Using Science to Guide Diagnosis, Management, Therapeutics and Prevention

The competent graduate knows and can explain the scientific underpinnings, at the molecular, cellular, organ, whole body, and environmental levels for states of health and disease based upon current understanding and cutting-edge advances in contemporary basic science. The graduate uses this information to diagnose, manage and prevent the common health problems of individuals, families, and communities in collaboration with them. The graduate develops a problem list and differential diagnosis, carries out additional investigations, chooses and implements interventions with consultation and referral as needed, determines outcome goals, recognizes and utilizes opportunities for prevention, monitors progress, shares information and educates, and adjusts therapy and diagnosis according to results.

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Virginia Thurston, Ph.D.
Competency Director, Using Science to Guide Diagnosis, Management, Therapeutics & Prevention

Sample Learning Experiences:

Indiana University School of Medicine—Clinical integration into basic science

1. Team-based learning (TBL) in South Bend—TBL modules were developed for most first year courses and piloted in second year courses
   1. Histology—went to a block schedule and converted a significant portion of didactic time to TBLs (included some behavioral science content)
   2. Biochemistry—also used a block schedule and converted a significant portion of course to TBL
   3. Neuroscience—used block schedule and offered a TBL per week of course
   4. Immunology/Microbiology—used block schedule; new faculty and thus offered two TBLs as pilots.
   5. Pharmacology—piloted a TBL case
   6. Medical Genetics—offered three TBL cases
   7. For 2007-08, all courses will increases number of TBLs and those courses who did not pilot in 06-07 will offer at least 3-4 TBLs.
2. TBL in Indianapolis—TBL modules were developed and piloted for both first and second year courses. These include Immunology, Physiology, Pharmacology, and Introduction to Clinical Medicine II.
3. Pathophysiology and PBL in Terre Haute—Mary Johnson and Gabi Nindl Teach students to understand the biological basis for the tests that are run to determine a patient’s health status. The students are then asked to apply that knowledge as they work through clinical problems that use these tests to guide therapy. Four Micro and four Physiology cases are used during the semester.

Indiana University School of Medicine—Clinical integration into basic science

Clinical Therapeutics course in fourth year—Klaus Hilgarth

Experiences at Other Universities—Clinical integration into basic science

1. Standardized Family—Use of a ‘paper’ family to aid the integration of basic science concepts to clinical medicine. The ‘family’ highlights the diagnosis and treatment of common clinical problems.—Temple University
2. Students in Year 1 are given an early opportunity to practice clinical problem-solving using D×R (Diagnostic Reasoning), a multimedia patient simulation program. D×R provides a patient for students to examine through a menu driven history, physical examination, laboratory tests and treatment. Faculty review the record of the student’s inquiry, then provide feedback about problem-solving strategy. Value is placed on the investigative process rather than the final diagnosis. Relevant learning resource material and content knowledge questions have been added to select D×R cases to better integrate clinical problems into the basic science curriculum.—Southern Illinois University SOM
3. The Web Initiative for Surgical Education (WISE-MD) modules are rich media, web-based educational tools, designed for integration into the third-year medical student surgical clerkship curriculum. The modules present a comprehensive picture of patient care, including core knowledge, technical skills, professionalism, and the clinical reasoning skills that guide the physician’s decision-making process. New York University SOM wise-md.med.nyu.edu/Init.action

Experiences at Other Universities—Basic science integration into clinical years

1. Required clinical clerkships are divided into blocks, punctuated by three week- long intersessions that feature ethics, health systems, clinical decision making, and advances in basic science. The fourth year, Advanced Studies, features the Area of Concentration Program. Areas include: medical humanities, the science of medicine, global and public health, the health care system, medical education, and advocacy.—University of California, San Francisco SOM
2.  
   1. Integrated Patient Presentations—one session per quarter (2.5-3 hrs each) is scheduled to summarize and integrate course information and to give students a clinical perspective on the basic science information they are learning.
   2. All courses during both the M1 and M2 years have been cosequenced so the students are still presented with information on organs & systems covered in distinct basic science courses but at the same time during the academic year.—The Chicago Medical School at Rosalind Franklin University
3. Return to basic sciences in 4th year—Wake Forest University School of Medicine

Example Assessments

1. Interactive computer instruction and/or videotapes
2. Multiple choice questions using clinical vignettes (USMLE recommends that 40% of exam questions be in a clinical vignette format)
3. Long and short essay questions
4. Research projects, papers and/or presentations
5. Laboratory-based educational experiences
6. Presentations of written or oral journal critiques
7. Small group discussions.
8. Southern Illinois University SOM uses the following assessment for their clinical reasoning which requires a scientific basis:
   Clinical Reasoning
   • Generates and justifies a broad range of hypotheses (DD×)
   • Relates knowledge of basic mechanisms to patient findings and treatment
   • Tests hypotheses by use of H&P and diagnostic tests
   • Generates broad learning issues from cases
   • Synthesizes information effectively
   • Contributes to therapeutic plan for cases at a level appropriate to training
9. ACGME assessment toolbox— www.acgme.org/Outcome/assess/Toolbox.pdf
10. USMLE Step 1

Bibliography

For more details on this competency, please click here.