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Integration: It's all in the mind (of the learner)!
Cognition before curriculum: rethinking the integration of basic science and clinical learning Kulasegaram K et al: Academic Medicine 2013, vol 88, No 10
Reviewed by Lavjay Butani


What was the study question?
The aim of the study was to describe approaches that educators have used to integrate basic science instruction with clinical knowledge and to assess their outcomes.

How was the study done?
The authors reviewed the health professions literature and used a framework that categorized integration into three levels: programs, courses and individual teaching sessions.

What were the results?
At a program level, horizontal (across different courses) and vertical (across disciplines such as the longitudinal clerkships or across the basic and clinical sciences) integration are commonly used. Teaching methods within this structure include using problem based learning curricula and introducing clinical experiences in basic science years and vice versa. At a course level, strategies include demonstrating application of basic science to clinical situations (e.g. case based teaching) and merging courses/course instructors. Session level strategies incorporate basic science education with clinical scenarios within each session. Program and course level integration are challenging and have not been shown to promote integration due to the many confounders that can affect learner outcomes at a macro level. Session level integration has been shown to be successful in controlled studies.

What are the implications of these findings?
Integration seems less dependent on the structure of the curriculum or the methods of instruction and more on the content of each session. The community should therefore focus more on how we design educational sessions as opposed to creating elaborate program structures that by themselves may lead to little benefit for the learner.

Editor's note: Both Educating Physicians: A call for reform of medical school and residency and the Future of medical education in Canada report call for an increased integration of basic and clinical sciences. This study concludes that the real impact of such integration occurs at individual teaching sessions, something that each of us can control as we teach at the bedside and in the classroom (SLB).

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