“There can be no doubt that the future of pathology and of therapeutics, and, therefore, of practical medicine, depends upon the extent to which those who occupy themselves with these subjects are trained in the methods and impregnated with the fundamental truths of biology.”
That statement, attributed to biologist and anatomist Thomas Huxley, appears in a 1909 paper entitled “The Preparation for the Study of Medicine” (Popular Science, volume 75). The author, Dr. Frederic T. Lewis, goes on to support this position by presenting the results of a study of first year medical students based on the number of science courses they’d taken before entering. Because Dr. Lewis didn’t have the benefit of Power Point, I’ve transcribed his findings into the chart below:
I provide this not because his findings are directly relevant to us today, but to make the point that the issue of how much science is needed or appropriate for the study of clinical medicine has been contentious since the beginning of formal medical education.
In his transformative review and 1910 report on the status of North American medical schools, Abraham Flexner strongly supports a scientific basis of medical education. In his second chapter “The Proper Basis of Medical Education”, he makes a strong case that, in order to provide optimal care and engage future developments, a physician must have a deep understanding of the scientific underpinnings of human function in health and disease.
Flexner goes on to say that those entering medical school must have a “competent knowledge” of the “fundamental sciences” of chemistry, biology and physics, so that the clinical sciences of anatomy, physiology, pathology, bacteriology and “physiological chemistry” can be engaged in medical school.
Flexner’s influence on medical education in the 20th century cannot be overstated. The fundamental model of basic science prerequisites to admission, followed by first and second year courses in anatomy, physiology, biochemistry, microbiology, pathology and pharmacology became standard, and the basis for accreditation standards. Medical students took courses and labs in these subjects that were very similar to those taken by undergraduates taking degrees in those subjects, sometimes even in combined classes.
In recent years, a number of factors have influenced the choice of basic science content in undergraduate medical education, and how it should be taught:
- A desire to ensure the science being taught was relevant to medical practice
- A very practical need to be selective with respect to curricular content, given the tremendous expansion of material to be taught.
- A desire to integrate the teaching of basic science with the clinical skills and reasoning courses
- The development of new areas of science that are highly relevant to practice and must now also be taught, such as immunology, genetics and advanced imaging.
- The desire to take advantage of more effective teaching methodologies, recognizing that the lecture format is limited as a means of promoting individual understanding, and that traditional laboratory experiments are both logistically impractical and of limited relevance to those learning clinical applications.
Medical schools have therefore been very much challenged with two key issues of what basic science should they teach and, critically, how should it be taught?
At Queen’s, we re-organized our basic science teaching at the time of last major curricular revision in 2008. The Foundations Curriculum developed at that time included two consolidated first year Scientific Foundations courses, Normal Human Structure and Normal Human Function.
This came at a time when our basic science departments were amalgamating into a single consolidated Department of Biomedical and Molecular Sciences which, under the leadership of Department Head Dr. Michael Adams, took on the directorship of these courses.
Last year, in an effort to integrate the courses both with each other and with the other courses running in the same terms (particularly Clinical Skills) and our Facilitated Small Group Learning curriculum, it was decided to amalgamate the two into a single Human Structure and Function course that would run through the entire first year.
This past week, I met with Course Director Dr. Chris Ward, Year 1 Director Dr. Michelle Gibson, and Dr. Adams to discuss our approach to next year’s course. We recognized that there is a wonderful opportunity here to better link it not only to contemporaneous courses, but also to those clinical courses that will follow in subsequent terms and years.
We’ll therefore be putting out a call to invite clinical teaching faculty to provide input as to basic science content they feel would facilitate teaching in their courses and would better prepare students to engage the teaching of clinical presentations.
In fact, we invite all faculty to share their views regarding the nature of basic science that is now relevant to clinical practice and their perspectives as to when and how that science should be introduced. We also welcome opportunities for clinicians and pathologists to participate in the basic science teaching in first year in partnership with our basic science instructors. This type of cooperative teaching is not only highly effective but models the collaborative practice that we wish our students to emulate.
So, whether you share Dr. Huxley’s perspective above or not, we’d love to hear from you.
Undergraduate Medical Education