Integrating Basic and Clinical Sciences
Presentation by: Amy L. Wilson-Delfosse, Ph.D.
James Bruzik, Ph.D.
Case Western Reserve University
School of Medicine
Why Did Case Change?
The Western Reserve curriculum designed in the 1950s continued with only minor
revisions despite enhancements in computer technology and unprecedented
changes in the health care system
Classrooms with ~30% of students attending
Watching lectures online double time
Paper syllabus boundaries
Students not preparing for class
Teacher-centered
Why Did Case Change?
Course silos “I don’t know if you’ve had this yet but”
Multiple choice tests –nothing else counted, binge and purge
approach to learning
Difficult to get faculty to teach – clinical and research productivity
Dean’s Vision – research and scholarship block and MD thesis
Principles of Western Reserve2:
Building on Western Reserve1
Integration of health and disease (normal and abnormal) –
systems biology
Experiential learning, scholarship, critical thinking, lifelong
learning
Active interchange of ideas between students and faculty
Graduate school environment – independent study and selfdirected learning
Weave scientific foundations and clinical medicine
throughout the 4 year curriculum
Principles of Western Reserve2:
Building on Western Reserve1
Integration of health and disease (normal and abnormal) –
systems biology
Experiential learning, scholarship, critical thinking, lifelong learning
Active interchange of ideas between students and faculty
Graduate school environment – independent study and selfdirected learning
Weave scientific foundations and clinical
medicine throughout the 4 year curriculum
Western Reserve2 Curriculum
Year I
Year II
Year III
Year IV
Core Clinical Rotations
IQ+ Program
Foundations of Medicine and Health
(20 months, including vacation)
(48 weeks, flexible scheduling)
Research &
Scholarship
(16 week block +
electives, flexible
scheduling)
Advanced Clinical and Scientific
Studies
Areas of Concentration
Electives
(10 months, flexible scheduling)
WR2 Foundations of Medicine and Health
Structure (Anat., Histo-Path, Radiology)
Foundations of Clinical Medicine
(GI, Nutrition,
Energy,
Metabolism,
Biochemistry)
1 Week
Clinical
Immersion
(CV, Pulm,
Renal, Cell
Regulation,
Pharmacology,
Cell physiology)
1 Week
Clinical
Immersion
(Host Defense,
Microbiology,
Blood, Skin,
Auto-immune)
Cognition,
Sensation,
and
Movement
1 Week
Clinical
Immersion
(Neuro, Mind
Musculoskeletal,
Cellular
Neurophysiology
Reflection, Integration & Assessment
(Endo, Repro,
Development,
Genetics, Mol
Biol, Cancer
Biology)
1 Week
Clinical
Immersion
Host
Defense
and Host
Response
Reflection, Integration & Assessment
1 Week
Clinical
Immersion
Reflection, Integration & Assessment
(Medical
Error, Public
Health,
Inequities,
Bioethics,
Professionali
sm
Epi/Biostats)
Homeostasis
Food to Fuel
Reflection, Integration & Assessment
(5 wk)
The
Human
Blueprint
Reflection, Integration & Assessment
Becoming
a Doctor
March Year 2
Reflection, Integration & Assessment
July Year 1
B
O
A
R
D
R
E
V
I
E
W
B
L
O
C
K
Case Inquiry Group (IQ)
Student-centered small groups with a faculty facilitator
Case-based
Self-directed learning
Team work
Quality improvement – “check out”
WR2: Eary Patient Experiences
August to December
January (Year 1) to
January
Year 1
December (Year 2)
Year 2
Introduction to clinical
Advanced Clinical Skills
skills
RAMP (Rotating
Clinical Preceptorships
Apprenticeships in Medical
Practice)
FCM Seminars
Health Policy, Leadership and
Advocacy, Professionalism, Ethics
Web Resources
Integration
and
Assessment
Core and Advanced Clinical Experiences:
Core Clinical Rotations
Core 1 (16 weeks): Internal Medicine and Surgery + Peri-Op
and Acute Pain
Core 2 (16 weeks): Pediatrics, OB-Gyn, Family Medicine
(Prevention/Wellness)
Core 3 (8 weeks): Neuroscience and Psychiatry + Chronic pain
Advanced Cores (4 weeks each):
Undifferentiated and Emergent Care
Aging and Society: Geriatrics, Chronic Disease, Palliative
Care, Health Systems
4 hours Friday afternoon in group of 10-12 students
Reinforce importance of basic science and emerging
basic science knowledge in the practice of clinical
medicine
Continue to use a team-based, learner-centered small
group to enhance professional growth and
development
Practice advanced skills in communication, physical
exam, clinical reasoning, evidence based medicine
Reflection
Case discussion – DDX and learning objectives
Research and discussion with experts
(basic science and clinical faculty)
Skills practice
Checkout
Example Case: HLHS
Check-in: Debrief, possible directed reflections on dealing
with a sick child or the parent of a sick child.
Go through the case in step by step – starting with a “blue
baby”– generate a differential diagnosis, discuss the
perinatal changes in the circulation
Come up with a list of learning objectives and questions for
the experts.
HLHS continued …
Expert session - paired basic scientist & neonatologist
meet with larger group. Mini-didactics + Q+A –
focusing on emerging science on the heritable nature
of this problem + clinical insights.
HLHS continued …
Skills practice – Students interview the standardized
parent of this baby – script calls for integration of
recently learned information + focus on delivering bad
news and communicating with families.
Check out
Assessment
Attendance
Facilitator assessment
Case development/presentation (teams)
Students write cases and run the IQ+ afternoon
Opportunities for scholarship
Opportunities for peer teaching
Acknowledgements
The faculty, staff and students of CWRU School of Medicine