Contextualizing the relevance of basic sciences: small-group simulation with debrief for first- and second-year medical students in an integrated curriculum

Pathology as a Basic Medical Subject: Its Relevance and Application During Clinical Practice in Jordanian MD Programs, Interns' and Residents' Perspectives

Aim

Medical literature revealed that there is a lack of information about the opinions of medical interns and residents about curricula provided to them during their undergraduate programs, either in a group of detached subjects or an incorporated and efficacious topic (ie, pathology).

Purpose

To assess and compare the interns' and residents' perspectives towards Pathology as a subject. To recognize their opinions toward the relevance and application of Pathology while practicing clinically.

Methods

This study was a cross-sectional online, self-administered questionnaire targeting interns and residents. The questionnaire consisted of 30 questions, enquiring about the demographic data, subject strength, teaching duration, interest in the subject, and usefulness of Pathology as a subject in clinical practice.

Results

Overall, 103 participants completed the survey. The female and male percentage was 59.2% and 40.8% respectively. 86.4% of participants were interns, while 13.6% were residents. 87% of participants agreed that applying pathology during clinical practice is a skill that should be strengthened in the early stages of preclinical education of Medicine. A modest percentage believed that a practitioner could efficiently treat the majority of patients with no need to know the specifics of the pathological mechanisms involved. Most of the participants believed that pathology courses helped them in making a differential diagnosis, analysis of normal and pathological constituents, and dissection and identification of structures.

Conclusion

This study highlights the positive perceptions of Jordanian interns and residents toward pathology courses. It also demonstrates that participants prefer an active and dynamic educational model with an emphasis on better integration of pathology courses and clinical experiences that fit their needs in clinical practice. Thus, we recommend future studies to compare the competencies of interns and residents enrolled in the courses with integrated medical curricula, of pathology versus those who studied the conventional medical curricula of pathology, as well as to evaluate their perceptions of medical education.

A cross-disciplinary approach to learning medical physiology and behavioral skills involving drama students performing as simulated patients

The early years of physiology education in medical curricula provide unique challenges. As well as inculcating concepts that are seen as difficult, modern curricula require that students learn in context in case-based learning courses. Additionally, regulating bodies stress that the soft skills of compassion, communication, and empathy are embedded throughout curricula. This has driven work in our organization involving drama and final-year medicine students during which they collaborate in realistic simulations of doctor/patient interactions. We adapted this transdisciplinary approach to second-year physiology tutorials. This emphasized the holistic importance of physiology to patient care, while also embedding "human factors" skills from the very earliest stages of the curriculum. After preparing by attending acting classes based on aspects of Konstantin Stanislavski's "System," the authors supervised tutorials in which drama students participated in a "physiology of hypofertility" session for second-year medical students, playing a 34-year-old woman with premature menopause (or their partner). Opinion (from all students) was evaluated by Likert questionnaires (which included open questions). A focus group of drama students was also interviewed, and the conversation was recorded for thematic analysis. Positive Likert scores were recorded for the authenticity of the tutorials, skills development, fostering empathy, and motivating students to improve. All participants evaluated the tutorial as highly enjoyable. These scores are reflected in positive open commentary on the questionnaires and in the focus group interviews. The results suggest that even basic science tutorials give opportunities for interdisciplinary study and enhancement of behavioral skills while gaining enthusiastic student acceptance.NEW & NOTEWORTHY This work details how physiology tutorials for early years medical students are transformed by taking the clinical case off the two-dimensional page and instead having the case scenario acted by drama students. This adds context and authenticity. The benefits are twofold: emphasizing the importance of physiology to the budding clinician and embedding empathy and compassion from the earliest points in a clinician's career.

A systematic scoping review of group reflection in medical education

BACKGROUND

Reviewing experiences and recognizing the impact of personal and professional views and emotions upon conduct shapes a physician's professional and personal development, molding their professional identity formation (PIF). Poor appreciation on the role of reflection, shortages in trained tutors and inadequate 'protected time' for reflections in packed medical curricula has hindered its integration into medical education. Group reflection could be a viable alternative to individual reflections; however, this nascent practice requires further study.

METHODS

A Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure a review of group reflections in medical education. Independent searches of articles published between 1st January 2000 and 30th June 2022 in bibliographic and grey literature databases were carried out. Included articles were analysed separately using thematic and content analysis, and combined into categories and themes. The themes/categories created were compared with the tabulated summaries of included articles to create domains that framed the synthesis of the discussion.

RESULTS

1141 abstracts were reviewed, 193 full-text articles were appraised and 66 articles were included and the domains identified were theories; indications; types; structure; and benefits and challenges of group reflections.

CONCLUSIONS

Scaffolded by current approaches to individual reflections and theories and inculcated with nuanced adaptations from other medical practices, this SSR in SEBA suggests that structured group reflections may fill current gaps in training. However, design and assessment of the evidence-based structuring of group reflections proposed here must be the focus of future study.

Integrating Foundational and Clinical Science Remotely by Combining Team-Based Learning and Simulation

Integrating foundational and clinical science in medical and other professional healthcare degree programs has been well established as a means to enhance learning. However, implementation remains challenging, and a significant gap exists in guidance for non-professional degree programs to effectively accomplish both types of integration. Additionally, many modalities described in the literature are resource-intensive, scale poorly to larger groups, and are widely inaccessible. We present an online modality combining team-based learning and a simulation-based learning experience that fosters vertical and horizontal integration of physiology, pharmacology, and clinical science. The tools utilized include a vital sign simulator, video conferencing software, and a document-sharing platform. The activity demonstrated improved knowledge comparing pre- and posttests and evidence that the activity helped students integrate physiology, pharmacology, and clinical medicine. The novel structure is effective and accessible, uses open-source software and standard equipment available to most undergraduate and graduate faculty, and is adaptable to in-person, hybrid-remote, and fully remote delivery.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01817-9.

The Physician Experience Teaching an Integrated Curriculum to First-Year Medical Students

Introduction The authors review a model of early medical student education that leverages the strengths of physician educators in curriculum development and small-group instruction in the first year of medical school. Objective The objective of this study was to understand the experience of practicing physicians who helped to design, implement, and deliver the first-year curriculum at a new medical school. Methods Survey data were collected for all first-year physician instructors and first-year medical students at the new Kaiser Permanente Bernard J. Tyson School of Medicine during the inaugural 2020-2021 academic year. Physician involvement in curriculum design and implementation, time required for teaching preparation, ratings of collaboration with basic scientists, and confidence and satisfaction of the clinician educators with first-year medical student education, as well as student satisfaction with physician educators, were all explored. Results Despite extensive time commitment from the physician educators and some reported variability in confidence ratings for course content, physicians rated their experience teaching first-year medical students at the new medical school highly. They rated their collaboration with basic scientists highly as well. Medical students rated their physician educators highly across multiple assessment domains. Conclusion The successful combination of basic scientists with physician educators in first-year medical education may provide a road map for other medical schools seeking to further integrate clinical sciences into basic science education.

Effect of self-regulated learning and technology-enhanced activities on anatomy learning, engagement, and course outcomes in a problem-based learning program

Problem-based learning (PBL) offers advantages for teaching anatomy and physiology for physical therapy students as clinical cases provide a scaffold for a comprehensive review of body systems. Although the utilization of interactive anatomy software greatly contributes to an active learning environment and efficient use of time, simply providing textbook readings, access to anatomy software, and models is not enough to engage students to become active in reaching their learning goals. Time constraints, meaningful technology implementation, resource abundance, and unfamiliarity are challenges that decrease the effectiveness of both facilitating and learning anatomy. The present study investigated the use of three supplemental learning tools to support anatomy instruction in a self-regulated manner. Friedman test results demonstrated significant differences for perceived engagement [χ²(2) = 15.74, P < 0.001, W = 0.23] but not for perceived learning. Survey responses demonstrated that perceived engagement was greatest with the nondigital supplemental learning tool compared with the two technology-enhanced learning tools (iBooks Author + SoftChalk and SoftChalk alone). Multivariate regression analyses demonstrated statistically significant relationships between the nondigital supplemental learning tool and anatomy practical scores (P < 0.001). The technology-enhanced supplemental learning tools did not further increase learning outcomes as measured by practical scores compared with nondigital learning tools. Incorporation of instructor-created instructional materials independent of technology is an efficient method to drive self-regulated learning, enhance engagement, and improve anatomy course outcomes and may overcome barriers associated with a purely self-directed PBL model.

Basic Medical Sciences Knowledge Retention for Clinical Practice

BACKGROUND

The basis for studying the clinical sciences is the recall and comprehension of basic medical science facts. Do not, however, directly alter clinical information and as studies revealed that there are basic sciences knowledge retention of medical students gaps in clinical practice. The purpose of this study was to assess medical students' basic medical sciences knowledge retention and a relevance of basic sciences knowledge for clinical for practice.

METHODS

An institutional-based descriptive cross-section epidemiological study design was carried out in the University of Gondar from April to May of 2021. A total of 15 basic and clinical sets of questions were used for data collection. The data were entered and analyzed using SPSS version 20 to analyze data.

RESULTS

A total of 191 medical students participated with response rate of 100%. Of these, 48.6% were male. Of all participant students, 69 (36.1%) have had the academic status of excellent with a commutative grade point average greater that 3.6 out of 4.0. Students who correctly responded for all categories of questions for basic and clinical sciences were 8.6±2.7 and 5±2.8 of second years, 5.5±2.3 and 7.1±1.2 of fourth years, 6.5±1.4 and 6.7±1.0 of fifth years, 5.3±0.8 and 8.4±2.5 of sixth years, respectively. As a representative year, the score of second year students' performance for the basic sciences is a statistically significant with overall impact of the basic sciences (6.49±2.5, F=12.51, P≤0.001) and clinical sciences (4.0±1.9, F=14.73, P≤0.001).

CONCLUSION

It is proposed that basic sciences knowledge should be aligned with clinical sciences preparation so that students may grasp disease diagnosis and treatment concepts in an integrated manner.

Antiviral Pharmacology: A Standardized Patient Case for Preclinical Medical Students

INTRODUCTION

Pharmacology is an important learning topic in preclinical medical education. Simulated patient encounters allow students to apply basic science knowledge in a clinical setting and have been useful in previous studies of pharmacology education. We developed a standardized patient (SP) encounter to reinforce antiviral pharmacology content for first-year medical students.

METHODS

Students were instructed to recommend a medication for shingles during an SP encounter and to answer questions from the SP on mechanism of action and adverse effects. Students then attended a large-group debrief session. Following the activity, students evaluated the exercise through a voluntary survey. For knowledge assessment, students were randomized into two groups to complete three multiple-choice questions either before or after the learning activity.

RESULTS

In 2020 and 2021, 144 and 145 students, respectively, participated. In 2020, there was no significant difference in the proportion of correct answers between the pre- and postsimulation groups (p > .05). In 2021, the postsimulation group significantly outperformed the presimulation group in knowledge of mechanism of action (p < .01) and adverse effects (p < .01), but no difference was seen between the groups regarding medication selection (p = .27). Most learners assessed the instructional design as effective for the tasks assigned.

DISCUSSION

This SP activity provided an opportunity for early medical students to practice integrating antiviral pharmacology knowledge into a patient encounter and was well received by learners. The instructional method offers a clinically relevant approach for reinforcing pharmacology knowledge for preclinical medical students.

Medical Students' Attitude and Perception Towards Basic Medical Science Subjects at Wollo University, Northeast Ethiopia

INTRODUCTION

The knowledge of basic medical science could help to remember a fact and be used to understand causal mechanisms of disease process that improve the accuracy of diagnostic formulations.

OBJECTIVE

To assess the perception and attitude of medical students towards basic medical science subjects along with retention rate and clinical relevance in Wollo University.

METHODS

Institutional-based cross-sectional study design was employed in Wollo University from September, 2020 to October, 2020. A pre-tested and structured self-administered questionnaire was used for data collection. All opinions were rated using a positive-point Likert scale, which ranges from "strongly disagree" to "strongly agree." The data were entered and analyzed using SPSS version 20.

RESULTS

A total of 153 students participated with a 100% response rate. Among them, 45 (29.4%), 38 (24.8%), 39 (25.5%), and 31 (20.3%) were PC-II, C-I, C-II, and Intern students, respectively. Ninety-six (62.7%) of medical students were very much interested in basic medical science subjects. But, 113 (73.9%) of them did not have plans to join the subjects as a future career. The main reasons in more than half 85 (55.7%) of the respondents were less financial growth followed by less chance of promotion 31 (20.3%). There were 66.7% of the students who considered anatomy as clinically relevant, whereas 53.6% and 47.1% considered physiology and biochemistry, respectively, to be clinically relevant. The number of students who could recall anatomy and physiology during relevant clinical discussions was 102 (66.7%) and 85 (55.6%), respectively. This percentage was relatively less for biochemistry (26.8%).

CONCLUSION

In conclusion, medical students have a positive attitude towards basic medical science subjects. However, they are hesitant to join the field because it offers them less financial growth and few chances of promotion. Moreover, anatomy and physiology were highly relevant subjects during clinical practice. But, the retention rate of basic medical science knowledge during their clinical year was low.

The Simulated Virology Clinic: A Standardized Patient Exercise for Preclinical Medical Students Supporting Basic and Clinical Science Integration

INTRODUCTION

Virology is inherently challenging due to the sheer volume of information medical students are responsible for learning. Cognitive integration of this content is critical for early medical students to practice applying this knowledge to diagnostic problem-solving. Simulation offers learners engaging opportunities to practice cognitive integration. We developed a simulated clinic activity for first-year medical students consisting of standardized patient (SP) encounters representing viral infections.

METHODS

Student small groups rotated through eight SP encounters during which they collected patient histories, reviewed physical exam findings, and developed a differential diagnosis and diagnostic plan for each case. The instructor debriefed students on the cases afterward. We assessed students' evaluation of the activity through online surveys.

RESULTS

Two hundred seventy-eight students participated in the simulated clinic in 2018 and 2019. Students rated the activity as very effective for learning about the infections represented and for providing opportunities to integrate clinical skills. Students agreed that the event's instructional design was appropriate for its objectives and that the problem-solving aspect was intellectually stimulating. They indicated that the most effective aspects were solidifying illness scripts for the infections represented, integrating knowledge and skills to diagnose patients in a realistic clinical context, and working collaboratively to problem-solve.

DISCUSSION

The simulated virology clinic is an effective method for providing students opportunities to integrate microbiology and clinical skills and has been positively received by students. This instructional method offers learners an opportunity to solidify illness scripts for viral infections using an interactive, collaborative approach.

The GI Simulated Clinic: A Clinical Reasoning Exercise Supporting Medical Students' Basic and Clinical Science Integration

INTRODUCTION

Cognitive integration is required to perform clinical decision-making tasks, even in the preclinical curriculum of medical school. Simulation supports students' cognitive integration by providing practical application of basic science knowledge in a relevant clinical context. To address the need for integrative activities in our curriculum, we implemented a simulated clinic exercise with cases representing gastrointestinal diseases for first-year medical students.

METHODS

Basic science and clinical skills course directors collaborated to design this simulated clinic event, during which student small groups rotated through a series of standardized patient encounters. During each encounter, one student performed the history and physical exam, following which the small group collaboratively developed a prioritized differential diagnosis. Afterwards, the gastroenterology course director debriefed students to highlight key learning points. We collected learner evaluation data following the event.

RESULTS

Two hundred eighty first-year medical students participated in the simulated clinic in 2018 and 2019. Students rated these events as effective for learning about clinical features of the diseases presented and for reinforcing skills learned in the clinical skills course. Students agreed that the small-group format, pace, and duration were appropriate and that the problem-solving aspect was intellectually stimulating. The most effective aspects were opportunities to solidify illness scripts, apply knowledge to solve a problem, and encounter diseases in a realistic clinical context.

DISCUSSION

This simulated clinic model effectively supported preclinical students' basic and clinical science integration to complete diagnostic reasoning tasks for gastrointestinal gastrointestinal conditions and was evaluated favorably by learners.

Simulation as a Tool to Illustrate Clinical Pharmacology Concepts to Healthcare Program Learners

Purpose of Review

Recent Findings

Summary

Patient-Centered Team-Based Learning in Pre-Clinical Curriculum Supporting the Application of Knowledge to Real-World Clinical Experience

We report an active learning session which effectively supported 1st year medical students applying their learning experience in a clinical setting. A team-based learning (TBL) on familial hypercholesterolemia (FH) with a live patient was given to deliver basic genetics knowledge in a clinically relevant context. Subsequently, two participating students applied their learning experience by presenting a differential diagnosis of homozygous FH in a patient at a medical mission in Central America. We propose that combining active learning with clinically relevant scenarios effectively fosters student's clinical reasoning skills and can bridge the perceived gap between basic science and clinical education.

Utilization of high-fidelity simulation to address challenges with the basic science immunology education of preclinical medical students

BACKGROUND

Immune function and dysfunction are highly complex basic science concepts introduced in the preclinical medical school curriculum. A challenge for early learners is connecting the intricate details and concepts in immunology with clinical manifestations. This impedes relevance and applicability. The impetus in medical education reform is promoting consolidation of basic science and clinical medicine during the first two years of medical school. Simulation is an innovation now widely employed in medical schools to enhance clinical learning. Its use in basic science curriculums is largely deficient. The authors piloted simulation as a novel curricular approach to enhance fundamental immunology knowledge and clinical integration.

METHODS

The authors introduced a Primary Immunodeficiency Disease (PIDD) simulation during a basic science immunology course for second-year medical students at the Zucker School of Medicine at Hofstra/Northwell. The simulation tasked small groups of students with evaluating, diagnosing and managing an infant with previously undiagnosed immunodeficiency. Joint facilitation by clinical and science faculty during terminal debriefings engaged students in Socratic discussion. Debriefing aimed to immerse basic science content in the context of the clinical case. Students completed a post-simulation Likert survey, assessing utility in reinforcing clinical reasoning, integration of basic science and clinical immunology, enhanced knowledge and understanding of immunodeficiency, and enhanced learning. A summative Immunodeficiency Objective Structured Clinical Examination (OSCE) question was created by faculty to assess students' recognition of a PIDD and clinical reasoning.

RESULTS

The simulation was well received by students with > 90% endorsing each of the objectives on the post-simulation survey. The authors also determined a statistically significant score variance on the summative OSCE question. Higher scores were achieved by the cohort of students completing the OSCE post-simulation versus the cohort completing the OSCE pre-simulation.

CONCLUSIONS

The innovative use of simulation in a highly complex basic science immunology course provides relevance and consolidation for preclinical learners. Additional data will be collected to continuously assess application of concepts and proficiency stemming from this novel curricular intervention. The authors advocate the initiation and/or expansion of simulation in non-clinical basic science courses such as immunology to bridge the gap between theory and practice.

Perceived clinical relevance and retention of basic sciences across the medical education continuum

Medical programs are under pressure to maintain currency with scientific and technical advances, as well as prepare graduates for clinical work and a wide range of postgraduate careers. The value of the basic sciences in primary medical education was assessed by exploring the perceived clinical relevance and test performance trends among medical students, interns, residents, and experienced clinicians. A pilot study conducted in 2014 involved administration of a voluntary 60-item multiple-choice question test to 225 medical students and 4 interns. These participants and 26 teaching clinicians rated the items for clinical relevance. In 2016, a similarly constructed test (main study) was made a mandatory formative assessment, attempted by 563 students in years 2, 4, and 6 and by 120 commencing general practice residents. Test scores, performance trends, clinical relevance ratings, and correlations were assessed using relevant parametric and nonparametric tests. Rank order and pass-fail decisions were also reviewed. The mean test scores were 57% (SD 7.1) and 52% (SD 6.1) for the pilot and main studies, respectively. Highest scores were observed in pathology and social sciences. Overall performance increased with increasing year of study. Test scores were positively correlated with perceived relevance. There were moderate correlations (r = 0.50-0.63; P < 0.001) between participants' scores in the basic science and summative exams. Assessments may be key to fostering relevance and integration of the basic sciences. Benchmarking knowledge retention and result comparisons across topics are useful in program evaluation.

Student perception on the integration of simulation experiences into human physiology curricula

A variety of medical simulators have been developed over recent years for students of all medical professions. These simulators serve to teach basic science concepts, advanced clinical skills, as well as empathy and student confidence. This study aimed to understand the students' perception of the integration of high-fidelity simulation exercises into the teaching of human physiology. Research groups were made up of both osteopathic and podiatric medical students. Data were obtained using a Likert-scale survey. Results indicated that students believed the simulation experiences were beneficial to further understanding of physiological concepts, as well as seeing these concepts in a clinical setting. Variations were noted between podiatric and osteopathic medical students' perception on how the experiences helped them develop clinical and personal confidence, and if the experience helped illustrate correlations between laboratory values and accompanying physiology. Results illustrated no differences in perception between the sexes. Although all students agreed that the experience helped with the understanding of physiology, podiatric medical students did not necessarily find value in the simulation for their development as future clinicians. We predict that differences in perception are largely based on the different curriculums of the students questioned. The present study indicated that incorporation of simulation experiences in the first year of medical school enhanced learning basic science physiology concepts and promoted the development of self-confidence as future clinicians. Incorporating simulation into the didactic coursework should be promoted in other medical schools' curricula.

Applying the Hedgehog Concept to Transform Undergraduate Medical Education

As the U.S. health care system changes and physician responsibilities shift, medical educators must reconsider how best to prepare medical school graduates for the future practice of medicine. Thoughtful reexamination of the goals of undergraduate medical education (UME) and the roles of educators, medical students, and physicians is warranted to ensure that they align with evolving health care environments and delivery systems. In this Invited Commentary, the authors apply Jim Collins's "hedgehog concept" from Good to Great-a business-world framework designed to transform companies-to UME. The hedgehog concept is defined by the intersection of an organization's passion, area of expertise, and economic and resource engines. Focusing on this single concept can guide key decisions, reject what does not align conceptually, and drive overall organizational success. The authors use the hedgehog concept to frame the programmatic development of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (Zucker SOM), a millennial medical school, as an organization with the passion to develop innovative UME curricula by challenging the status quo; the drive to be the best at leveraging health system resources to train graduates to excel in systems-based care; and the economic and resource engine of faculty time, financial and infrastructure support, and reputation building. The success of this approach is assessed at Zucker SOM through student and graduate outcomes data. The authors suggest that this hedgehog concept is generalizable to other UME programs whose leaders seek to transform medical education to meet 21st-century workforce and health care delivery needs.

Cognitive processing differences of experts and novices when correlating anatomy and cross-sectional imaging

The ability to correlate anatomical knowledge and medical imaging is crucial to radiology and as such, should be a critical component of medical education. However, we are hindered in our ability to teach this skill because we know very little about what expert practice looks like, and even less about novices' understanding. Using a unique simulation tool, this research conducted cognitive clinical interviews with experts and novices to explore differences in how they engage in this correlation and the underlying cognitive processes involved in doing so. This research supported what has been known in the literature, that experts are significantly faster at making decisions on medical imaging than novices. It also offers insight into the spatial ability and reasoning that is involved in the correlation of anatomy to medical imaging. There are differences in the cognitive processing of experts and novices with respect to meaningful patterns, organized content knowledge, and the flexibility of retrieval. Presented are some novice-expert similarities and differences in image processing. This study investigated extremes, opening an opportunity to investigate the sequential knowledge acquisition from student to resident to expert, and where educators can help intervene in this learning process.

Integration of Basic and Clinical Sciences: Faculty Perspectives at a U.S. Dental School

Although dental education has traditionally been organized into basic sciences education (first and second years) and clinical education (third and fourth years), there has been growing interest in ways to better integrate the two to more effectively educate students and prepare them for practice. Since 2012, The University of Texas School of Dentistry at Houston (UTSD) has made it a priority to improve integration of basic and clinical sciences, with a focus to this point on integrating the basic sciences. The aim of this study was to determine the perspectives of basic and clinical science faculty members regarding basic and clinical sciences integration and the degree of integration currently occurring. In October 2016, all 227 faculty members (15 basic scientists and 212 clinicians) were invited to participate in an online survey. Of the 212 clinicians, 84 completed the clinician educator survey (response rate 40%). All 15 basic scientists completed the basic science educator survey (response rate 100%). The majority of basic and clinical respondents affirmed the value of integration (93.3%, 97.6%, respectively) and reported regular integration in their teaching (80%, 86.9%). There were no significant differences between basic scientists and clinicians on perceived importance (p=0.457) and comfort with integration (p=0.240), but the basic scientists were more likely to integrate (p=0.039) and collaborate (p=0.021) than the clinicians. There were no significant differences between generalist and specialist clinicians on importance (p=0.474) and degree (p=0.972) of integration in teaching and intent to collaborate (p=0.864), but the specialists reported feeling more comfortable presenting basic science information (p=0.033). Protected faculty time for collaborative efforts and a repository of integrated basic science and clinical examples for use in teaching and faculty development were recommended to improve integration. Although questions might be raised about the respondents' definition of "integration," this study provides a baseline assessment of perceptions at a dental school that is placing a priority on integration.