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A total overhaul
A total overhaul
The problem of transitioning pre-clinical students to clerkship/clinical experience is well understood in the medical education community. The Alliance for Clinical Education has released a virtual lecture, "Thinking Like Doctors," related to this exact problem. In the video, Dr. Elizabeth Stuart goes over a number of strategies to mitigate the issues of misapplied knowledge in the context of preclinical students transitioning to clinical scenarios.
Later in the video, a participant asks about a complete overhaul of foundational science curriculum completed by the University of Miami Miller School of Medicine; the presenter and moderator both agree this sounds like it would work well. Other medical schools have completed similar massive curriculum revisions, many with great success, such as the Shared Discovery Curriculum created by the College of Human Medicine at Michigan State University.
Other opportunities and related hurdles
Other opportunities and related hurdles
Overarching revision of a curriculum is a massive undertaking, one that requires years of analysis, preparation and review, not to speak of financial costs. And condensing the preclinical science curriculum has potential drawbacks as well, such as missed opportunities for in-depth learning of certain subjects and systems (McDaniel et al., 2020) . Instead of rebuilding curriculum from the ground up, what other options do medical schools have to improve student application of science and systems knowledge? Survey respondents brought up many possible strategies, while others highlighted constraints related to those same strategies.
One suggestion brought up by survey respondents is to provide students with early opportunities to visit clinics to apply their course knowledge to real-life scenarios (referred to as "early clinical experience," or ECE, in some curricula). This is plausible with smaller class sizes, but, as described by other respondents, issues arise with larger classes; there is not enough room in hospitals and clinics to give all students an equal opportunity to apply pre-clerkship knowledge. Another consideration of the ECE strategy is that medical schools cannot guarantee consistent clinical experiences for all students, meaning not all students will have equal opportunity for clinical application.
Another suggestion which is often used to great impact is the use of simulated experiences. But like ECE, simulated experiences are difficult to provide to large cohorts due to space requirements, and cost of simulation patients and facilities can be prohibitive. Additionally, assessment is often subjective and inconsistent (Westervelt, 2021).
Virtual cases assigned to individual students are a common suggestion, but additional concerns arise: without instructor feedback, virtual cases are dependent on the student understanding the material in the first place (Bisschops et al., 2021). Additionally, rubrics for such open-ended scenarios are difficult to build and implement.
In-person case review in a medium- to large-group setting can be a boon for student understanding. However, this setting necessitates faculty and clinicians to facilitate, so organizing such activities can be difficult, especially when clinician time is at a premium (Bisschops et al., 2021). Then there are concerns related to group experiences, specifically that weaker students will be "brought up" by stronger students. And again, the question of how to grade students on these activities is a consideration.
Photo by Pavel Danilyuk; Pexels.com
Key Takeaways
Key Takeaways
It is clear from the ubiquity of research related to student understanding in medical education that there is both awareness of the problem and a number of techniques available to address it. However, it is also clear from the research that every proposed solution offers both affordances and constraints, and consideration must be made to the context when applying each solution. In the next section, I will propose and explore a potential solution that addresses the constraints present in larger medical school cohorts.
References:
References:
Alliance for Clinical Education. (2022, January 20). ACE 101 Series: Thinking Like Doctors [Video]. YouTube. https://www.youtube.com/watch?v=6kL8XZwM_DQ
Bisschops, J., Moulik, S., & Schneider, G. W. (2021). Improving Nutrition Education with Second-Year Medical Students: From Take-Home Assignment to Large-Group Application Exercise. Medical Science Educator, 31(4), 1287–1290. Springer Nature Journals. https://doi.org/10.1007/s40670-021-01342-7
McDaniel, C. M., Forlenza, E. M., & Kessler, M. W. (2020). Effect of Shortened Preclinical Curriculum on Medical Student Musculoskeletal Knowledge and Confidence: An Institutional Survey. Journal of Surgical Education, 77(6), 1414–1421. ScienceDirect.
MSU MD. (2017). Shared Discovery Curriculum [Video]. Vimeo. https://vimeo.com/179347590
Rahmani, M. (2020). Medical Trainees and the Dunning–Kruger Effect: When They Don’t Know What They Don’t Know. Journal of Graduate Medical Education, 12(5), 532–534. https://doi.org/10.4300/JGME-D-20-00134.1
Westervelt, M. J. (2021). Understanding Faculty Assessment Decisions of Medical Student Clinical Reasoning Ability. eScholarship. https://escholarship.org/uc/item/8xp5634h
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