Flexner Revisited: The Role and Value of the Basic Sciences in Medical Education

Abstract

A central tenet of Flexner's report was the fundamental role of science in medical education. Today, there is tension between the time needed to teach an ever-expanding knowledge base in science and the time needed for increased instruction in clinical application and in the behavioral, ethical, and managerial knowledge and skills needed to prepare for clinical experiences. One result has been at least a perceived reduction in time and focus on the foundational sciences. In this context, the International Association of Medical Science Educators initiated a study to address the role and value of the basic sciences in medical education by seeking perspectives from various groups of medical educators to five questions: (1) What are the sciences that constitute the foundation for medical practice? (2) What is the value and role of the foundational sciences in medical education? (3) When and how should these foundational sciences be incorporated into the medical education curriculum? (4) What sciences should be prerequisite to entering the undergraduate medical curriculum? (5) What are examples of the best practices for incorporating the foundational sciences into the medical education curriculum? The results suggest a broad group of experts believes that an understanding of basic science content remains essential to clinical practice and that teaching should be accomplished across the entire undergraduate medical education experience and integrated with clinical applications. Learning the sciences also plays a foundational role in developing discipline and rigor in learners' thinking skills, including logical reasoning, critical appraisal, problem solving, decision making, and creativity.

La pédagogie médicale est-elle une discipline ?

“…-Le début du XX e siècle, lorsque les facultés de médecine nord-américaines adoptèrent le curriculum flexnérien, considérant qu'elles devaient désormais se préoccuper des questions pédago-giques et pas uniquement servir d'outils de promotion du statut professionnel des médecins ou d'entreprises commerciales [17,18] . Cette réforme curriculaire n'a toutefois pas été réalisée sur la base de principes pédagogiques ou de leur éva-luation au sein des facultés mais sur l'observation du fonctionnement de ces institutions, à partir de laquelle Flexner fonda ses opinions et ses convictions [19,20] .…”

Nanomedicine concepts in the general medical curriculum: initiating a discussion

“…Efforts to establish truly integrated medical curricula continue to be undertaken with varying degrees of success. 49,50,125,126 The issue further is compounded by students who often do not clearly understand the relevance of their basic science classes to clinical care, and by encounters with clinical faculty who do not adequately model the role of basic science knowledge in clinical decision-making. 48 As proposed above, applicable concepts in nanomedicine should be incorporated comprehensively across the medical curriculum, during both preclinical and clinical stages.…”

“…45 Numerous examples may be found in the medical education literature of commentaries issuing similar warnings. [46][47][48][49][50][51] While the commentaries offer a variety of sometimes competing perspectives (eg, in terms of the extent and depth of basic science content in the medical curriculum or the relative importance of the basic sciences compared to the development of clinical diagnostic skills in the professional education of doctors), there is general consensus that unprecedented advances in scientific knowledge and in contemporary medical practice necessitate corresponding adaptations in the general medical curriculum.…”

“…[46][47][48][49][50][51][52][53][54][55][56][57] This is likely to be one of the primary objections against incorporating key nanomedicine concepts into what long has been argued is an already "overstuffed curriculum". 118 Nevertheless, if there is broad agreement within the medical education community that existing basic science content in the general medical curriculum does not adequately address "the expanding scientific knowledge base of medicine", 45 it then becomes necessary to consider the ways in which "medical school curricula must continue to adapt in order to best prepare physicians for practice in the twenty-first century".…”

Integrating Basic Sciences in the Medical Laboratory Sciences Curriculum: A Case Study of Strategies and Approaches

“…Embedded within these competencies are areas of reasoning, skill and practice that strongly relate to scientific thinking and foundational knowledge in the sciences. Studying science concepts has long been touted within the medical community as essential to providing a strong lifelong foundation in critical thinking, trouble shooting and the development and expansion of clinical reasoning skills (Finnerty et al, 2010). In our curricular design of the MLSc program at UOIT, we have attempted to both vertically and horizontally integrate basic science courses in Anatomy and Physiology, Biochemistry, Pathophysiology, Chemistry and Molecular Biology within a packed curriculum of clinical courses in the five disciplines of Biochemistry, Hematology, Microbiology, Transfusion and Histology.…”