Daniel Michelle, Morrison Gail, Hauer Karen E, Pock Arnyce, Seibert Christine, Amiel Jonathan, Poag Molly, Ismail Nadia, Dalrymple John L, Esposito Karin, Pettepher Cathleen, Santen Sally A
M. Daniel is vice dean for medical education and clinical professor of emergency medicine, University of California, San Diego School of Medicine, San Diego, California, and former assistant dean for curriculum, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119 .
G. Morrison is executive director, The Innovation Center for Online Medical Education, and professor of medicine and former senior vice dean for education, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Acad Med. 2021 Aug 1;96(8):1125-1130. doi: 10.1097/ACM.0000000000003908. Epub 2020 Dec 29.
Calls for curricular reform in medical schools and enhanced integration of basic and clinical science have resulted in a shift toward preclerkship curricula that enhance the clinical relevance of foundational science instruction and provide students with earlier immersion in the clinical environment. These reforms have resulted in shortened preclerkship curricula, yet the promise of integrated basic science education into clerkships has not been sufficiently realized because of barriers such as the nature of clinical practice, time constraints, and limited faculty knowledge. As personalized medicine requires that physicians have a more nuanced understanding of basic science, this is cause for alarm. To address this problem, several schools have developed instructional and assessment strategies to better integrate basic science into the clinical curriculum. In this article, faculty and deans from 11 U.S. medical schools discuss the strategies they implemented and the lessons they learned to provide guidance to other schools seeking to enhance basic science education during clerkships. The strategies include program-level interventions (e.g., longitudinal sessions dedicated to basic science during clerkships, weeks of lessons dedicated to basic science interspersed in clerkships), clerkship-level interventions (e.g., case-based learning with online modules, multidisciplinary clerkship dedicated to applied science), bedside-level interventions (e.g., basic science teaching scripts, self-directed learning), and changes to formative and summative assessments (e.g., spaced repetition/leveraging test-enhanced learning, developing customized examinations). The authors discovered that: interventions were more successful when buy-in from faculty and students was considered, central oversight by curricular committees collaborating with faculty was key, and some integration efforts may require schools to provide significant resources. All schools administered the United States Medical Licensing Examination Step 1 exam to students after clerkship, with positive outcomes. The authors have demonstrated that it is feasible to incorporate basic science into clinical clerkships, but certain challenges remain.
对医学院课程改革以及加强基础科学与临床科学整合的呼吁，已促使向预科课程转变，这种转变增强了基础科学教学的临床相关性，并让学生更早地融入临床环境。这些改革导致预科课程缩短，但由于临床实践的性质、时间限制和教师知识有限等障碍，将基础科学教育融入见习课程的愿景尚未充分实现。鉴于个性化医疗要求医生对基础科学有更细致入微的理解，这令人担忧。为解决这一问题，一些学校已制定教学和评估策略，以更好地将基础科学融入临床课程。在本文中，来自11所美国医学院的教师和院长讨论了他们实施的策略以及学到的经验教训，为其他寻求在见习期间加强基础科学教育的学校提供指导。这些策略包括项目层面的干预措施（例如，见习期间专门用于基础科学的纵向课程、穿插在见习期间的为期数周的基础科学课程）、见习层面的干预措施（例如，基于案例的在线模块学习、专注于应用科学的多学科见习）、床边层面的干预措施（例如，基础科学教学脚本、自主学习）以及形成性和总结性评估的变革（例如，间隔重复/利用测试强化学习、开发定制考试）。作者发现：当考虑到教师和学生的支持时，干预措施会更成功，课程委员会与教师合作进行的集中监督是关键，并且一些整合工作可能需要学校提供大量资源。所有学校在见习结束后都对学生进行了美国医师执照考试第一步考试，结果良好。作者证明了将基础科学纳入临床见习是可行的，但仍存在某些挑战。
