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Integrating Foundational Sciences in a Clinical Context in the Post-clerkship Curriculum

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Abstract

Purpose

This study aims to design, implement, and launch courses that integrate foundational science learning and clinical application in a post-clerkship undergraduate medical school curriculum.

Method

In academic year 2015–2016 (AY15–16), as part of a comprehensive curricular revision, Vanderbilt University School of Medicine (VUSM) formally implemented “Integrated Science Courses” (ISCs) that combined rigorous training in the foundational sciences with meaningful clinical experiences. These courses integrated foundational sciences that could be leveraged in the clinical environment, utilized a variety of instructional modalities, and included quantitative and qualitative (competency-based milestones) student assessments. Each ISC underwent a rigorous quality-improvement process that required input on foundational science content, student experience, and student performance assessment.

Results

Eleven ISCs were delivered to 173 students in AY15–16, with some students taking more than one ISC. Immediately after completing each course, 93% (n = 222) of ISC enrollees completed a course evaluation. Students (91%; n = 201) “agreed” or “strongly agreed” that foundational science learning informed and enriched the clinical experiences. Furthermore, 94% (n = 209) of students thought that the clinical experiences informed and enriched the foundational science learning. Ninety-four percent of the students anticipated using the foundational science knowledge acquired in future clinical training and practice.

Conclusion

The teaching of foundational sciences in the clinical workplace in the post-clerkship medical curriculum is challenging and resource intensive, yet feasible. Additional experience with the model will inform the mix of courses as well as the breadth and depth of foundational science instruction that is necessary to foster scientifically based clinical reasoning skills in each student.

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Notes

  1. At VUSM, foundational sciences are broadly defined to encompass the knowledge and skills that form the foundation of clinical practice; it focuses on the “why” of patient care rather than the “what” or “how” (i.e., clinical decision making). Foundational science includes basic science, population and system science, sociological and psychological science, and where appropriate, humanities (e.g., medical ethics). The emphasis is on origins, composition, purpose, mechanisms, interactions, and consequences.

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Acknowledgements

We thank Dr. Bonnie Miller and the Vanderbilt University School of Medicine (VUSM) leadership for their support, the ISC directors, and the faculty who delivered and/or reviewed the foundational sciences in the ISCs. We also thank Dr. Charlene Dewey for constructing and executing Curriculum Design Sessions for the ISC directors. The Immersion Phase medical student liaisons Deirdre Finnegan, Nathan Friedman, and Jared Shenson provided ongoing course feedback. Special thanks to Brenna Hansen and Kacy Morgan, Immersion Phase Program Coordinators, for their administrative support.

Funding

Kimberly Brown Dahlman was supported in part by grants 5P30CA068485-21 and U10CA180847 from the National Institutes of Health (NIH) and the TJ Martell Foundation. Neil Osheroff was supported in part by grant GM033944 from the NIH and Merit Review award I01Bx002198 from the United States Veterans Administration. Matthew Weinger’s time was supported in part by the Geriatric Research Education and Clinical Centers of the Department of Veterans Affairs. Donald E Moore was supported in part by CMS Contract 1L1CMS331461-01-00 with Vanderbilt University and The Mid-South Practice Transformation Network. The innovation described in this study was implemented with partial financial support from the American Medical Association (AMA) as part of its Accelerating Change in Medical Education Initiative. The content of this manuscript reflects the views of VUSM and does not necessarily represent the views of AMA or other participants in this Initiative.

Author information

Authors and Affiliations

  1. Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA

    Kimberly Brown Dahlman & Lourdes Estrada

  2. Department of Anesthesiology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA

    Matthew B. Weinger

  3. Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, 37232, USA

    Matthew B. Weinger

  4. Department of Medical Education and Administration, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA

    Matthew B. Weinger, Kimberly D. Lomis, Lillian Nanney & Donald E. Moore Jr

  5. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA

    Kimberly D. Lomis

  6. Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA

    Lillian Nanney

  7. Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA

    Lillian Nanney

  8. Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA

    Neil Osheroff

  9. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA

    Neil Osheroff

  10. Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, 37232, USA

    Neil Osheroff

  11. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA

    William B. Cutrer

Authors
  1. Kimberly Brown Dahlman
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  2. Matthew B. Weinger
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  3. Kimberly D. Lomis
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  4. Lillian Nanney
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  5. Neil Osheroff
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  6. Donald E. Moore Jr
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  7. Lourdes Estrada
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  8. William B. Cutrer
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Corresponding author

Correspondence to Kimberly Brown Dahlman.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.

Electronic Supplementary Material

Online resource 1

Characteristics of Integrated Science Courses. The table describes the core foundational sciences, clinical settings, and sample curricular elements for each of the 11 ISCs launched at VUSM in academic year 2015–2016. (PDF 121 kb)

Online resource 2

Course evaluation survey. This anonymous electronic survey was sent to students after the completion of each ISC in academic year 2015–2016. Students were required to complete the survey no later than 2 weeks after the end of each course. (PDF 162 kb)

Online resource 3

ISC Evaluation outcomes. A table containing student ratings of particular ISC elements from academic year 2015–2016 is shown. (PDF 107 kb)

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Dahlman, K.B., Weinger, M.B., Lomis, K.D. et al. Integrating Foundational Sciences in a Clinical Context in the Post-clerkship Curriculum. Med.Sci.Educ. 28, 145–154 (2018). https://doi.org/10.1007/s40670-017-0522-1

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  • DOI: https://doi.org/10.1007/s40670-017-0522-1

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