Transitions in Basic Medical Science Teaching

Summary

This chapter will trace changes in the goals, instruction and governance of basic science education over the last century. In the first half of the 20th century basic science departments organized by discipline (e.g. anatomy, physiology, pathology) and did their best to teach medical students the basic science facts and concepts which basic science faculty thought were necessary for the practice of medicine. This included utilizing the scientific method to solve problems relative to their discipline. By the end of the 20th century, in some medical schools the basic science content was being defined by interdisciplinary groups and taught in more integrated ways with the expectation that this would enable students to be better able to recall, integrate and utilize their basic science knowledge in clinical situations. Research which suggested that problem solving skills are less generalizable than originally thought, promoted the teaching of problem solving in each discipline or sub-discipline, e.g. gastroenterology and nephrology.

At the start of the 20th century, instructional methodology used in basic science courses consisted almost entirely of discipline-based lecture and laboratory activities. Currently most medical schools have added a variety of small group formats that not onlyfocus on the application of basic science concepts to clinical problems but add a focus on interpersonal skill development, and promote self directed learning.

Assessment, which many believe drives the system, has changed dramatically. About half way through the century, essay questions were replaced by multiple-choice questions in both medicalschooland licensure exams. Toward the endofthe century objective structured clinical exams utilizing standardized patients were commonly found in both medical school and licensure exams, thus introducing more authenticity to the evaluation system. The changesdescribedabove have come aboutfor a variety ofreasons including economic and social. However, research in metacognition and other areas has provided an expanding foundation for improvement in basic science medical education. We expect this trend to become even more apparentas the new centuryprogresses.