Over the past several decades undergraduate medical education (UME) has been shifting from traditional discipline-based curricula towards integrated, clinically focused curricula. Since as early as 1961, the Association of American Medical Colleges (AAMC) proposed that UME curricular objectives should strive to go beyond a detailed, systematic knowledge of the basic sciences and focus on synthesizing necessary knowledge and skills directly related to medical conditions and patient care. The AAMC endorsed eliminating the distinct separation between learning the basic sciences in the pre-clerkship phase and clinical sciences in the clerkship phase as exists in the discipline-based curriculum. Furthermore, medical education research indicates that focusing on basic sciences may only promote memorization of basic science facts rather than the development of critical reasoning. Many medical schools have employed an integrated curriculum to promote the retention of knowledge and acquisition of skills through application-based approaches.
I am a physiology educator at The University of Texas at Tyler School of Medicine, and our school has adopted an integrated curriculum. How has this change in curricular design affected me, a physiology educator who previously learned and taught in a discipline-based curriculum?
In integrated curricula, multiple disciplines are presented simultaneously to provide the students with a comprehensive and cohesive presentation of clinical conditions. Foundational sciences, such as physiology, are not presented as a stand-alone topic within one course. Rather, the concepts are presented in a so-called “piecemeal” approach with small pieces or bits of large concepts presented here and there throughout the curriculum. Some physiologists argue that this approach may lead to a disruptive and incomplete grasp of physiology. For example, homeostasis is a physiological concept of balance within an environment, such as a cell, organ and system. In a discipline-based curriculum, the concept of homeostasis is introduced within the first days of medical school education. Correspondingly, in a thousand-page-long textbook of medical physiology, the concept of homeostasis is usually introduced at least once within the first few pages. In an integrated curriculum, though, it is possible that the formal concept of homeostasis will not be introduced until later, for example not until the endocrinology course. Since the maintenance of homeostasis is needed for the human body to survive and function correctly, homeostatic mechanisms and its disturbances are discussed every time a medical condition is discussed. Therefore, unless educators intentionally point out that connection, the learners may spend time “piecing the bits” one by one repeatedly until they reach the “Ah Ha” moment in their learning.
I asked myself what I could do to help the students reach that “Ah Ha” moment earlier than later. Introducing the Core Concepts of Physiology is an option. As described by Drs. Joel Michael and Jenny McFarland, the Center of Physiology Education, American Physiology Society, the Physiology Core Concepts are:
- A set of big ideas designed and heavily vetted by physiology educators
- Provide a framework for understanding the discipline
- Facilitate application of knowledge to learn new content
- Applicable across all physiological systems
Thus far, there are fourteen core concepts, including homeostasis. A reason for developing the core concepts was that often students do not recognize that the seemingly different physiological processes that occur in various systems, such as cells, tissue, organ and systems, have common underlying foundational principles. Thus, students spend time and effort to learn and memorize the same principle or concept disguised as a brand new physiological process. But if they learn, for example, the core concepts of Homeostasis, they should be able to distinguish the common components within different homeostatic processes. Understanding and deliberately utilizing those components in teaching and learning should help them to “piece the bits” faster and more efficiently. This should also help eliminate the need to memorize the seemingly different homeostatic mechanisms.
Next, how to introduce the core concepts into our curriculum, which has a spiral flow? I decided to make a series of mini-video presentations of ~10-13 mins introducing one core concept at a time. To present the material in an easily digestible manner I used the non-biomedical phenomena we experience routinely in our daily lives such as cruise control. Lastly, to make sure that the mini-videos are not being presented as unidirectional instructions or in a “sage-on-the-stage" approach, the material is presented as a dialog between two physiologists, myself and my colleague. These mini-videos will be housed in our learning management system for the students’ continuous access throughout our spiral curriculum of UME and GME and included in pre-work assignments when needed.
What do we expect from introducing the Core Concepts of Physiology into medical or healthcare curriculum? Our hope is that learners will have:
- Enhanced grasp of the fundamentals of physiological processes and ability to apply those throughout many seemingly different phenomena in various systems through learning transfer
- Improved depth of knowledge without increased cognitive load
- Avoided memorization of large amounts of material since the learning will be built upon mastering the common foundational knowledge
- Increased promotion of self-reinforced learning, recall of knowledge, experience interleaving
- Growth in clinical reasoning with emphasis on the pathophysiological mechanisms of disease etiology or progression
We also hope that our clinical teaching faculty will benefit, as they can adapt and use the common language of core concepts to reinforce the pathophysiological basis of diseases in clinical settings. Although I am confident that the core concepts of Physiology can also be used in a discipline-based curriculum, its implementation in an integrated curriculum is more advantageous. Since our curriculum is integrated, I am not solo teaching. Working with a diverse team of experts in different disciplines helped me to understand that the notion of core concepts can be translated into other disciplines.
In conclusion, introducing the core concepts of Physiology or those of any other disciplines provides a helpful framework in medical curricula that should help the students to “piece the bits” of medical knowledge together faster and easier. We expect a longitudinal impact on our students’ patient-centered practice throughout their time with us and beyond.
The author acknowledges Dr. Pamela Lucchesi, PhD, Professor and Director of Faculty Affairs, and Dr. Gary Beck Dallaghan, PhD, Professor and Assistant Dean of Assessment, The University of Texas at Tyler School of Medicine for their feedback on an early version of the blog post.
Did you know that the Harvard Macy Institute Community Blog has had more than 360 posts? Previous blog posts have explored topics including reversing the vertical integration pendulum, story telling as an anti-racist tool in curricular development, and innovation and education.
Demidmaa R Tuvdendorj
