Part of transforming undergraduate medical school curriculum means shifting the way educators and medical students think about the basic sciences. What do tomorrow’s physicians need to know to treat patients in the future?
Physicians must have strong foundations in both basic sciences—including cell and molecular biology, biochemistry, pharmacology and physiology—and clinical sciences, which means mastering a large body of knowledge. Some of the schools in the AMA’s Accelerating Change in Medical Education initiative are devising new ways to incorporate basic sciences into the curriculum to ensure tomorrow’s physicians not only have the right information but know how to apply it and adapt to it.
At Vanderbilt University School of Medicine, there’s movement toward a hub-and-spokes model, with the hub being the core basic science content and the spokes being a variety of different clinical settings where students can apply their basic science knowledge.
For example, the core of the cancer course includes molecular drivers of cancer, screening and imaging for the disease. The spokes include medical oncology, intervention, pediatric oncology, genetics—all different settings within Vanderbilt University Medical Center where students can get hands-on experience applying what they’ve learned. The integrated course model allows students not only to advance their knowledge and skill in a basic science core but also to do “deep dives” into specific topics if they are interested.
The Vanderbilt model also allows student to see how different clinical teams take on various parts of treatment, which is crucial for physicians of the future.
“You’re not necessarily an expert in any particular area all the time, in every single field,” said Lourdes Estrada, PhD, assistant professor of cancer biology at Vanderbilt. “You’re really dependent on what your team provides for that care. We’re trying to revisit the question, ‘Do you need to know everything there is to know about these foundational sciences?’”
Similarly, the University of California San Francisco School of Medicine is redefining basic science by expanding the notion about which sciences are foundational to the practice of medicine and assessing what it means to “master” a science.
“It’s not sufficient to have knowledge of how the body works,” said Catherine Lucey, MD, vice dean for education at UCSF. “You have to understand the sciences that help us [make sense of] the patient’s approach to illness, impact on environment, how patients make decisions … the complex problems that face physicians and patients today require knowledge in at least six domains of science.”
Those six domains include:
- Biomedical science or the “traditional” idea of basic science
- Social and behavioral science, including addiction, medication adherence and lifestyle changes
- Clinical and translational science, which encompasses how biological principles are applied to real-world environments
- Systems engineering, or the science around safe, reliable and consistent delivery of high-quality, patient-centered care
- The science of learning, so students understand how to continue to learn and adapt throughout their careers
- Population science and public health
“If all you know is just one of those ‘arms,’ you’re not going to be very well-suited to solve the complex challenges in front of us,” Dr. Lucey said.
By thinking about the basic sciences in a different way, the educators that are part of the Accelerating Change in Medical Education consortium of schools hope to train physician leaders that have foundational knowledge. These physician leaders also will know how to ask appropriate questions, filter and apply data and cultivate a habit of inquiry—in short, to know how to think like scientists who continually progress in a rapidly changing health care environment.
