July 2002
Workshop Review: “Basic Science Education And Medical Education: Exploring Program Designs That Integrate”
Workshop leaders: Marcel D’Eon, University of Saskatchewan, Heather Lochlan, University of Ottawa,
Alan Neville, McMaster University, Henry Mandin, University of Calgary, and Martha Lyon, University of Calgary

Participants in the workshop were grouped by choice into possible organizational approaches to integrating basic and clinical sciences. Each group spent about two hours in discussion and prepared a poster to display in a “walkabout” late in the day. During the walkabout, all participants added questions and notes to the posters.

1. A number of interesting ideas and questions came from the groups looking at block-based and PBL curricula, as well as the group looking at the change process itself:
   • What should be taught in the curriculum, and how is that decision made? How does a faculty come to consensus about content?
   • How should the content be organized? (e.g. normal to abnormal, clinical problems, vertically integrated spiral design built in?)
   • Who should organize the curriculum? The issue of specialists vs generalists as organizers and/or teachers was raised in all groups.
   • How should the content be taught, once organized?
   • How can longitudinal “golden threads” be woven through the curriculum? What are important unifying themes?
   • How should students be assessed? Who should be involved in planning for the assessments?
   • How are faculty issues dealt with: number of faculty involved in teaching, team teaching, faculty development, faculty reward?
   • What is the role of senior management in facilitating change processes?
2. Two groups looked at aspects of the clinical presentation model for curriculum. In this model, the curriculum is organized around the ways in which patients present to their physicians (about 125 different presentations have been identified). These can be grouped into “system” groupings or other appropriate sequences. Vertical integration is built into the curriculum: students study all of the clinical presentations during the preclinical years and then study them again, in greater depth, when they encounter patients during their clerkships. Clinical skills are taught parallel to the clinical presentations. Schemes (developed by experts) are used to help students understand the content (basic science and clinical) in each presentation.

   The cognitive science basis for this clinical presentation curricular model is that content specificity
   is essential in diagnosing patient problems. There is no “general” problem-solving ability that applies in every case. A recent study* at the University of Calgary demonstrated that first-year students who structured their knowledge using the schemes were more successful on unit tests than those who did not. Another study presented at this conference** showed that clinicians using either schemes or pattern recognition showed greater success in diagnosis than those using hypothetico-deductive reasoning. Curricular threads, mentioned earlier, can be easily woven through this kind of curriculum. At the University of Calgary, an integrative course occurs at the end of each academic year providing for intentional repetition and knowledge transfer.
   

Notes:
* McLaughlin K and Mandin H. Using “concept sorting” to study learning processes and outcomes. Acad. Med. 2002;77:831-836.

** Coderre, S., Mandin, H., Harasym, P., and Fick, G.H. (University of Calgary). The effect of diagnostic reasoning on diagnostic success. Oral Presentation at 10th Ottawa Conference, July, 2002.

Reported by:
Jeanne Kangas, <jkangas@kcom.edu>
Curriculum Coordinator
Kirkesville College of Osteopathic Medicine