We describe a fourth-year course that addresses the LCME standard of teaching medical students “basic scientific and ethical principles of clinical and translational research, including the ways in which such research is conducted, evaluated, explained to patients, and applied to patient care” (1
The course falls in line with an increasing trend among medical schools to reintroduce basic science concepts in what have traditionally been the clinical years. The concept of medical school curricular reform with emphasis on integration of basic science into the clinical years was first introduced in the 1970s and 1980s. The McGill curriculum was developed in the 1970s and reported on in 1984 by Patel and Dauphinee (4
). They described a curriculum that included fourth-year medical students participating in a series of three-month integrated courses in traditional basic science subjects. Croen et al. (5
) reviewed US medical school curricula, reporting that in 1985 17 of 130 US medical schools (13%) required a basic science course during the third or fourth years. In their 1986 article, they also described their experience at the Albert Einstein College of Medicine with an eight-week basic science course which was developed in the mid-1970s. The course was primarily lecture-based at its inception, but evolved into a multidisciplinary case conference series presented prior to starting the fourth year. Subsequent reports are limited in number, most articles emphasizing the challenges associated with incorporation of basic science into the clinical years (6
). In 1998 Schmidt (7
) summarized the experience at eight anonymous US medical schools, and described difficulties including challenges in collaboration between basic and clinical scientists, as well as varied teaching formats. Little information was available about outcomes related to these attempts at curricular reform during the final two years of medical school.
In 2008 Spencer and colleagues (10
) noted a modest increase in basic science courses during the clinical years for US medical schools – 19% versus 13% found by Croen et al. (5
). Interestingly, by 2007 24% of Canadian medical schools had implemented required basic science curricular components during the final two years. Despite these increased efforts, they noted a large variation in teaching methods and curricular time. Course duration averaged four weeks, with a range of one week to 12 weeks.
In our PoD translational science course we noted a significant change in student attitude in a number of areas, including current understanding of how new advances reach clinical practice, importance of a basic science course in the fourth year curriculum and improved understanding of current issues in the index diseases. Questions 2 and 3 in (rating current understanding of how new advances reach clinical practice and the importance of research to improving our care of patients) are central to the objectives of PoD; the changes in student attitudes underscore the success of the course.
Despite a positive change in student attitude in these areas, it is not surprising that pre- and post-course data revealed no changes in the students’ assessment of whether research will be part of their career, or the importance of research in improving patient care. It is unlikely that a four-week experience during the fourth year would change students’ short-term research interests, although the long-term effect may be more positive. In addition, the qualitative review of student evaluations and the top negative themes emphasize the challenges facing course directors and faculty participants in such a course ().
The most frequent negative theme was the timing of the course within the curriculum. The curriculum committee felt that February of the fourth year was the most appropriate time, since there are drawbacks earlier and later in the fourth year. For example, a summer course would conflict with sub-internships; an autumn or early winter course would conflict with residency interviews; and a spring course would risk complete loss of student commitment, being so close to graduation. Course length was also a frequent negative-comment theme. Shortening the course from four to two weeks was often mentioned by the students, but the PoD course director and faculty have found immersion of the students back into basic science mode requires more than two weeks, especially when focusing on providing necessary background knowledge to understand index diseases better and allowing for meaningful small-group project creation.
The positive-comment evaluation themes () underscore some of the strengths of the chosen format. In particular, students were very positive about the small-group projects as effective learning tools intended to spur them to integrate knowledge gained via the two lecture series. In addition, they were enthusiastic about the small-group clustering of students by intended specialty, and reinforced the benefits of the course placement at the beginning of the second half of the fourth year. A committed and enthusiastic course director also seemed to be essential.
It is important to note the limitations of the current report. Although the data are based on six consecutive years of operation, this only reflects the experience at our institution, and it is unclear how this experience translates to other student groups or medical schools. In addition, we describe and report on outcomes of a single format and method of teaching with measurements based on students’ perceptions rather than an independent measurement of outcomes. PoD is only one method of introducing students to CTR and its central role in the advancement of clinical medicine (10
). The goal of revisiting basic science in the third and fourth years is to offer students a better understanding of how new approaches to important diseases are developed and integrated into clinical practice, i.e. the process of clinical and translational research. Yet the intermediate- and long-term effects of such a course and experience are not clear. Further work is needed to determine if a change in attitude during the second half of fourth-year medical school influences efforts and accomplishments during residency or a practice career.
In conclusion, this article describes an innovative approach to integrate a basic science course that emphasizes the role of translational and clinical research teaching during the clinical years of medical school. Resulting assessment data allow a better understanding of the ways in which students benefit from the experience. The strength of the information obtained is bolstered by the prospective data collection and the high participation rates. The consistency of course timing, format and message throughout its history are added strengths. Having a basic science course in the fourth year that teaches CTR – after students have completed both basic science and clinical core course requirements – is a novel, effective way to fulfill the LCME CTR standard.