A proposal for teaching basic clinical skills for mastery: the case against vertical integration

Vertical integration in medical education: the broader perspective

Curricular integration represents collaborations between disciplines to establish a coherent curriculum and has become the dominant recommendation for medical education in the second half of the twentieth century. Vertical integration specifically is the integration between the clinical and basic science parts throughout the program. Vertically integrated curricula present basic sciences imbedded in a clinical context from the start of medical school.The authors briefly discuss vertical integration in relationship with context theory, motivation theory, professional identity formation, transition to practice and the continuum of education and practice. They conclude that vertical integration, rather than horizontal integration, extends far beyond curriculum structure. They consider vertical integration a philosophy of education, with impact on students' maturation and engagement with the profession, and which applies not only to undergraduate education but to the lifelong learning of professionals. The definition of vertical integration as "an educational approach that fosters a gradual increase of learner participation in the professional community through a stepwise increase of knowledge-based engagement in practice with graduated responsibilities in patient care" is more comprehensive than its older conceptualization.

Expanding the scope of anatomical sciences: the case of "Human evolution: The fossil evidence" course at the Sackler School of Medicine, Tel-Aviv University

The Anatomy Department at Tel-Aviv University Medical School offers its students an elective course of 26 didactic hours on human evolution. The course is open to students from all faculties, who must fulfill all academic requirements, without a prerequisite of a background in anatomy. Approximately 120 students attend annually, a third of them are nonmedical students who major in philosophy, archeology, and sociology. This article discusses the course's contributions to students' understanding of a scientific concept that a scientific theory can be contradicted by new evidence, because facts govern science. Also, research methods of applying scientific principles establish the understanding of the human body, which evidently contributes to health and medicine. In the classes, the students are divided into mini-groups of 2-3 students, while the lecturer moves among students to examine fossils. In addition, analogies, open-discussions, and explanations accompany the tangible experiences. The lecturer of the course is an experienced anthropologist-anatomist researcher. He is a role-model and a mentor, sharing with the students his belief that a scientist should be persistent in his research to overcome difficult circumstances. Students, regardless of their backgrounds, express high appreciation of the course in their feedback questionnaires. The message conveyed by this course is that not only knowledge counts but also its integration with scientific principles. This course teaches us that science can bring students from different areas to study together and share ideas. In conclusion, this is a unique course in the eyes of the faculty and students alike.

Perspective: moving students beyond an organ-based approach when teaching medical interviewing and physical examination skills

Medical interviewing and physical examination skills are core pillars of clinical medicine. Though nearly all U.S. medical students participate in preclinical courses designed to teach these skills, medical school faculty often comment that students' abilities remain limited on entering their clinical clerkships. The reason for this contention is not clear.The author briefly describes the current preclinical curricula at most medical schools that are designed to teach patient interviewing and examination. An organ-based curriculum is commonly employed, although the limitations of such an approach readily become apparent. For example, many hospitalized patients do not suffer from single-organ illnesses, but rather from infections or metabolic derangements, which cause numerous abnormalities to several body systems. Furthermore, clinical reasoning skills are rarely taught in such preclinical courses, though these abilities form the foundation for effective doctoring. These findings suggest an opportunity for content development surrounding patient interviewing and examination. The author proposes an educational approach that depicts how the confluence of both content knowledge skills and clinical reasoning skills can work synergistically to enhance preclinical teaching of the medical interview and physical examination.