevant scientific fields. A return to science with greater depth after clinical clerkships has been suggested, although few schools have adopted such curricula and implementation can present challenges. The authors describe an innovation at Harvard Medical School, the Advanced Integrated Science Courses (AISCs), which are taken after core clerkships. Students are required to take 2 such courses, which are offered in a variety of topics. Rather than factual content, the learning objectives are a set of generalizable skills to enable students to critically evaluate emerging research and its relationship to medical practice. Making these generalizable skills the defining principle of the courses has several important advantages: it allows standardization of acquired skills to be combined with diverse course topics ranging from basic to translational and population sciences; students can choose courses and projects aligned with their interests, thereby enhancing engagement, curiosity, and career relevance; schools can tailor course offerings to the interests of local faculty; and the generalizable skills delineate a unique purpose of these courses within the overall medical school curriculum. For the 3 years AISCs have been offered, students rated the courses highly and reported learning the intended skill set effectively. The AISC concept addresses the challenge of preparing students for this era of rapidly expanding science and should be readily adaptable to other medical schools.

A scientific methodology course for advanced medical students: an eight-year perspective

Background: Exponential increases in the development of medical knowledge, the expansion of areas where medicine develops its activities, the emergence of new pathologies ( e.g., COVID-19), novel diagnostic methods and therapeutic strategies, together with the appearance of multiple communication and information technologies, determined that the education of future physicians required targeted training in scientific methodology.

Methods: The design and execution of a course in scientific methodology in the curriculum of Facultad de Medicina, Universidad de la República, Uruguay, is described. The course is carried out at an advanced stage of the medical studies for all the students, in which they develop a 10-month research project supervised by the medical school faculty. Students undergo all stages of a research endeavor: generation of hypothesis, elaboration of a research protocol, submission to the Research Ethics and Animal Welfare Committees, data recollection, analysis, interpretation and publication of the results.

Results: The course is undertaken at the Facultad de Medicina, Universidad de la República, Uruguay, the main university of the country, with high numbers of students enrolled. The course involves the participation of 600 students and up to 300 professors per year, which implies a huge institutional effort

Conclusions: The scientific methodology course resulted in one of the most important incorporations of the current 2008 curriculum. Local students, faculty and international evaluators have qualified this activity as an educational breakthrough, being a gratifying and productive experience. The course represented the first exposure of medical students to the research methodology, scientific literature and publication rules, and emphasized the dynamic nature of medical knowledge within modern medical education. Moreover, for some students it constituted the onset of academic research careers. An additional positive outcome was the reactivation of some faculty research projects, in a way that largely exceeded the boundaries of the course.

"What is the mechanism?": Cues, barriers, and opportunities to discuss foundational science during internal medicine rounds

BACKGROUND

Repeated application of foundational science (FS) during medical reasoning results in encapsulation of knowledge needed to develop clinical expertise. Despite proven benefit of educating learners using a FS framework to anchor clinical decision making, how FS is integrated on clinical rotations has not been well characterized. This study examines how and when FS discussion occurs on internal medicine teaching rounds.

MATERIAL AND METHODS

We performed a convergent mixed method study. Six internal medicine teams at a quaternary hospital were observed during rounds and team members interviewed. Transcripts were analyzed using thematic analysis. Descriptive statistics provided a summary of the observations.

RESULTS

Our study revealed that rounds used a teacher-centered model where FS knowledge was transmitted as pearls external to the clinical context. FS content arose primarily when the patient was complex. Barriers preventing FS discussion were lack of time and perceived lack of personal FS knowledge.

CONCLUSION

Our study describes scenarios that commonly elicit discussion of FS on inpatient medicine rounds highlighting a 'transmission' model of FS knowledge. We suggest a learner-centered model that engages students in the practice of integrating FS into clinical reasoning.

Generalists as Clinical Physiologists: Bringing Science Back to the Bedside

BACKGROUND

Few generalists engage in basic science research or feel comfortable teaching physiology at the bedside. This may reflect a lack of understanding or confidence teaching physiologic principles.

AIM

To inspire general internists to relearn and teach physiology in clinical practice.

SETTING

An active biomedical research laboratory.

PARTICIPANTS

We educated 67 faculty participants (4 primary care, 59 hospitalists, and 4 other specialties) from 24 medical centers, representing 17 states.

PROGRAM DESCRIPTION

The 5-day course was structured around re-learning basic physiology principles and developing teaching skills. Participants engaged in hands-on experiments through 4 modules using aquatic species, each paired with a physiology content primer. Participants also developed teaching scripts based on their experiments.

PROGRAM EVALUATION

Post-course surveys revealed that 97% felt confident teaching physiology at the bedside, 100% felt the course enhanced their understanding of the mechanisms of disease, and there was a significant improvement in self-reported teaching ability.

DISCUSSION

An immersive, hands-on faculty development course that integrated physiology with clinical decision-making increased participants' comfort level and self-rated ability to teach and incorporate physiology in their clinical work. We believe faculty development is one potential solution to the growing chasm between clinicians and scientists in general medicine.

Virtual Self-learning Modules Integrating Pharmacology Concepts into a Geriatric Elective

Given barriers to vertical integration during clinical rotations, many struggle with employing effective virtual strategies to revisit foundational sciences during clerkship. To address this, we developed virtual geriatric pharmacology self-learning modules (SLMs) for a fourth-year geriatric elective using cases, interactive exercises, resources, feedback, and quizzes. To evaluate effectiveness, learners were administered a pre- and post-elective quiz with survey. Learners improved performance after using SLMs, valued pharmacology clerkship integration and reinforcement, and agreed SLMs improved understanding, confidence, and attitudes. Thus, SLMs were an effective virtual method for integrating pharmacology that could be modified to teach other foundational sciences during clerkships.

Evaluation of an online case-based learning module that integrates basic and clinical sciences

OBJECTIVE

Case-based online modules can be created to integrate basic science and clinical science knowledge. An integrated module was designed, implemented, and evaluated for student performance and perception.

METHODS

Five faculty members from both basic science and clinical education departments developed an integrative, online, case-based learning module. The case involved a patient with facial asymmetry, and the student was led to a diagnosis of Bell's palsy. Material on Bell's palsy was presented in an integrated module in addition to traditional lecture for a fall cohort of students and was presented only in traditional lecture format to a winter cohort of students. Both cohorts were given the same 5 multiple-choice questions on Bell's palsy as part of a midterm exam, and the scores of these test questions were compared between cohorts. A 13-question, mixed-methods survey was given to the fall cohort to determine their perceptions of the module and their learning.

RESULTS

Multiple-choice test question performance was equivalent between cohorts for the Bell's palsy questions (fall 2018: mean = 3.68, SD = 0.99; winter 2019: mean = 3.51, SD = 0.92). Perception survey responses indicated that students felt positively about the integrated module and that it was applicable and helpful with improving, reinforcing, and integrating basic science and clinical knowledge.

CONCLUSION

This study provides evidence that case-based integrated modules are perceived favorably by students and result in similar exam question performance. They can be a useful tool to help students connect information throughout the chiropractic curriculum.

Medical Students' Attitude and Perception Towards Basic Medical Science Subjects at Wollo University, Northeast Ethiopia

INTRODUCTION

The knowledge of basic medical science could help to remember a fact and be used to understand causal mechanisms of disease process that improve the accuracy of diagnostic formulations.

OBJECTIVE

To assess the perception and attitude of medical students towards basic medical science subjects along with retention rate and clinical relevance in Wollo University.

METHODS

Institutional-based cross-sectional study design was employed in Wollo University from September, 2020 to October, 2020. A pre-tested and structured self-administered questionnaire was used for data collection. All opinions were rated using a positive-point Likert scale, which ranges from "strongly disagree" to "strongly agree." The data were entered and analyzed using SPSS version 20.

RESULTS

A total of 153 students participated with a 100% response rate. Among them, 45 (29.4%), 38 (24.8%), 39 (25.5%), and 31 (20.3%) were PC-II, C-I, C-II, and Intern students, respectively. Ninety-six (62.7%) of medical students were very much interested in basic medical science subjects. But, 113 (73.9%) of them did not have plans to join the subjects as a future career. The main reasons in more than half 85 (55.7%) of the respondents were less financial growth followed by less chance of promotion 31 (20.3%). There were 66.7% of the students who considered anatomy as clinically relevant, whereas 53.6% and 47.1% considered physiology and biochemistry, respectively, to be clinically relevant. The number of students who could recall anatomy and physiology during relevant clinical discussions was 102 (66.7%) and 85 (55.6%), respectively. This percentage was relatively less for biochemistry (26.8%).

CONCLUSION

In conclusion, medical students have a positive attitude towards basic medical science subjects. However, they are hesitant to join the field because it offers them less financial growth and few chances of promotion. Moreover, anatomy and physiology were highly relevant subjects during clinical practice. But, the retention rate of basic medical science knowledge during their clinical year was low.

Are Clerks Proficient in the Basic Sciences? Assessment of Third-Year Medical Students' Basic Science Knowledge Prior to and at the Completion of Core Clerkship Rotations

Basic sciences are a cornerstone of undergraduate medical education (UME), yet research indicates that students' basic science knowledge is not well retained. Many UME curricula are increasing the integration between the basic and clinical sciences with the goal of enhancing students' knowledge levels; however, the impact of clerkship training on students' basic science knowledge remains inconclusive. Thus, using clerkship directors' expectations as framework, we aimed to assess third-year medical students' basic science knowledge during clerkship training and evaluate the influence of clerkship training on their basic science knowledge. Using concepts deemed necessary by clerkship directors, we created a basic science assessment for each clerkship rotation. Assessments were distributed to third-year medical students as a pre- and post-test to assess their basic science knowledge prior to and at the completion of each rotation. On average, students retained ≥ 60% of relevant basic science knowledge from pre-clerkship, and neither clerkship rotation order, nor the basic science discipline being assessed, impacted students' basic science knowledge levels. Post-test data revealed that students, on average, reinforced fundamental concepts during clerkship. Interestingly, even though lower-performing students demonstrated the greatest post-test improvement, they still left each rotation with knowledge deficits compared with their highest-performing peers, suggesting that the clinical experience of clerkship appears to be particularly beneficial for lower-performing students, in regard to enhancing their basic science knowledge. Overall, results indicate that earlier exposure to clinical learning in UME, along with integration of basic science education into clerkship, could promote students' basic science knowledge acquisition and retention.

Presentation and evaluation of the teaching concept "ENHANCE" for basic sciences in medical education

A solid understanding of basic sciences is a prerequisite for successful completion of medical education. Therefore, it is essential to improve the quality of teaching and to ensure the applicability of basic sciences. Based on practical experiences and previous research, we developed an innovative step-by-step concept, called ENHANCE, for the implementation or revision of teaching units, especially for basic sciences. We used comparative self-assessment gains, a questionnaire to assess teaching quality as well as end-of-semester evaluations (students' satisfaction and open-ended questions) to evaluate the ENHANCE concept. It was found that ENHANCE-based teaching units were related to increased students' satisfaction, high attendance rates and that restructuring the course curriculum yielded in a positive assessment of teaching effectiveness. The revised courses were rated as the very best of all classes in several semesters. Qualitative data showed that students particularly appreciated the level of comprehension and how helpful the courses were for the understanding and preparation of the regular curriculum.

Using Clinical Cases to Restore Basic Science Immunology Knowledge in Physicians and Senior Medical Students

The majority of medical students and many physicians find basic science immunology confusing and the teaching of immunology to be uninteresting. Physicians undergoing training in a range of disciplines treat patients with immunological disease, including allergy/immunology and rheumatology. It is essential for senior medical students and physicians to understand the pathology of immune diseases and the pharmacology of immune interventions. In order to optimize this learning, underlying concepts of basic immunology need to be revised, or sometimes learned for the first time. Teachers may need to overcome baseline attitudinal negativity. Medical students and postgraduates are more able to relate to basic immunology if approached through a clinical route. Case presentations and case-based discussions are a familiar format for medical students and physicians, though typically utilized to enhance understanding of clinical presentation, investigation, and treatment. Hence, they may be more receptive to “difficult” immunology concepts when presented in a familiar teaching framework. Although there is data supporting case-based learning for basic immunology in medical students, there is little data in physicians. Extrapolating from the medical student literature, I devised a program of clinical cases for physicians whereby understanding the immunopathological basis of the condition and/or its immunological treatment was employed as a platform to appreciate the basic science immunology in more depth. A variety of cases were selected to illustrate different immunological topics. The sessions were small group and highly interactive in nature. As this programme has only recently been introduced, formal evaluation has yet to be concluded.

Quantitative and qualitative evaluation of a learning model based on workstation activities

BACKGROUND

Moving towards a horizontal and vertical integrated curriculum, Work-Station Learning Activities (WSLA) were designed and implemented as a new learning instrument. Here, we aim to evaluate whether and how this specific learning model affects academic performance. To better understand how it is received by medical students, a mixed methods research study was conducted.

METHODS

In the quantitative strand, two cohorts of first year students were compared: academic year 2015-2016 n = 320 with no exposure to WSLA, and academic year 2016-2017 n = 336 with WSLA. Learning objectives at different levels of Bloom's taxonomy were identified and performance evaluated from multiple-choice questions. In the qualitative strand, a total of six students were purposely selected considering academic performance and motivation, and submitted to semistructured interviews.

RESULTS

Performance at both cohorts for learning objectives at lower levels of Bloom's taxonomy was similar (38.8 vs. 39.0%; p = 0.955). In contrast, students in the WSLA group outperformed significantly those not exposed for learning objectives involving upper levels (68.5 vs. 54.2%; p <0.001). A multivariate analysis confirmed that the probability of mastering the second (more complex) objective is 1.64 times higher in students with WSLA methodology (OR 95% CI, 1.15-2.34; p = 0.007) than with traditional methodology. In the interviews, students perceived the clinical scenario of WSLA as a motivator and recognized this methodology as a more constructive framework for understanding of complicated concepts.

CONCLUSIONS

In summary, our mixed methods research supports WSLA as a strategy that promotes deep learning and has a positive impact on academic performance for learning objectives involving higher order thinking skills in medical curricula.

Investigating the validity of web-enabled mechanistic case diagramming scores to assess students' integration of foundational and clinical sciences

As medical schools have changed their curricula to address foundational and clinical sciences in a more integrated fashion, teaching methods such as concept mapping have been incorporated in small group learning settings. Methods that can assess students' ability to apply such integrated knowledge are not as developed, however. The purpose of this project was to assess the validity of scores on a focused version of concept maps called mechanistic case diagrams (MCDs), which are hypothesized to enhance existing tools for assessing integrated knowledge that supports clinical reasoning. The data were from the medical school graduating class of 2018 (N = 136 students). In 2014-2015 we implemented a total of 16 case diagrams in case analysis groups within the Mechanisms of Health and Disease (MOHD) strand of the pre-clinical curriculum. These cases were based on topics being taught during the lectures and small group sessions for MOHD. We created an overall score across all 16 cases for each student. We then correlated these scores with performance in the preclinical curriculum [as assessed by overall performance in MOHD integrated foundational basic science courses and overall performance in the Clinical and Professional Skills (CAPS) courses], and standardized licensing exam scores [United States Medical Licensing Exam (USMLE)] Step 1 (following core clerkships) and Step 2 Clinical Knowledge (at the beginning of the fourth year of medical school). MCD scores correlated with students' overall basic science scores (r = .46, p = .0002) and their overall performance in Clinical and Professional Skills courses (r = .49, p < .0001). In addition, they correlated significantly with standardized exam measures, including USMLE Step 1 (r = .33, p ≤ .0001), and USMLE Step 2 CK (r = .39, p < .0001). These results provide preliminary validity evidence that MCDs may be useful in identifying students who have difficulty in integrating foundational and clinical sciences.

Assessing Stakeholder Perceptions of the Utility of Genetic Information for the Clinical Care of Mental Health Disorders: We Have a Will but Need to See the Way

Academic stakeholders' (primarily mental health researchers and clinicians) practices and attitudes related to the translation of genetic information into mental health care were assessed. A three-part survey was administered at two large, urban universities. Response frequencies were calculated. Participants (N = 64) reported moderate levels of translational practice, adequate levels of genetic knowledge, and variable levels of genetic competence. They held positive attitudes toward translating genetic information about mental health broadly but negative attitudes about the impact that such information would have on specific aspects of care. The current study lays the groundwork for further inquiry into translating genetic information to mental health care.

Survey of Gross Anatomy Education in China: The Past and the Present

Medical education in mainland China has undergone massive expansion and reforms in the past decades. A nation-wide survey of the five-year clinical medicine programs aimed to examine the course hours, pedagogies, learning resources and teaching staff of anatomy both at present and over the past three decades (1990-1999, 2000-2009, and 2010-2018). The directors or senior teachers from 90 out of the 130 five-year clinical medicine programs were invited to fill out a factual questionnaire by email. Ultimately, sixty-five completed questionnaires were received from 65 different schools. It was found that the total number of gross anatomy course hours has decreased by 11% in the past 30 years and that systematic and regional anatomy have been increasingly taught separately among the surveyed medical schools. Problem-based learning has been adopted in thirty-five (54%) of the surveyed schools, and team-based learning is used in ten (15%) of the surveyed schools. The surveyed schools reported receiving more donated cadavers in recent years, with the average number increasing from 20.67 ± 20.29 in 2000-2009 to 36.10 ± 47.26 in 2010-2018. However, this has not resulted in a decrease in the number of students who needed to share one cadaver (11.85 ± 5.03 in 1990-1999 to 14.22 ± 5.0 in 2010-2018). A decreasing trend regarding the teacher-student ratio (1:25.5 in 2000-2009 to 1:33.2 in 2010-2018) was also reported. The survey demonstrated the historical changes in gross anatomy education in China over the past thirty years.

Expectations and Perceptions of Students' Basic Science Knowledge: Through the Lens of Clerkship Directors

Basic sciences are a cornerstone of undergraduate medical education (UME) as they provide a necessary foundation for the clinical sciences to be built upon and help foster trainees' competency. However, research indicates that students' basic science knowledge is not well retained, and as a result, students are ill-prepared, with respect to their basic science knowledge, when entering clerkship. One potential reason why students may not be prepared for clerkship is a lack of understanding as to which basic science concepts are critical for medical students to retain from pre-clerkship. We facilitated interviews with all core UME clerkship directors to establish which basic science concepts they expect students to know prior to each clerkship rotation, along with student's basic science strengths and areas of improvement. Interviews revealed that students are expected to have some knowledge of every basic science prior to clerkship, with pharmacology being a strong focus, as many specialties deal with common drugs and classes of drugs. Additionally, general anatomy and physiology knowledge were deemed student strengths in two rotations. Clerkship directors focused on perceived areas of improvement more than perceived strengths, with the most prevalent areas being pharmacology, microbiology, and detailed anatomy. These results represent views of clerkship directors from one Canadian institution; however, since clerks rotate through institutions across Canada, this data provides the impetus for creating a national discussion to help foster standardization of UME curricula, with the overarching goal of ensuring all graduates are proficient in the necessary fundamentals as they transition into residency.

Mento's change model in teaching competency-based medical education

BACKGROUND

Resistance to change is customary and is expected in any organization. However, most of the downsides of change can be avoided if the organization/individual prepares for the change by acknowledging guided strategies. In healthcare, change is the state of nature, which has also translated to medical education (ME). ME in the current era has undergone a shift from a traditional content-based curriculum to a competency-based curriculum. Recently, however, the broader social-accountability movement has accelerated this rate of transformation. One of the key challenges to educators harbingering this transformation to competency-based medical education (CBME) is to redesign the processes of teaching.

AIM

Here we define a framework designed using Mento's model of change that will totally agree with introducing positive change in teaching in an institution undergoing transformation from a traditional content-based curriculum to a competency-based curriculum.

METHODOLOGY

Using Schein's "unfreezing" as a guide term we critically reflected on the popular change-management models, to home in on Kotter's model of change to transform organizations. However, Kotter's change-model draws from Situational and Contingency Leadership Theories, which may not agree with academic organizations involved in ME. As such organizations adhere to Transactional and Transformational Leadership archetypes, where Leadership is constructively executed by "The Leader Team", we decided to adopt Mento's change-model for our study. Mento's model not only draws from the precepts of Kotter's model, but also incorporates axioms of Jick's and GE's change-models.

RESULTS

Using Mento's model a framework was blueprinted to implement active learning (AL) strategies in CBME. Here we have elaborated on the framework using the exemplar of flipped teaching. The development of this framework required the design and execution of a faculty development program, and a step by step guidance plan to chaperon, instruct and implement change in teaching to harbinger CBME. Further, we have also reflected on the change process using Gravin's framework.

CONCLUSION

To our knowledge this is the first report of the use of Mento's model of change in medical education. Also, the blueprinted framework is supported by acknowledged leadership theories and can be translated to implement any curricular change in CBME.

Using an integrated teaching approach to facilitate student achievement of the learning outcomes in a preclinical medical curriculum in India

Today most education institutions around the world have adopted the philosophy of outcome-based education. The emphasis in outcome-based education is achievement of outcomes; hence the curriculum should be designed in a way that it includes the components targeted specifically at achieving these outcomes. A discipline-based approach results in fragmentation of learning and lack of clinical applicability. Integrated teaching could be a solution to achieve required outcomes in a holistic way. Hence, the aim of this study was to develop, implement, and evaluate an integrated teaching module. Temporal coordination of the basic sciences, along with correlation of learned topics to clinical settings, was done in the first year of the undergraduate medical program. The module was evaluated by obtaining qualitative and quantitative feedback from students. Student assessment was conducted with a test that had case vignettes and multiple-choice questions. In addition, students' change in learning approaches and self-directed learning readiness were collected. Students' perception regarding the educational environment was also obtained. Analysis of the data showed positive feedback from the students regarding the integrated teaching. Students' average score in the test was 86%. There was a significant increase in the scores for the deep approach and self-directed learning readiness in the posttest compared with the pretest. Moreover, students were found to be satisfied with the educational environment. Evaluation of integrated teaching revealed that it was well accepted by the students. Moreover, it facilitated the achievement of the students' outcomes.

Exploring opportunities for embedding graduate attributes in a first-year undergraduate anatomy course for allied health students

BACKGROUND

There is a growing discontent within the health care industry regarding the state of preparedness of graduates to adequately function in a dynamic work environment. It is therefore required of higher education institutions to equip graduates with skills beyond disciplinary expertise, which would allow them to function optimally in work environments. This study presents a team dissection project that incorporates graduate attributes in an undergraduate first-year anatomy course for the medical orthotics and prosthetics program.

METHOD

Focus group interviews with students (n = 23) were used to demonstrate the achievement of graduate attributes by aligning student perceptions of the dissection project with graduate attributes and indicators thereof.

RESULTS

Students were positive about the effectiveness of the dissection project in enforcing anatomical knowledge; ensuring active engagement with human material; enhancing communication skills and teamwork; and increasing sensitivity towards cultural diversity. These views related largely to those graduate attributes which engage students towards becoming active and reflective learners; creative thinkers; independent and collaborative workers; effective communicators; and culturally and socially aware citizens. Areas of dissatisfaction included challenges with the use of technology for the video preparation; repetition of presentations and large dissection teams.

CONCLUSION

There is an emerging view that graduate attributes be integrated as early as possible into program curricula so as to become intrinsic in a student's academic and professional development. Through the expansion of a dissection project forming part of a subject taught very early on in a program's curriculum, the integration of graduate attributes and discipline-specific competencies are highlighted.

Perceived clinical relevance and retention of basic sciences across the medical education continuum

Medical programs are under pressure to maintain currency with scientific and technical advances, as well as prepare graduates for clinical work and a wide range of postgraduate careers. The value of the basic sciences in primary medical education was assessed by exploring the perceived clinical relevance and test performance trends among medical students, interns, residents, and experienced clinicians. A pilot study conducted in 2014 involved administration of a voluntary 60-item multiple-choice question test to 225 medical students and 4 interns. These participants and 26 teaching clinicians rated the items for clinical relevance. In 2016, a similarly constructed test (main study) was made a mandatory formative assessment, attempted by 563 students in years 2, 4, and 6 and by 120 commencing general practice residents. Test scores, performance trends, clinical relevance ratings, and correlations were assessed using relevant parametric and nonparametric tests. Rank order and pass-fail decisions were also reviewed. The mean test scores were 57% (SD 7.1) and 52% (SD 6.1) for the pilot and main studies, respectively. Highest scores were observed in pathology and social sciences. Overall performance increased with increasing year of study. Test scores were positively correlated with perceived relevance. There were moderate correlations (r = 0.50-0.63; P < 0.001) between participants' scores in the basic science and summative exams. Assessments may be key to fostering relevance and integration of the basic sciences. Benchmarking knowledge retention and result comparisons across topics are useful in program evaluation.

Medical education dilemma: How can we best accommodate basic sciences in a curriculum for 21st century medical students?

Over the years, the medical curriculum has been changed to accommodate a variety of evolving disciplines and an exploding scientific knowledge of the basic sciences to prepare “a competent physician” of the 21st century. Therefore, we must be innovative in our approach of curricular development if we wish to continue to incorporate new basic sciences knowledge in the face of decreasing contact hours to satisfy the buzz word, “integration”. Certainly, the challenges are phenomenal. The question how to best integrate basic sciences, is not easy to answer as the objectives of the courses and outcome vary from one medical school to another and the fact is, one size does not fit all. However, if we believe that basic sciences are the language of medicine and foundation of clinical knowledge, then we must resolve this ongoing dilemma by introducing basic sciences through a better alignment in a given curriculum. The purpose of this review is to evaluate different curricular models for their basic sciences content and address their strengths and weaknesses. In addition, we will introduce a spiral design to integrate basic sciences for senior students. Finally, we will provide some insight as to how learning and retention of basic science content can be sustained.

Turning science into teaching: a challenge for scientists

This article was migrated. The article was marked as recommended. Teaching basic science in the medical school remains a challenge, and the lack of appropriate resources is one of important limitation. Building up such resources is difficult, time-costly and does not always result in effective, solid and student-centered instruction. This "personal view" aims to stimulate scientists and scientific journals to engage with new ideas and innovative resources for biomedical education. The time has now come to plan research and education as mutually beneficial activities, supporting each other rather than competing with each other. Scientific research should be converted into digital learning resources hosted by scientific journals on a regular basis, and subjected to peer-review to ensure quality and integration of contents, appropriate cognitive approach and rigorous criteria of selection. Turning science into teaching represents an investment with mutual benefits, for students and educators. Academic educators can produce resources to face the teaching burden, and gather the opportunity to increase personal productivity. Students can take advantage from being engaged in innovative learning environments where educators act as catalysts for learning, instead of just transmitters of knowledge.

The Quality Of Evidence In Preclinical Medical Education Literature: A Systematic Review

INTRODUCTION

To practice effective evidence-based teaching, the need for well-designed studies that describe outcomes related to educational interventions is critical. The quality of the literate in basic science disciplines is unknown. The study objective was to conduct a systematic review of the literature to assess study design in articles describing innovations in preclinical medical education.

METHOD

The authors searched PubMed for all articles published in English between 2000 and 2017 describing interventions in preclinical medical education related to anatomy, physiology, and biochemistry. Articles were scored using a modification of the Medical Education Research Study Quality Instrument.

RESULTS

Of the 817 articles identified, 177 met final inclusion criteria (75 anatomy, 86 physiology, and 16 biochemistry). Laboratory, student-driven, and online activities were the most frequently reported. The average score for all papers was 15.7 (27 points possible). More than 80% reported experiences with one cohort of students and >97% involved only one institution. Only 25-49% of reports utilized a comparison (control) group. Proper statistical models for analysis of results were used in only 44-62% of papers.

CONCLUSION

Manuscripts had a strong tendency toward single institutional studies that involved one cohort of students. The use of a control/comparison group when assessing effectiveness was seen in <50% and nearly all reported outcomes solely in the form of student satisfaction or factual recall/skill performance.

A novel 6D-approach to radically transform undergraduate medical education: preliminary reflections from MBRU

BACKGROUND

Designers of undergraduate medical education (UME) need to address the exponentially expanding volume and variability of scientific knowledge, where by didactic teaching techniques need to be augmented by innovative student-centric pedagogical strategies and implementation of milieus, where information, communication and technology-enabled tools are seamlessly integrated, and lifelong information gathering, assimilation, integration and implementation is the ultimate goal. In UME, the basic sciences provide a solid scaffold allowing students to develop their personal critical decisional framework as well as define the understanding of normal human physiology, pivotal for the identification, categorization and management of pathophysiology. However, most medical schools confine themselves to "stagnant curricula", with the implementation of traditional "teacher centered" pedagogical techniques in the dissemination of the courses pertaining to basic sciences in UME.

METHOD

To tackle the above paucity, we present a novel "6D-Approach" for the dissemination of concepts in basic sciences through mentored journal-clubs. The approach is informed by a teaching principle derived from Constructivism. The technique in which the 6D-approach can be implemented in UME, is shown using an example from a first-year course of Molecular Biology and Principles of Genetics at our medical school. A reflection on the impact of 6D-Approach for students as well as instructors is also presented.

RESULT

The 6D-approach was positively received by the students and the formal feedback for the course: Molecular Biology and Principles of Genetics, where the approach was repeatedly employed, indicated that students expressed satisfaction with the teaching strategies employed in the course, with ~ 89% of the students in the cohort strongly agreeing with the highest grading score "extremely satisfied". Further, the approach through the use of mentored journal clubs encourages retention of knowledge, critical thinking, metacognition, collaboration and leadership skills in addition to self-evaluation and peer feedback.

CONCLUSION

Hence, through the 6D-Approach, our attempt is to initiate, advance and facilitate critical thinking, problem-solving and self-learning in UME, demonstrated by graduating accomplished, competent and safe medical practitioners.

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.

Early experience with a combined surgical and obstetrics/gynecology clerkship: We do get along

BACKGROUND

In 2012, the Ohio State University College of Medicine (OSUCOM) implemented a new undergraduate medical curriculum. We compare outcomes of a third year traditional clerkship format to a combined Surgery and Obstetrics/Gynecology 'ring'.

METHODS

Performance outcomes of 4 consecutive classes were compared between pre- (2014, 2015) and post-curricular revision (2016, 2017).

RESULTS

Three hundred ninety-one students consented use of their educational data for research. We examined medical knowledge (NBME scores, USMLE Step 1 and Step 2 CK scores) and student satisfaction between pre- and post-curricular revision. Results demonstrated no statistically significant difference in the Obstetrics/Gynecology NBME shelf examination. Surgery NBME and USMLE Step 2 scores were increased and statistically significant but satisfaction of both disciplines was higher pre-curricular revision.

CONCLUSION

Medical knowledge outcomes in this combined 'ring' were similar to or higher than performance in previous years'. Future analyses are needed to assess the impact of OSUCOM curricular revision.

Benchmarking for research-related competencies - a curricular mapping approach at medical faculties in Germany

OBJECTIVES

Internationally, scientific and research-related competencies need to be sufficiently targeted as core outcomes in many undergraduate medical curricula. Since 2015, standards have been recommended for Germany in the National Competency-based Learning Objective Catalogue in Medicine (NKLM). The aim of this study is to develop a multi-center mapping approach for curricular benchmarking against national standards and against other medical faculties.

METHOD

A total of 277 faculty members from four German medical faculties have mapped the local curriculum against the scientific and research-related NKLM objectives, using consented procedures, metrics, and tools. The amount of mapping citations of each objective is used as indicator for its weighting in the local curriculum. Achieved competency levels after five-year education are compared.

RESULTS

All four programs fulfill the NKLM standards, with each emphasizing different sub-competencies explicitly in writing (Scholar: 17-41% of all courses; Medical Scientific Skills: 14-37% of all courses). Faculties show major or full agreement in objective weighting: Scholar 44%, scientific skills 79%. The given NKLM competency level is met or even outperformed in 78-100% of the courses.

CONCLUSIONS

The multi-center mapping approach provides an informative dataset allowing curricular diagnosis by external benchmarking and guidance for optimization of local curricula.

Basic Sciences Fertilizing Clinical Microbiology and Infection Management

Basic sciences constitute the most abundant sources of creativity and innovation, as they are based on the passion of knowing. Basic knowledge, in close and fertile contact with medical and public health needs, produces distinct advancements in applied sciences. Basic sciences play the role of stem cells, providing material and semantics to construct differentiated tissues and organisms and enabling specialized functions and applications. However, eventually processes of "practice deconstruction" might reveal basic questions, as in de-differentiation of tissue cells. Basic sciences, microbiology, infectious diseases, and public health constitute an epistemological gradient that should also be an investigational continuum. The coexistence of all these interests and their cross-fertilization should be favored by interdisciplinary, integrative research organizations working simultaneously in the analytical and synthetic dimensions of scientific knowledge.

Integration of Basic and Clinical Science in the Psychiatry Clerkship

OBJECTIVE

Integration of basic and clinical science is a key component of medical education reform, yet best practices have not been identified. The authors compared two methods of basic and clinical science integration in the psychiatry clerkship.

METHODS

Two interventions aimed at integrating basic and clinical science were implemented and compared in a dementia conference: flipped curriculum and coteaching by clinician and physician-scientist. The authors surveyed students following each intervention. Likert-scale responses were compared.

RESULTS

Participants in both groups responded favorably to the integration format and would recommend integration be implemented elsewhere in the curriculum. Survey response rates differed significantly between the groups and student engagement with the flipped curriculum video was limited.

CONCLUSIONS

Flipped curriculum and co-teaching by clinician and physician-scientist are two methods of integrating basic and clinical science in the psychiatry clerkship. Student learning preferences may influence engagement with a particular teaching format.

Testing and evaluation: the present and future of the assessment of medical professionals

The aim of this review is to highlight recent and potential future enhancements to the United States Licensing Examination (USMLE) program. The USMLE program is co-owned by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards. The USMLE includes four examinations: Step 1, Step 2 Clinical Knowledge, Step 2 Clinical Skills, and Step 3; every graduate of Liaison Committee on Medical Education-accredited allopathic medical schools and all international medical graduates must pass this examination series to practice medicine in the United States. From 2006 to 2009, the program underwent an indepth review resulting in five accepted recommendations. These recommendations have been the primary driver for many of the recent enhancements, such as an increased emphasis on foundational science and changes in the clinical skills examination, including more advanced communication skills assessment. These recommendations will continue to inform future changes such as access to references (e.g., a map of metabolic pathways) or decision-making tools for use during the examination. The NBME also provides assessment services globally to medical schools, students, residency programs, and residents. In 2015, >550,000 assessments were provided through the subject examination program, NBME self-assessment services, and customized assessment services.

Exploring eye movements of experienced and novice readers of medical texts concerning the cardiovascular system in making a diagnosis

This study used the eye-tracking method to explore how the level of expertise influences reading, and solving, two written patient cases on cardiac failure and pulmonary embolus. Eye-tracking is a fairly commonly used method in medical education research, but it has been primarily applied to studies analyzing the processing of visualizations, such as medical images or patient video cases. Third-year medical students (n = 39) and residents (n = 13) read two patient case texts in an eye-tracking laboratory. The analysis focused on the diagnosis made, the total visit duration per text slide, and eye-movement indicators regarding task-relevant and task-redundant areas of the patient case text. The results showed that almost all participants (48/52) made the correct diagnosis of the first patient case, whereas all the residents, but only 17 students, correctly diagnosed the second case. The residents were efficient patient-case-solvers: they reached the correct diagnoses, and processed the cases faster and with a lower number of fixations than did the students. Further, the students and residents demonstrated different reading patterns with regard to which slides they proportionally paid most attention. The observed differences could be utilized in medical education to model expert reasoning and to teach the manner in which a good medical text is constructed. Eye-tracking methodology appears to have a great deal of potential in evaluating performance and growing diagnostic expertise in reading medical texts. However, further research using medical texts as stimuli is required. Anat Sci Educ 10: 23-33. © 2016 American Association of Anatomists.

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.

Status of physiology education in US Doctor of Pharmacy programs

The purpose of the present study was to assess the current status of physiology education in US Doctor of Pharmacy (PharmD) programs. A survey instrument was developed and distributed through SurveyMonkey to American Association of Colleges of Pharmacy (AACP) Biological Sciences section members of 132 PharmD programs. Survey items focused on soliciting qualitative and quantitative information on the delivery of physiology curricular contents and faculty perceptions of physiology education. A total of 114 programs responded to the survey, resulting in a response rate of 86%. Out of 114 schools/colleges, 61 programs (54%) offered standalone physiology courses, and 53 programs (46%) offered physiology integrated with other courses. When integrated, the average contact hours for physiology contents were significantly reduced compared with standalone courses (30 vs. 84 h, P < 0.0001). Survey respondents identified diverse strategies in the delivery and assessment of physiology contents. Eighty percent of the responding faculty (n = 204) agree/strongly agree that physiology is underemphasized in PharmD curriculum. Moreover, 67% of the respondents agree/strongly agree that physiology should be taught as a standalone foundational course. A wide variation in the depth and breadth of physiology course offerings in US PharmD programs remains. The reduction of physiology contents is evident when physiology is taught as a component of integrated courses. Given current trends that favor integrated curricula, these data suggest that additional collaboration among basic and clinical science faculty is required to ensure that physiology contents are balanced and not underemphasized in a PharmD curriculum.

Vertical integration of biochemistry and clinical medicine using a near-peer learning model

Vertical integration has been extensively implemented across medical school curricula but has not been widely attempted in the field of biochemistry. We describe a novel curricular innovation in which a near-peer learning model was used to implement vertical integration in our medical school biochemistry course. Senior medical students developed and facilitated a case-based small group session for first year biochemistry students. Students were surveyed before and after the session on their attitudes about biochemistry, as well as the effectiveness of the session. Prior to the session, the students believed biochemistry was more important to understanding the basic science of medicine than it was to understanding clinical medicine or becoming a good physician. The session improved students' attitudes about the importance of biochemistry in clinical medicine, and after the session they now believe that understanding biochemistry is equally important to the basic sciences as clinical medicine. Students would like more sessions and believe the senior student facilitators were knowledgeable and effective teachers. The facilitators believe they improved their teaching skills. This novel combination of near-peer learning and vertical integration in biochemistry provided great benefit to both first year and senior medical students, and can serve as a model for other institutions. © 2016 by The International Union of Biochemistry and Molecular Biology, 44(6):507-516, 2016.

Medical students' attitudes towards early clinical exposure in Iran

OBJECTIVE

This study was carried out to investigate the medical students' attitudes towards early clinical exposure at Tehran University of Medical Sciences.

METHODS

A cross-sectional study was conducted during 2012-2015. A convenience sample of 298 first- and second-year students, enrolled in the undergraduate medical curriculum, participated in an early clinical exposure program. To collect data from medical students, a questionnaire consisting of open-ended questions and structured questions, rated on a five-point Likert scale, was used to investigate students' attitudes toward early clinical exposure.

RESULTS

Of the 298 medical students, 216 (72%) completed the questionnaires. The results demonstrated that medical students had a positive attitude toward early clinical exposure. Most students (80.1%) stated that early clinical exposure could familiarize them with the role of basic sciences knowledge in medicine and how to apply this knowledge in clinical settings. Moreover, 84.5% of them believed that early clinical exposure increased their interest in medicine and encouraged them to read more. Furthermore, content analysis of the students' responses uncovered three main themes of early clinical exposure, were considered helpful to improve learning: "integration of theory and practice", "interaction with others and professional development" and "desire and motivation for learning medicine".

CONCLUSIONS

Medical students found their first experience with clinical setting valuable. Providing clinical exposure in the initial years of medical curricula and teaching the application of basic sciences knowledge in clinical practice can enhance students' understanding of the role they will play in the future as a physician.

Predictors of High Motivation Score for Performing Research Initiation Fellowship, Master 1, Research Master 2, and PhD Curricula During Medical Studies: A Strobe-Compliant Article

Translational research plays a crucial role in bridging the gap between fundamental and clinical research. The importance of integrating research training into medical education has been emphasized. Predictive factors that help to identify the most motivated medical students to perform academic research are unknown. In a cross-sectional study on a representative sample of 315 medical students, residents and attending physicians, using a comprehensive structured questionnaire we assessed motivations and obstacles to perform academic research curricula (ie, research initiation fellowship, Master 1, Research Master 2, and PhD). Independent predictive factors associated with high "motivation score" (top quartile on motivation score ranging from 0 to 10) to enroll in academic research curricula were derived using multivariate logistic regression analysis. Independent predictors of high motivation score for performing Master 1 curriculum were: "considering that the integration of translational research in medical curriculum is essential" (OR, 3.79; 95% CI, 1.49-9.59; P = 0.005) and "knowledge of at least 2 research units within the university" (OR, 3.60; 95% CI, 2.01-6.47; P < 0.0001). Independent predictors of high motivation score for performing Research Master 2 curriculum were: "attending physician" (OR, 4.60; 95% CI, 1.86-11.37; P = 0.001); "considering that the integration of translational research in medical curriculum is essential" (OR, 4.12; 95% CI, 1.51-11.23; P = 0.006); "knowledge of at least 2 research units within the university" (OR, 3.51; 95% CI, 1.91-6.46; P = 0.0001); and "male gender" (OR, 1.82; 95% CI, 1.02-3.25; P = 0.04). Independent predictors of high motivation score for performing PhD curriculum were: "considering that the integration of translational research in medical curriculum is essential" (OR, 5.94; 95% CI, 2.33-15.19; P = 0.0002) and "knowledge of at least 2 research units within the university" (OR, 2.63; 95% CI, 1.46-4.77; P = 0.001). This is the first study that has identified factors determining motivations and barriers to carry out academic research curricula among undergraduate and postgraduate medical students. Improving these 2 areas will certainly have an impact on a better involvement of the next generation of physicians in translational medicine.

Nanomedicine concepts in the general medical curriculum: initiating a discussion

Various applications of nanoscale science to the field of medicine have resulted in the ongoing development of the subfield of nanomedicine. Within the past several years, there has been a concurrent proliferation of academic journals, textbooks, and other professional literature addressing fundamental basic science research and seminal clinical developments in nanomedicine. Additionally, there is now broad consensus among medical researchers and practitioners that along with personalized medicine and regenerative medicine, nanomedicine is likely to revolutionize our definitions of what constitutes human disease and its treatment. In light of these developments, incorporation of key nanomedicine concepts into the general medical curriculum ought to be considered. Here, I offer for consideration five key nanomedicine concepts, along with suggestions regarding the manner in which they might be incorporated effectively into the general medical curriculum. Related curricular issues and implications for medical education also are presented.