One of the most common ways that was found in the analysis of website data was the integration of basic and clinical sciences. It was found that 55.8% of all medical programs utilized the term “integration of basic and clinical sciences” to some degree. Teaching the clinical sciences along with the foundational basic sciences is a vital aspect of the medical curriculum, especially during the pre-clerkship years when students are beginning to learn the ways in which to treat patients. This important time in a medical student’s career is not only a time to learn about the human body, but also how to treat the human body. Cooke et al. (2010, pg. 216) proposed similar guidelines for the incorporation of clinical experience:
• Closely connect formal knowledge and clinical experience, including provisions of early clinical immersion and later revisiting of the sciences
• Examine diseases and clinical situations from multiple perspectives • Give learners access to different roles and responsibilities of physicians • Promote learner’ ability to work collaboratively with other health
professionals to effectively deliver patient care in complex systems Students need to not just know the foundational knowledge related to their coursework, but they need to be able to apply that knowledge in a clinical setting. Ways in which medical schools can do this are through case studies, problem-based learning sessions, and team-based learning sessions. Below is an example of a problem-based learning session that students in the Neuroscience and Behavior course at Indiana University School of Medicine (IUSM) complete.
Nadine is a 63 year old Caucasian female who presented to the emergency department due to an episode of confusion with a fever of 100.5F and a cough. It was determined by the emergency department that she suffered from delirium secondary to an atypical pneumonia and was admitted to rule out sepsis. Her delirium improved and she was released from the hospital shortly, but after continuing episodes of confusion her husband decided to bring her to their family physician. The family physician performed an MMSE and took additional labs, after which she was referred to a neurologist.
After further neuropsychological testing, the neurologist determined that Nadine was suffering from mild to moderate dementia, most likely due to Alzheimer’s disease. The neurologist ruled out non-neurodegenerative disease processes by utilizing a careful history and physical examination skills along with MRI studies. He started Nadine on a standard Alzheimer’s treatment regimen and instructed her to return every four to six months or if a significant neurological event occurs.
A few years later the neurologist is puzzled that Nadine has not experienced the steady neurodegeneration expected from an Alzheimer’s patient. He reviews Nadine’s chart and determines that she most likely suffers from vascular rather than Alzheimer’s dementia. A FMRI confirms this diagnosis and the neurologist starts her on antiplatelet therapy. In addition, Nadine seems to be suffering from depression symptoms and she is started on an SSRI. Nadine’s husband admits he is suffering from stress related to caretaking for Nadine and he agrees to seek support from Alzheimer’s caretaker support groups and be evaluated by their family physician for depression symptoms.
This case is based on the natural disease history of Nadine of Pittsburgh, PA, including accurate and original laboratory, neurological, and imaging results. Release of information and permission to include her story in this PBL was obtained from her power of attorney. Supplemental materials and images were obtained through the Ruth Lilly Library medical library of the Indiana University School of Medicine.
For this case, students have a list of session objectives that must complete and understand during the duration of the case, including the following:
1. Become familiar with common etiologies and presentations of altered mental status in the elderly
2. Understand the basic history, physical exam, and laboratory work-up for an elderly patient presenting with altered mental status
3. Learn how to discriminate between normal aging processes, delirium, and dementia using the CAM and MMSE tools
4. Become familiar with common causes and treatments for delirium in the elderly
5. Describe the neuropsycological, biochemical, and neuroanatomy changes that occur in dementia
6. Become familiar with the natural history and treatment of Alzheimer’s and vascular dementia
7. Understand the role psychiatric comorbidities and social circumstances can play in the treatment of a dementia patient
Additional ways to integrate basic science and clinical knowledge is to allow the students to interact with patients relatively early in their medical career (Cooke et al., 2010). It’s important to not make students wait until their clerkship years to interact with patients. Rather, students need to begin patient interaction as soon as possible, so students can utilize their basic science knowledge in the real world and not just in a classroom setting. As this research is primarily about classroom-based education of medical students in their pre-clerkship years, the author does not delve deeper into this argument, other than to say it’s important for students to understand their medical education is not solely in the classroom, but also out in the world interacting with real people.