Mr. Kulasegaram is a PhD candidate, Clinical Epidemiology and Biostatistics Program and Program for Education Research and Development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. He is also a Wilson Centre Fellow, University of Toronto, Toronto, Ontario, Canada. Dr. Martimianakis is director of scholarship, assistant professor, Department of Paediatrics, and scientist, Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Dr. Mylopoulos is assistant professor of paediatrics, University of Toronto, scientist, Learning Institute, Sick Kids Hospital, and scientist, Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Dr. Whitehead is vice chair for education, associate professor, Department of Family and Community Medicine, scientist, Wilson Centre, and education scientist, Centre for Ambulatory Care Education, Women's College Hospital, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Dr. Woods is assistant professor, Department of Surgery, and education scientist, Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Acad Med. 2013 Oct;88(10):1578-85. doi: 10.1097/ACM.0b013e3182a45def.
Integrating basic science and clinical concepts in the undergraduate medical curriculum is an important challenge for medical education. The health professions education literature includes a variety of educational strategies for integrating basic science and clinical concepts at multiple levels of the curriculum. To date, assessment of this literature has been limited.
In this critical narrative review, the authors analyzed literature published in the last 30 years (1982-2012) using a previously published integration framework. They included studies that documented approaches to integration at the level of programs, courses, or teaching sessions and that aimed to improve learning outcomes. The authors evaluated these studies for evidence of successful integration and to identify factors that contribute to integration.
Several strategies at the program and course level are well described but poorly evaluated. Multiple factors contribute to successful learning, so identifying how interventions at these levels result in successful integration is difficult. Evidence from session-level interventions and experimental studies suggests that integration can be achieved if learning interventions attempt to link basic and clinical science in a causal relationship. These interventions attend to how learners connect different domains of knowledge and suggest that successful integration requires learners to build cognitive associations between basic and clinical science.
One way of understanding the integration of basic and clinical science is as a cognitive activity occurring within learners. This perspective suggests that learner-centered, content-focused, and session-level-oriented strategies can achieve cognitive integration.
将基础科学和临床概念整合到本科医学课程中，是医学教育面临的一项重要挑战。在卫生专业教育文献中，包含了多种在课程的多个层次整合基础科学和临床概念的教育策略。迄今为止，对这些文献的评估十分有限。
在这项批判性叙述性综述中，作者使用先前发表的整合框架，分析了过去 30 年（1982-2012 年）发表的文献。纳入的研究记录了在项目、课程或教学单元层面的整合方法，并旨在改善学习成果。作者评估了这些研究以确定整合的成功证据，并确定有助于整合的因素。
在课程层面有一些策略得到了很好的描述，但评估效果不佳。许多因素有助于成功学习，因此，确定这些层面的干预措施如何导致成功的整合是困难的。来自单元层面的干预和实验研究的证据表明，如果学习干预试图将基础科学和临床科学联系起来建立因果关系，那么整合是可以实现的。这些干预措施关注学习者如何连接不同的知识领域，并表明成功的整合需要学习者在基础科学和临床科学之间建立认知关联。
理解基础科学和临床科学整合的一种方法是将其视为学习者内部的认知活动。这一观点表明，以学习者为中心、以内容为重点、以单元为导向的策略可以实现认知整合。
