Integrating Basic and Clinical Sciences

Presentation by: Amy L. Wilson-Delfosse, Ph.D.James Bruzik, Ph.D.Case Western Reserve UniversitySchool of Medicine

Why Did Case Change?

The Western Reserve curriculum designed in the 1950s continued with only minor revisions despite enhancements in computer technology and unprecedented changes in the health care system

Classrooms with ~30% of students attending

Watching lectures online double time

Paper syllabus boundaries

Students not preparing for class

Teacher-centered

Why Did Case Change?

Course silos “I don’t know if you’ve had this yet but”

Multiple choice tests –nothing else counted, binge and purge approach to learning

Difficult to get faculty to teach – clinical and research productivity

Dean’s Vision – research and scholarship block and MD thesis

Principles of Western Reserve2: Building on Western Reserve1

Integration of health and disease (normal and abnormal) – systems biology

Experiential learning, scholarship, critical thinking, lifelong learning

Active interchange of ideas between students and faculty

Graduate school environment – independent study and self-directed learning

Weave scientific foundations and clinical medicine throughout the 4 year curriculum

Principles of Western Reserve2: Building on Western Reserve1

Integration of health and disease (normal and abnormal) – systems biology

Experiential learning, scholarship, critical thinking, lifelong learning

Active interchange of ideas between students and faculty

Graduate school environment – independent study and self-directed learning

Weave scientific foundations and clinical medicine throughout the 4 year curriculum

Year I Year II Year III Year IV

Foundations of Medicine and Health

(20 months, including vacation)

Core Clinical Rotations

IQ+ Program

(48 weeks, flexible scheduling)

Research &

Scholarship

(16 week block +

electives, flexible

scheduling)

Advanced Clinical and Scientific

Studies

Areas of Concentration

Electives

(10 months, flexible scheduling)

Western Reserve2 Curriculum

Refl

ect

ion

, In

teg

rati

on

& A

ssess

men

t

Refl

ect

ion

, In

teg

rati

on

& A

ssess

men

t

Refl

ect

ion

, In

teg

rati

on

&

Ass

ess

men

t

Refl

ect

ion

, In

teg

rati

on

&

Ass

ess

men

t

July Year 1

March Year 2

Homeostasis

Host Defense and Host Response

Cognition, Sensation,

and Movement

Food to Fuel

(Host Defense,

Microbiology,

Blood, Skin,Auto-

immune)

(Endo, Repro,

Development,

Genetics, Mol Biol, Cancer

Biology)

(GI, Nutrition,

Energy, Metabolism, Biochemistry

)

(Neuro, MindMusculoskelet

al, Cellular Neurophysiolo

gy

(CV, Pulm, Renal, Cell Regulation,

Pharmacology, Cell

physiology)

The Human Bluepri

nt

Refl

ect

ion

, In

teg

rati

on

&

Ass

ess

men

t

1 Week Clinical Immersi

on

1 Week Clinical Immersi

on

1 Week Clinical Immersi

on

1 Week Clinical Immersi

on

1 Week Clinical Immersi

on

BOARD REVIEW BLOCK

(Medical Error, Public Health,

Inequities, Bioethics, Profession

alism Epi/Biostat

s)

Becoming a

Doctor

(5 wk)

Refl

ect

ion

, In

teg

rati

on

&

Ass

ess

men

t

Structure (Anat., Histo-Path, Radiology)

Foundations of Clinical Medicine

WR2 Foundations of Medicine and Health

Case Inquiry Group (IQ)

Student-centered small groups with a faculty facilitator

Case-based

Self-directed learning

Team work

Quality improvement – “check out”

August to December

Year 1

January (Year 1) to

December (Year 2)

January

Year 2

Introduction to clinical

skills

Advanced Clinical Skills

RAMP (Rotating

Apprenticeships in Medical

Practice)

Clinical Preceptorships

FCM Seminars Health Policy, Leadership and

Advocacy, Professionalism, Ethics

Web Resources

Integration andAssessment

WR2: Eary Patient Experiences

Core and Advanced Clinical Experiences: Core Clinical Rotations

Core 1 (16 weeks): Internal Medicine and Surgery + Peri-Op and Acute Pain

Core 2 (16 weeks): Pediatrics, OB-Gyn, Family Medicine (Prevention/Wellness)

Core 3 (8 weeks): Neuroscience and Psychiatry + Chronic pain

Advanced Cores (4 weeks each): Undifferentiated and Emergent Care Aging and Society: Geriatrics, Chronic Disease, Palliative

Care, Health Systems

4 hours Friday afternoon in group of 10-12 students

Reinforce importance of basic science and emerging basic science knowledge in the practice of clinical medicine

Continue to use a team-based, learner-centered small group to enhance professional growth and development

Practice advanced skills in communication, physical exam, clinical reasoning, evidence based medicine

Reflection

Case discussion – DDX and learning objectives

Research and discussion with experts (basic science and clinical faculty)

Skills practice

Checkout

Example Case: HLHS

Check-in: Debrief, possible directed reflections on dealing with a sick child or the parent of a sick child.

Go through the case in step by step – starting with a “blue baby”– generate a differential diagnosis, discuss the perinatal changes in the circulation

Come up with a list of learning objectives and questions for the experts.

Expert session - paired basic scientist & neonatologist meet with larger group. Mini-didactics + Q+A – focusing on emerging science on the heritable nature of this problem + clinical insights.

HLHS continued …

Skills practice – Students interview the standardized parent of this baby – script calls for integration of recently learned information + focus on delivering bad news and communicating with families.

Check out

HLHS continued …

Assessment

Attendance

Facilitator assessment

Case development/presentation (teams)Students write cases and run the IQ+ afternoonOpportunities for scholarship Opportunities for peer teaching

Acknowledgements

The faculty, staff and students of CWRU School of Medicine