Abstract
Purpose
Medical students must be provided the basic science knowledge appropriate and applicable for preparing them for best-practice medicine. To date, there have been no documented studies in the USA that have directly surveyed practicing physicians on their perspectives of their basic science/preclinical medical school education and how it could be modified to help them deliver best patient care. This study was the first to examine this information.
Method
A survey was administered to the alumni of Touro College of Osteopathic Medicine, Harlem, NY (2011–2018), with questions on examining perspectives on basic science disciplines, the need for a basic science refresher course, and other educational topics. In addition, questions relating to demographics and type of medical practice were also asked. Statistical analysis was performed using SPSS.
Results
(1) Gender (N = 122): 55% male and 44% female; (2) medical specialty (N = 107): 51.40% Primary Care physicians (Family medicine, Internal medicine, Pediatrics), 48.60% Other Specialties; (3) top Disciplines that “should have more”: Physiology (41.1%), Pharmacology (39.3%), and Preventative Medicine/Public Health (39.3%); Top disciplines that “should have less”: Histology Laboratory (38.32%), Embryology (35.51%), Histology (didactic) (28.30%) (N = 107); (4) top topics “most important” to be included in curriculum: Analysis of Journal Articles (70.10%), Clinical Cases (70.1%), and Early Patient Exposure (64.5%) (N = 107); (5) presentation of a clinically relevant Basic Science refresher course had a positive response (84.4%) (N = 107).
Conclusions
Pharmacology, Physiology, Clinical Cases, Journal Article Analysis, and Early Patient exposure were among topics requiring “more” in preclinical education. A clinically relevant basic science course was deemed useful. The perspectives of practicing physicians should be included when designing future medical school curriculums.
Keywords: Basic science disciplines, Medical school curriculum, Integration, Best-practice medicine
Introduction
The objective of medical education is to successfully prepare students to obtain sufficient knowledge needed to effectively serve their patient populations. The basic sciences remain the backbone of medical education as these disciplines provide the fundamentals required to the understanding of clinical medicine and ultimately, patient care. Therefore, the development of a medical education curriculum, especially for the preclinical years, should be a continuous process aimed at both integrating the basic sciences with clinical applications as well as updating information based on the available medical knowledge [1, 2]. Implementing these changes to the curriculum remains a challenge for medical school faculty and administrations, and many recent curriculum changes in medical schools have been initiated or influenced by medical students within their own medical school [3–7]. Although the role of the physician has shifted to reflect the vast knowledge appropriate to advancing patient care, there is often minimal adaptation of curriculum structure to address the needs of the practicing physician once they have finished their undergraduate medical education [2]. Therefore, it is critical that practicing physicians have input on the medical school curriculum, which would give them and their future colleagues the basis for best patient care. Although a few publications have studied physician suggestions on areas within the medical curriculum, they have focused on specific areas of expertise rather than the undergraduate medical curriculum in total [8–11]. It is for this reason that we developed a survey for the alumni of Touro College of Osteopathic Medicine (TouroCOM) who are presently practicing physicians for their feedback on the content of their medical education, narrowing the focus on the preclinical disciplines for this preliminary smaller study.
The main objectives of our study were fourfold: (1) To evaluate the need of increasing or decreasing the content of their basic science disciplines; (2) to evaluate how well basic science concepts were included with their second year clinical coursework; (3) to evaluate whether a clinically relevant basic science refresher course would be useful to these practicing physicians (4) to evaluate the importance of specific topics into the curriculum. The results, which are obtained from this study, should be beneficial to medical school educators and administrators, leading to the design of a curriculum which best serves all future physicians. This includes physicians who provide care to diverse geographical areas (rural, urban, suburban, etc.) and those who hold various physician roles (residents, attending physicians, private care etc.). There have been no documented studies in the USA to date, which have directly surveyed practicing physicians on the knowledge gained from their preclinical medical school education and how this impacts their current practice of medicine. Our study is the first to examine these perspectives.
Methods
Survey
During the Fall Semester of 2018, we sent a survey to the graduate physicians (2011–2018) from TouroCOM, Harlem NY. An Institutional Review Board (IRB) approval was obtained prior to survey distribution, highlighting our objectives and the questions that would be asked to these graduates. All current physicians (including residents) who attended this medical school were invited to participate in this survey, which was administered electronically on a school-approved platform (Qualtrics, Seattle, Washington), with additional reminders sent twice within 2-week intervals. This novel survey titled “Physician Assessment of Medical Curriculum” [12] contained eleven questions, took approximately 10 min to answer, and participants could opt out of the questions at any point, as the survey was voluntary and anonymous. All of this was indicated to the participant before they began the survey. In addition to gathering demographic information, such as age, gender, medical specialty, geographical area of practice, and years of medical practice, our main objective was to collect and analyze the respondents’ evaluation of their preclinical medical education via specific questions relating to their coursework. This included queries as to whether they felt the curricular content needed more, needed less, or was sufficient. In addition, we also questioned the respondents about educational experiences that may not have been provided at the time of their education, e.g., clinical cases and early patient interactions. A separate comment section was provided where the respondents could write additional information. In order to determine if the sample we obtained is representative of the population from which we were sampling, we compared the percentage of the gender and medical specialty of those physicians who responded to our survey to the gender and medical specialty of the entire population. The results of that examination revealed that the two groups showed no significant differences, and thus, we concluded that our sample is representative of the population of graduates from our medical school.
The survey was designed by the authors for this study, since this research was the first to evaluate the perspectives of practicing physicians on how their preclinical medical school curriculum influenced their current practice of osteopathic medicine.
Statistical Analysis
Descriptive statistics (summary of responses) was employed for all questions in our survey.
Since the focus of our survey was the preclinical curriculum, the moderator variable analysis was focused on determining whether the responses of the graduates to the questions concerning the disciplines and topics in their preclinical education differed based on their Medical Specialty. Medical specialty was classified into two groups: group-1-Primary Care, those that indicated Family Practice, Internal Medicine and Pediatrics [13, 14], and group-2-Other Specialties, e.g., Psychiatry, Radiology, Surgery (see Table 1 for Medical Specialties). Pearson chi-square was used to test for significance of relationships, and a contingency analysis table was constructed between the responses to Survey Questions 7 and 11 and medical specialty. Those that were significant were further analyzed using the adjusted standardized residuals for each cell in the contingency table, where ≥ + 1.96 indicated significantly greater response than by chance. Due to the exploratory nature of the analysis, α = 0.05 for all tests. SPSS was utilized for the quantitative statistical analysis. The survey questions were reviewed and analyzed by the Associate Dean of Pre-clinical Education and the Academic Dean of TouroCOM before distribution to the alumni. Their consensus was that the survey did ask the appropriate questions to answer the objectives of this study and thus by this assessment had content validity.
Table 1.
Medical specialty of survey respondents
| Anesthesiology | 1.9% (2) |
| Cardiology | 0.9% (1) |
| Dermatology | 0.9% (1) |
| Emergency medicine | 15.9% (17) |
| Endocrinology | 0% (0) |
| Family practice | 17.8% (19) |
| Gastroenterology | 1.9% (2) |
| Geriatrics | 0% (0) |
| Infectious disease | 1.9% (2) |
| Internal medicine | 21.5% (23) |
| Nephrology | 0% (0) |
| Neurology | 1.9% (2) |
| Ob-Gyn | 3.7% (4) |
| OMM | 0% (0) |
| Oncology | 0.9% (1) |
| Ophthalmology | 0% (0) |
| Orthopedics | 0.9% (1) |
| Pain management | 1.9% (2) |
| Pathology | 0% (0) |
| Pediatrics | 12.2% (13) |
| Plastic Surgery | 0% (0) |
| Psychiatry | 10.3% (11) |
| Radiology | 3.7% (4) |
| Rheumatology | 0% (0) |
| Surgery | 8.4% (9) |
| Urology | 0% (0) |
| Other | 15.9% (17) |
The percentages are based on the 107 of graduates who answered these questions. The frequency for each category is in parenthesis
In order to determine whether our sample was representative of the population of alumni, the distribution of Gender and Medical Specialties for the current sample was compared with three alumni groups, Alumni from 2011 to 2014, Alumni from 2015 to 2018, and the Total Alumni Population. The comparison of the distribution of Gender of the current sample with the Alumni from 2011 to 2014 was not significant (chi-square = 2.223, df = 1, p = .136). The comparison of the distribution of Gender of the current sample with the Alumni from 2015 to 2018 was also not significant (chi-square = .612, df = 1, p = .434) as was the comparison of the distribution of Gender of the current sample with the Total Alumni Population (chi-square = 1.389, df = 1, p = .239). The comparison of the distribution of Medical Specialty (Primary Care and Other Specialties) of the current sample with the Alumni from 2011 to 2014 was not significant (chi-square = .651, df = 1, p = .420). The comparison of the distribution of Medical Specialty of the current sample with the Alumni from 2015 to 2018 was also not significant (chi-square = .912, df = 1, p = .340) as was the comparison of the distribution of Medical Specialty of the current sample with the Total Alumni Population (chi-square = .875, df = 1, p = .350). Therefore, we can conclude that the current data do not provide evidence that our sample was significantly different from any of the three Alumni groups in terms of Gender and Medical Specialty.
Results
Demographics
The results of the demographics of our respondents are summarized as follows:
The majority of the respondents (73.77%) were graduates within the past 5 years (2013–2018) (N = 122)
Gender: 67 (54.82%) male and 54 (44.26%) female, with one choosing not to answer (N = 122)
Medical Specialty: Primary Care physicians-group 1: (Family medicine, Internal medicine, Pediatrics) = 51.4% and Other Specialties-group 2 = 48.6%; the top three reported medical specialties were Internal medicine (21.5%), Family practice (17.8%), and Emergency medicine (15.9%) (N = 107) (see Table 1)
-
(4)
With respect to practice setting, 42.07% were part of an academic hospital program; 25.52% were part of a community hospital; 15.17% were part of an academic affiliated hospital; 7.59% were non-hospital practitioners; and 2.76% were practicing in a rural hospital.
Curriculum
The results of the remainder of the survey related to our four objectives concerning curriculum content:
Objective (1) To assess how the respondents would evaluate the course disciplines in the preclinical curriculum (see survey question 7). Table 2 shows the opinions of the respondents on the courses in the preclinical curriculum with an emphasis on their Basic Science disciplines. The top three basic science disciplines that showed the need to “have more” were Physiology (41.1%), Pharmacology (39.3%), and Microbiology (30.8%) with Preventative Medicine/Public Health (39.3%) and Behavior Science (34.6%) showing a strong response. The top three disciplines that showed the need to “have less” were Histology Laboratory (38.3%), Embryology (35.5%), and Histology (didactic) (28.0%). The “Sufficient” response for the remainder of the disciplines ranged from Anatomy (75.7%) to Neuroscience Laboratory (48.6%).
Table 2.
Opinions of Touro College of Osteopathic Medicine graduates on courses in their preclinical education
| Courses in preclinical education | Should have more | Sufficient | Should have less | No opinion |
|---|---|---|---|---|
| Anatomy | 15% (16) | 75.7% (81) | 9.3% (10) | 0% |
| Anatomy Laboratory | 19.6% (21) | 65.4% (70) | 14.0% (15) | 1.9% (2) |
| Behavior Science | 34.6% (37) | 53.3% (57) | 10.3% (11) | 1.9% (2) |
| Cultural Competence in Medicine | 22.4% (24) | 54.2% (58) | 19.6% (21) | 3.7% (4) |
| Embryology# | 11.2% (12) | 53.3% (57) | 35.5% (38) | 0% |
| Histology# | 5.6% (6) | 65.4% (70) | 28.0% (30) | 0% |
| Histology Laboratory# | 8.4% (9) | 52.3% (56) | 38.3% (41) | 0.9% (1) |
| Immunology | 20.6% (22) | 73.8% (79) | 5.6% (6) | 0% |
| Microbiology | 30.8% (33) | 65.4% (70) | 3.7% (4) | 0% |
| Medical Biochemistry | 10.3% (11) | 68.2% (73) | 20.6% (22) | 0.9% (1) |
| Medical Genetics | 19.6% (21) | 63.6% (68) | 15.9% (17) | 0.9% (1) |
| Neuroscience | 26.2% (28) | 60.7% (65) | 13.1% (14) | 0% |
| Neuroscience Laboratory | 19.6% (21) | 48.6% (52) | 27.1% (29) | 4.7% (5) |
| Pathology | 28.0% (30) | 69.2% (74) | 2.8% (3) | 0% |
| Pharmacology* | 39.3% (42) | 59.8% (64) | 0.9% (1) | 0% |
| Physiology* | 41.1% (44) | 57.9% (62) | 0.9% (1) | 0% |
| Preventive Medicine/Public Health* | 39.3% (42) | 48.6% (52) | 11.2% (12) | 0.9% (1) |
| Professionalism/Medical Ethics | 23.4% (25) | 61.7% (66) | 14.9% (16) | 0% |
| Virology | 22.4% (24) | 62.6% (67) | 8.4% (9) | 6.5% (7) |
#Courses respondents felt needed less coverage
*Courses respondents felt needed more coverage
The percentages are based on the 107 of graduates who answered these questions. The frequency for each category is in parenthesis
Relationship Between Medical Specialties and Disciplines
For simplification, the relationship between the medical specialties and disciplines was performed by dividing the medical specialties into two groups: group 1 representing Primary Care (family practice, internal medicine, pediatrics) and group 2-Other Specialties. It was observed that group 1 (Primary Care) respondents would modify the following disciplines with more coverage: Immunology, Microbiology, Pathology, Pharmacology, and Physiology, while they would modify Neuroscience Lab with less coverage. In contrast, group 2 (Other Specialties) would modify all the disciplines with less coverage with the exception of Pharmacology and Physiology, where the respondents (> 65%) answered that the coverage of these disciplines were sufficient.
Objective (2) To evaluate how well basic science concepts were integrated with their second year clinical coursework (see survey question 8). The following question was asked: “Do you feel your second year clinical courses included Basic Science concepts?” and was answered in the following manner: ‘were emphasized,” 3.75%; “yes,” 69.44%; “minimum,” 25%; and “no,” 1.85%.
Objective (3) To evaluate whether a clinically relevant basic science refresher course would be useful to these physicians and which topics would hold the most interest (see survey questions 9 and 10). A total of 84.4% answered “yes” (59.6%) or “maybe” (24.8%) to having a basic science refresher course at this point in their career, while 15.60% were not in favor of an additional presentation.
Relationship Between Medical Specialties and Refresher Course
The relationship between Medical Specialty and responding to the idea of having a Basic Science Refresher Course was not significant (chi-square = 1.351, df = 1, p = .245). The percentage of those in Primary Care (group 1) who responded yes or maybe to the question was 89.1% while the percentage of those in Other Specialties (group 2) who responded yes or maybe to the question was 81.0%. These results indicate that physicians in all specialties thought that it was or might be a good idea to a have Basic Science Refresher Course.
Table 3 shows the topics based on highest to lowest interest for a Basic Science refresher course with Pharmacology (65.4%), Physiology (63.5%), and Pathology (50.5%), ranked as the top three topics.
Table 3.
Topics of interest for a Basic Science refresher course
| Pharmacology | 65.4% (70) |
| Physiology | 63.5% (68) |
| Pathology | 50.5% (54) |
| Anatomy | 42.0% (42) |
| Immunology | 37.4% (40) |
| Biochemistry | 31.8% (34) |
| Neuroscience | 22.4% (24) |
| Genetics | 19.6% (21) |
| Histology | 9.3% (10) |
The percentages are based on the 107 who answered these questions. The frequency for each category is in parenthesis
Objective (4) To evaluate the importance of specific topics in the curriculum (see survey question 11). The results shown in Table 4 indicate that both Clinical Cases (70.1%) and Analysis of Journal Articles (70.1%) ranked as most important, with Early Patient Exposure (64.5%) and Integration of Curriculum within and between the preclinical years (62.6%) ranking as second and third, respectively.
Table 4.
Opinions of Touro College of Osteopathic Medicine graduates on topics in their preclinical education
| Areas of preclinical education | Should have more | Sufficient | Should have less | No opinion |
|---|---|---|---|---|
| Basic Statistics | 48.6% (52) | 35.5% (38) | 12.1% (13) | 3.7% (4) |
| Early Patient Exposure | 64.5% (69) | 29.9% (32) | 2.8% (3) | 2.8% (3) |
| Clinical Cases | 70.1% (75) | 28.0% (30) | 0.9% (1) | 0.9% (1) |
| Pathophysiology | 54.2% (58) | 44.9% (48) | 0% | 0.9% (1) |
| Integration of Curriculum Within and Between Preclinical Years | 62.6% (67) | 30.8% (33) | 1.9% (2) | 4.7% (5) |
| Analysis of Journal Articles | 70.1% (75) | 24.3% (26) | 1.9% (2) | 3.7% (4) |
|
Research/Scholarly Activity |
50.5% (54) | 33.6% (36) | 7.5% (8) | 8.4% (9) |
The percentages are based on the 107 of graduates who answered these questions. The frequency for each category is in parenthesis
Discussion
This survey is the first to question recent osteopathic medical graduates on how well their preclinical curriculum supported them for best-practice medicine. The respondents were well-represented by gender (54.92% males, 44.26% females), practice specialties and practice settings (57.17% academic hospitals/affiliated programs, 28.8% community/rural hospitals, 7.59% non-hospital based practices). According to a 2018 report by the American Osteopathic Association (AOA) [14], the profession grows and evolves because these trained physicians have a tendency to practice in the most in-demand specialties, which include family, internal, and emergency medicine. Therefore, it was no surprise that the top three specialties practiced by the physicians who participated in this survey were the same cited by the AOA [14]. In addition, our data indicated that the medical specialties of our respondents (51.4% Primary Care, 48.6% Other Specialties) did not show a significant difference with our total alumni population and correlate with that reported for actively practicing osteopathic physicians [14].
The first main objective of our survey was to determine if practicing physicians believed that the basic science aspect of their curriculum was appropriate in preparation for their medical practice. It was not unexpected that both Physiology and Pharmacology were ranked among the highest disciplines with a need for more coverage and this supports the educational concept that in order to understand the mechanism of a drug therapeutically, the physician must have a good understanding of normal human physiology. The fact that Preventative Medicine/Public Health (PM/PH) and Behavior Medicine were also ranked among the top disciplines likely represents the emergence of these important fields in both preventing diseases and understanding psychological and community health issues, including health policy [15]. Well-designed interventions that focus on achieving improvements in lifestyle-related risk factors could result in sufficient savings in the short and medium term to substantially offset intervention costs [16]. In addition, our participants are practicing osteopathic physicians, whose philosophy emphasizes preventative medicine, as well as treating the whole patient including their psychological well-being. Therefore, it is not unexpected that PM/PH and Behavior Medicine would be disciplines that the respondents felt needed more coverage.
It was noteworthy that disciplines like Histology, both lab and didactic, as well as Embryology were assessed as needing less coverage. This may be explained by the fact that over half (55.14%) of our survey participants specialized in internal, family, or emergency medicine, which do not routinely utilize histological specimens and/or prenatal anatomy in their scope of practice. Additionally, these results may suggest that these topics may be better presented as integrated into more clinical disciplines, e.g., pathology and obstetrics/gynecology, and that their importance in these contexts be emphasized.
In comparing the relationship between Primary Care physicians (group1) and Other Specialties (group 2) to the preclinical disciplines, it is interesting to note that group 1 physicians responded with the need for more coverage for many of the basic science disciplines (Immunology, Microbiology, Pathology, Pharmacology, and Physiology) as compared with group 2. This may reflect the nature of the general practice of Primary Care physicians and their need for foundations in many different disciplines for best-practice medicine compared with specialists who mainly emphasize one medical area.
As to topics in their preclinical education, it was not surprising that the participants felt a need for more clinical cases, since clinical cases integrate the basic science disciplines with clinical scenarios. A clinical case exposes medical students to patient history and compels them to use critical thinking to arrive at a differential diagnosis, proper testing, and eventual diagnosis and treatment [17]. These results agree with a previous study stating that graduates of a problem-based learning (PBL) curriculum that uses clinical cases as the basis of its education felt “better prepared and more competent … with medical supervisors concurring…” [18]. As one respondent stated about the use of clinical cases and education:
“Would have benefited more if we incorporated more clinical scenarios to book learning so we can apply/connect our knowledge” (Resident physician; neurology).
In addition to clinical cases, the respondents indicated that analysis of journal articles needs more emphasis and focus in their undergraduate medical education. In fact, journal clubs are an effective teaching method in both residency programs and continuing medical education (CME) [19]. Continuing education necessitates a physician to constantly evaluate and keep up-to-date with the latest evidence-based medicine as reported in journal articles. Therefore, the ability to quickly analyze and understand the content of these publications is of utmost importance for physicians to be able to perform best-practice medicine as well as keeping their knowledge current.
It was also not unexpected that early patient exposure was in the top three topics the respondents felt “should have more” since a hands-on and practical approach is essential in preparing students for treating future patients. A recent survey of first year practicing doctors in Britain substantiates this finding.
[18]. Research has shown that offering early clinical experiences may help students achieve clinical and team comfort, clinical skills, an understanding of physicians’ lives/practices, and broad exposure for career decisions [20].
Additionally, the integration of disciplines both within (horizontal) and between (vertical) the preclinical years was ranked as “should have more” for their medical education. Integration of curriculum has been established among many medical schools as being an effective learning method because it allows students to see the relationship and connection between the basic sciences and clinical medicine [21]. As one study concluded, students trained within an integrated curriculum made more accurate diagnoses than did students trained in a conventional curriculum [22].
The second objective of the survey in evaluating curriculum was to determine if these practicing physicians felt their second year clinical courses connected basic science concepts. Translational research, i.e., research that moves basic science discoveries from the laboratory bench into practical use with patients, emphasizes this integration, and several medical programs have found this very valuable in the development of both students’ medical and scientific careers [23, 24]. Our survey indicates that most respondents thought that the basic science concepts were emphasized, although close to 27% responded that there was minimal or no integration of the clinical material with their basic science topics. This difference can be due to the fact that emphasis of basic science topics in a discipline does not always translate into a clear integration for the students. This reflects the need for more integration between the first and second year of the curriculum, as indicated in Table 4 and as discussed above. These results are also supported by several studies, which have reported that content integration can improve diagnostic skills and promote the transfer of knowledge in a fashion that allows students to construct their own meaning from the information being taught [25–27]. This can lead to more successful patient outcomes in the future, minimizing stress on the physician since “integration of the basic and clinical sciences leads to a more gradual, steadier and finally higher level of mastery of clinical knowledge” [28].
Two respondents offered comments on the benefits of content integration into curriculum:
“I think that the best prepared residents I have worked with have come from schools that emphasized early clinical exposure and integration of basic sciences and clinical sciences into modules”. (Resident; surgery).
“I feel incorporating practical examples of basic sciences toward patient care would help understand the basic sciences better.” (private, group practice; pediatrics).
The third objective of our survey was to investigate whether physicians thought a short, basic science refresher presentation that was clinically relevant would enhance their ability for best-practice medicine. This idea was based on one reported school, which offers a physician re-entry course after returning to clinical practice after a period of inactivity [29, 30], and the investigators believe such a program could benefit all practicing physicians. This emphasizes the idea of life-long learning and is an important component of positive patient outcomes. Since the basic sciences are ever-changing, this type of refresher course would be able to update the science and its medical application. Historically, the response of students to basic sciences in medical school has been “why do we need to know this?” We were surprised to note that over 80% of the respondents would consider (Yes/Maybe) this type of continuing medical education series. We believe that making these types of presentations clinically relevant would allow physicians to keep current on the latest findings and applications of these topics. The positive response of both group 1 (89%) and group 2 (81%) to a relevant basic science refresher course showed no significant difference between the two groups. This result emphasizes the need these physicians feel to update their knowledge in multiple areas of basic science information. It was not unexpected that Pharmacology was listed as the top basic science topic for a refresher course (65.4%) since awareness of current drug therapies is a priority for best-practice medicine [31]. Additionally, Physiology and Pathology placed among the top three important topics in this area, 63.5% and 50.55% respectively, reflecting the fact that having a good grasp of these disciplines can help the physician both communicate and explain diseases and treatments.
Limitations/Future Directions
While this study provides an important first step in understanding which aspects of the preclinical medical school curriculum were essential for the best practice of medicine, it is limited in both number of respondents and to the graduates of only one medical school and in an urban area of the country. It should be emphasized that this study is based on the experiences of the respondents to only one medical school curriculum and needs to be considered when extrapolating to other medical curriculums. Thus, this work needs to be expanded to other osteopathic and allopathic medical school graduates, and include institutions in both rural and suburban areas to compare the perspectives of those practicing physicians. Additionally, with more medical school graduates in an expanded study, we will be able to compare the statistical significance of the perspectives between residents and longer practicing physicians. Since the survey design allowed multiple entries for specialties, this necessitated categorizing the physicians into two main groups: group 1- “Primary Care” and group 2-“Other Specialties” and may have led to generalization of some of our results. It should also be noted that, although vertical integration between first and second year education was included in specific questions, our survey did not specifically answer questions regarding horizontal integration. An improvement to the survey questionnaire will prevent these issues with a future study.
Conclusions
We believe that we achieved our goal to examine the perspectives of recent medical school graduates on which aspects of their medical school curriculum were or could be beneficial to their best practice of medicine. Our findings show that nearly 40% of our graduate practicing physicians would modify the content of their preclinical curriculum by increasing emphasis of some disciplines, e.g., Physiology and Pharmacology, and decreasing others, e.g., Embryology and Histology. The implication from these results is that as medicine changes, so should the emphasis of some the basic sciences be augmented or reduced in the medical curriculum. Since both Physiology and Pharmacology were ranked among the highest disciplines with a need for more coverage and that for other disciplines, e.g., Histology and Embryology ranked as needing less coverage, we need to modify our curriculum accordingly. In addition, learning to analyze journal articles, early patient exposure, integration of basic sciences with clinical cases and the opportunity for physicians to participate in a clinically relevant basic science refresher presentation was reported as being important in achieving best-practice medicine. In addition, the survey outcomes indicate that today’s physicians need a strong background in public and preventative health and these topics need more importance in medical school curriculum. All these data, taken together, can help faculty and administrators of medical schools establish effective ways to create an integrative, evidence-based medical school curriculum that will correlate the fundamentals of basic science to concepts of clinical medicine. This should help educate practicing as well as future physicians to perform best-practice medicine and provide patients with the greatest possible outcomes. We need to design our curriculum so it supports the educational needs of our practicing physicians.
Compliance with Ethical Standards
An Institutional Review Board (IRB) approval was obtained prior to survey distribution, highlighting our objectives and the questions that would be asked to these graduates.
Conflict of Interest
The authors declare that they have no conflict of interest.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Thomas PA, Kern DE. Internet resources for curriculum development in medical education: an annotated bibliography. J Gen Intern Med. 2004;19(5 Pt 2):599–605. doi: 10.1111/j.1525-1497.2004.99999.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Rooholamini A, Amini M, Bazrafkan L, Dehghani MR, Esmaeilzadeh Z, Nabeiei P, Rezaee R, Kojuri J. Program evaluation of an integrated basic science medical curriculum in Shiraz Medical School, using CIPP evaluation model. J Adv Med Educ Prof. 2017;5(3):148–154. [PMC free article] [PubMed] [Google Scholar]
- 3.Bland CJ, Starnaman S, Wersal L, Moorehead-Rosenberg L, Zonia S, Henry R. Curricular change in medical schools: how to succeed. Acad Med. 2000;75(6):575–594. doi: 10.1097/00001888-200006000-00006. [DOI] [PubMed] [Google Scholar]
- 4.Chen DR, Priest KC, Batten JN, Fragoso LE, Reinfeld BI, Laitman BM. Student perspectives on the “step 1 climate” in preclinical medical education. Acad Med. 2019;94(3):302–304. doi: 10.1097/ACM.0000000000002565. [DOI] [PubMed] [Google Scholar]
- 5.Burk-Rafel J, Jones RL, Farlow JL. Engaging learners to advance medical education. Acad Med. 2017;92(4):437–440. doi: 10.1097/ACM.0000000000001602. [DOI] [PubMed] [Google Scholar]
- 6.Goldfarb S, Morrison G. Continuous curricular feedback: a formative evaluation approach to curricular improvement. Acad Med. 2014;89(2):264–269. doi: 10.1097/ACM.0000000000000103. [DOI] [PubMed] [Google Scholar]
- 7.Fetterman DM, Deitz J, Gesundheit N. Empowerment evaluation: a collaborative approach to evaluating and transforming a medical school curriculum. Acad Med. 2010;85(5):813–820. doi: 10.1097/ACM.0b013e3181d74269. [DOI] [PubMed] [Google Scholar]
- 8.O'Keeffe GW, Davy S, Barry DS. Radiologist’s views on anatomical knowledge amongst junior doctors and the teaching of anatomy in medical curricula. Ann Anat. 2019;223:70–76. doi: 10.1016/j.aanat.2019.01.011. [DOI] [PubMed] [Google Scholar]
- 9.Hamano J, Hanari K, Tamiya N. Attitudes and other factors influencing end-of-life discussion by physicians, nurses, and care staff: a nationwide survey in Japan. Am J Hosp Palliat Care. 2019:1049909119876568. [DOI] [PubMed]
- 10.Wheat J, Brandon J, Cox M, et al. Teaching medical students in the rural setting long term: physicians’ attitudes and perceptions. South Med J. 2019;112(10):526–530. doi: 10.14423/SMJ.0000000000001023. [DOI] [PubMed] [Google Scholar]
- 11.Danek RL, Berlin KL, Waite GN, Geib RW. Perceptions of nutrition education in the current medical school curriculum. Fam Med. 2017;49(10):803–806. [PubMed] [Google Scholar]
- 12.Survey: Physicians Assessment of Medical Curriculum. https://tourocollege.az1.qualtrics.com/WRQualtricsControlPanel_rel/File.php?F=F_bOSHtCIg56dpTed
- 13.Association of American Family Practitioners. https://www.aafp.org/about/policies/all/primary-care.html. Accessed 6 Nov 6 2019
- 14.Osteopathic Medical Profession report 2018. https://osteopathic.org/wp-content/uploads/2018-OMP-Report.pdf. Accessed 6 Nov 2019
- 15.Fineberg H. Public health and medicine. Am J Prev Med. 2011;41(4):S149–S151. doi: 10.1016/j.amepre.2011.07.013. [DOI] [PubMed] [Google Scholar]
- 16.Ormond BA, Sillman BC, Waidmann TA, et al. Potential national and state medical care savings from disease prevention. Am J Public Health. 2011;101(1):157–164. doi: 10.2105/AJPH.2009.182287. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Bowe CM, Voss J, Thomas AH. Case method teaching: an effective approach to integrate the basic and clinical sciences in the preclinical medical curriculum. Med Teach. 2009;31(9):834–841. doi: 10.1080/01421590902922904. [DOI] [PubMed] [Google Scholar]
- 18.Miles S, Kellett J, Leinster SJ. Medical graduates’ preparedness to practice: a comparison of undergraduate medical school training. BMC Med Educ. 2017;17(1):33. doi: 10.1186/s12909-017-0859-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Lucia VC, Swanberg SM. Utilizing journal club to facilitate critical thinking in pre-clinical medical students. Int J Med Educ. 2018;9:7–8. doi: 10.5116/ijme.5a46.2214. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Wenrich MD, Jackson MB, Wolfhagen I, et al. What are the benefits of early patient contact?--a comparison of three preclinical patient contact settings. BMC Med Educ. 2013;13:80. doi: 10.1186/1472-6920-13-80. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Ganguly P, Yaqinuddin A, Al-Kattan W, et al. Medical education dilemma: how can we best accommodate basic sciences in a curriculum for 21st century medical students? Can J Physiol Pharmacol. 2019;97(4):293–296. doi: 10.1139/cjpp-2018-0428. [DOI] [PubMed] [Google Scholar]
- 22.Schmidt HG, Machiels-Bongaerts M, Hermans H, ten Cate T, Venekamp R, Boshuizen HP. The development of diagnostic competence: comparison of a problem-based, an integrated, and a conventional medical curriculum. Acad Med. 1996;71(6):658–664. doi: 10.1097/00001888-199606000-00021. [DOI] [PubMed] [Google Scholar]
- 23.Demyan L, Harview C, Miller E, Wilkerson L, Salusky IB. Development of a translational research pathway at the David Geffen School of Medicine University of California, Los Angeles. Int J Med Educ. 2017;8:334–335. doi: 10.5116/ijme.59ae.c221. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Gillman J, Pillinger M, Plottel CS, Galeano C, Maddalo S, Hochman JS, Cronstein BN, Gold-von Simson G. Teaching translational research to medical students: the New York University School of Medicine’s Master’s of Science in Clinical Investigation dual-degree program. Clin Transl Sci. 2015;8(6):734–739. doi: 10.1111/cts.12328. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Willey JM, Lim YS, Kwiatkowski T. Modeling integration: co-teaching basic and clinical sciences medicine in the classroom. Adv Med Educ Pract. 2018;9:739–751. doi: 10.2147/AMEP.S169740. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Kulasegaram KM, Chaudhary Z, Woods N, Dore K, Neville A, Norman G. Contexts, concepts and cognition: principles for the transfer of basic science knowledge. Med Educ. 2017;51(2):184–195. doi: 10.1111/medu.13145. [DOI] [PubMed] [Google Scholar]
- 27.Woods NN, Brooks LR, Norman GR, et al. It all makes sense: biomedical knowledge, causal connections and memory in the novice diagnostician. Adv Health Sci Educ Theory Pract. 2007;12(4):405. doi: 10.1007/s10459-006-9055-x. [DOI] [PubMed] [Google Scholar]
- 28.Van der Veken J, Valcke M, De Maeseneer J, et al. Impact on knowledge acquisition of the transition from a conventional to an integrated contextual medical curriculum. Med Educ. 2009;43(7):704–713. doi: 10.1111/j.1365-2923.2009.03397.x. [DOI] [PubMed] [Google Scholar]
- 29.Varjavand N, Pereira N, Delvadia D. Returning inactive obstetrics and gynecology physicians to clinical practice: the Drexel experience. J Contin Educ Heal Prof. 2015;35(1):65–70. doi: 10.1002/chp.21264. [DOI] [PubMed] [Google Scholar]
- 30.Varjavand N, Greco M, Novack DH, Schindler BA. Assessment of an innovative instructional program to return non-practicing physicians to the workforce. Med Teach. 2012;34(4):285–291. doi: 10.3109/0142159X.2012.660215. [DOI] [PubMed] [Google Scholar]
- 31.Wiernik PH. Public Policy Committee of the American College of Clinical Pharmacology. A dangerous lack of pharmacology education in medical and nursing schools: a policy statement from the American College of Clinical Pharmacology. J Clin Pharmacol. 2015;55(9):953–954. doi: 10.1002/jcph.539. [DOI] [PubMed] [Google Scholar]