Medical Teacher
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Restructuring a basic science course for core competencies: An example from anatomy teaching Jeremy K. Gregory, Nirusha Lachman, Christopher L. Camp, Laura P. Chen & Wojciech Pawlina To cite this article: Jeremy K. Gregory, Nirusha Lachman, Christopher L. Camp, Laura P. Chen & Wojciech Pawlina (2009) Restructuring a basic science course for core competencies: An example from anatomy teaching, Medical Teacher, 31:9, 855-861 To link to this article: http://dx.doi.org/10.1080/01421590903183795
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Restructuring a basic science course for core competencies: An example from anatomy teaching JEREMY K. GREGORY, NIRUSHA LACHMAN, CHRISTOPHER L. CAMP, LAURA P. CHEN & WOJCIECH PAWLINA Mayo Medical School, College of Medicine, Mayo Clinic, USA
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Abstract Medical schools revise their curricula in order to develop physicians best skilled to serve the public’s needs. To ensure a smooth transition to residency programs, undergraduate medical education is often driven by the six core competencies endorsed by the Accreditation Council for Graduate Medical Education (ACGME): patient care, medical knowledge, practice-based learning, interpersonal skills, professionalism, and systems-based practice. Recent curricular redesign at Mayo Medical School provided an opportunity to restructure anatomy education and integrate radiology with first-year gross and developmental anatomy. The resulting 6-week (120-contact-hour) human structure block provides students with opportunities to learn gross anatomy through dissection, radiologic imaging, and embryologic correlation. We report more than 20 educational interventions from the human structure block that may serve as a model for incorporating the ACGME core competencies into basic science and early medical education. The block emphasizes clinically-oriented anatomy, invites self- and peer-evaluation, provides daily formative feedback through an audience response system, and employs team-based learning. The course includes didactic briefing sessions and roles for students as teachers, leaders, and collaborators. Third-year medical students serve as teaching assistants. With its clinical focus and competency-based design, the human structure block connects basic science with best-practice clinical medicine.
Introduction Transformation of the United States health care delivery system cannot be achieved without restructuring medical education. Medical schools and residency programs will need to work together to develop a blueprint for seamlessly linking undergraduate and graduate training (Harden 2007b). This smooth progression, in a student-centered environment, should accentuate new skills, knowledge, and competencies to prepare students and residents for practice in and leadership of reformed delivery systems (Medicare Payment Advisory Commission (MedPAC) 2009). The gap between education and practice can be bridged by competency-based education (Tilley et al. 2007). The competency model evolves over the continuum of medical education, with different expectations for individuals as they move from being college undergraduates to medical students, residents, and practitioners. Several models exist for such level-appropriate, competency-based medical education. The CanMEDS 2000 Project identified the multiple roles that must be fulfilled by physicians: expert, communicator, collaborator, manager, health advocate, scholar, and professional (Royal College of Physicians and Surgeons (RCPS) Canada 1996). The Association of American Medical Colleges (AAMC) Medical Student Objectives Project concluded that physicianship could be broadly categorized under the
Practice points . Along with the transformation of health care delivery systems, it is essential to restructure medical education. . Traditional basic science courses can be successfully restructured as integrated, student-centered didactic blocks using specific competencies as templates. . The gross anatomy course serves as an example of incorporating educational interventions based on all six ACGME core competencies into the undergraduate medical curriculum. . Targeting the exposure to ACGME competencies early in the medical curriculum initiates a smooth progression from undergraduate to graduate levels of medical training.
competencies of knowledge, skill, altruism, and duty (AAMC 1998). The University of Dundee in Scotland has used a three-circle model of competence that focuses on what the doctor does, how the doctor approaches practice, and the doctor as a professional (Harden et al. 1999). The Institute of Medicine in 2001 made broad recommendations that medical education should emphasize patient care delivery in multidisciplinary teams, evidence-based practice and
Correspondence: Wojciech Pawlina, Department of Anatomy, Mayo Medical School, Mayo Clinic, Stabile Bld. 9-38C, 200 First Street SW, Rochester, MN 55905, USA. Tel: (507) 538-0584; fax: (507) 284-2707; email:
[email protected] ISSN 0142–159X print/ISSN 1466–187X online/09/090855–7 ß 2009 Informa Healthcare Ltd. DOI: 10.1080/01421590903183795
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continuous quality improvement, the effective use of information technology, and lifelong-learning skills (Institute of Medicine, Committee on Quality of Health Care in America (IOM) 2001). In 1999, the American Council for Graduate Medical Education (ACGME), the accrediting body for individual residency programs, endorsed six competencies as the essential building blocks for directing medical education toward an outcomes-based model of professional development (ACGME 1999). These six core competencies – patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice – were initially intended for residency training programs but have since been adopted by undergraduate programs across the United States (Carraccio et al. 2002). Despite the growing popularity of competency-based training in early medical education, many clerkship directors may not be confident that third-year medical students are able to sufficiently demonstrate some, or even all, of the core competencies (Windish et al. 2004). Significant world-wide progress has been reported in the last decade, however, regarding the move to outcome-based education (Harden 2007a, 2007b). The important role of competency-based educational goals in the basic sciences, not just in clinical training, was highlighted in a recent report from the Association of American Medical Colleges – Howard Hughes Medical Institute (AAMC-HHMI) Scientific Foundation for Future Physician Committee (AAMC-HHMI 2009). The report points to the discrepancy between basic science content in medical school curricula and the expanding scientific knowledge base that physicians need to be able to access, evaluate, and implement in order to provide the best care for their patients. Chief among the recommendations for bridging this gap is a change from required premedical school courses to required science competencies grounded in fundamental scientific principles (AAMC-HHMI 2009). The goal is for physicians to be inquisitive, critical thinkers dedicated to lifelong learning who are able to incorporate scientific methods into medical practice (Long & Alpern 2009). Part of this reform will need to be the incorporation of values of patient-centered care, quality improvement, and resource conservation into medical education (MedPAC 2009). Competency-based education aims to tailor education to the requirements of practice (Salam et al. 2008), and this process begins with integrating medical school curricula across disciplines and emphasizing the basic sciences that underpin subsequent clinical training (AAMCHHMI 2009). Recent curricular redesign at Mayo Medical School presented the opportunity to place greater emphasis on the six core competencies in the first 2 years of the medical curriculum and to transition basic science courses to outcomes-based models. Gross anatomy is one of several basic science courses from the ‘‘old’’ curriculum that was completely revised. The ACGME core competencies drove the process of integrating first-year gross anatomy, radiology, and embryology into one course. As a result, a 6-week (120-contact-hour) hybrid gross anatomy, radiology, and embryology didactic block entitled ‘‘Human Structure,’’ 856
comprised of more than 20 educational interventions that each targets one or more core competency, was implemented.
Application of competencies in human structure block Each of the ACGME core competencies is addressed below with descriptions of some of the specific educational interventions currently employed in the human structure block at Mayo Medical School. This article’s intent is not to evaluate the effectiveness of individual interventions but rather to provide the reader a variety of options for incorporating core competencies into the basic science portion of undergraduate medical curricula. A summary table (Table 1) listing all of the educational interventions is included at the end of this article.
Competency 1: Patient care Provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. (ACGME 1999) Though central in a physician’s profession, patient care is often disregarded or inadequately emphasized in the early years of undergraduate medical education. This may be attributable to the traditional curricular separation of basic science courses from clinical experiences. As a basic medical science with obvious clinical relevance, the human structure block is potentially an excellent framework within which we can introduce the novice medical trainee to the patient. The first method by which anatomy is made relevant to patient care is to parallel the human structure block with the instruction of physical exam. Mornings are spent in anatomy briefing the sessions, where core clinically-relevant knowledge is discussed in conjunction with cadaveric dissection and radiologic screening (Bartholmai et al. 2006), while two or three afternoons per week are devoted to examining the same body regions/organ systems on peers and simulated patients. For example, clinical faculty and residents in Physical Medicine and Rehabilitation teach the musculoskeletal exam as students progress from dissection of the shoulder and upper limb to the hip and lower limb. Exploration of the cadaver thorax is paired with physical examination of the lungs and heart. Practicing physicians and residents are also invited to participate in the laboratory sessions. Their presence offers students a closer experience of the value and applicability of basic sciences and encourages integrated thinking in terms of pathology, clinical manifestation of disease, and medical intervention. By the end of the 6-week didactic block, students have received formal instruction and supervised practice on all components of a complete physical exam. This facilitates the retention of anatomical knowledge along with the acquisition of clinical skills essential to patient care. The presentation of a concise patient history is the key to further and effective management of patients within the clinical environment. As one of their team projects, students in the human structure block are assigned a common clinical
Competencies in anatomy education
Table 1. Educational interventions in the human structure block targeting ACGME core competencies. Patient care . Human structure block runs concurrently with physical examination curriculum . Surgeons and subspecialist clinicians in dissection laboratory every day . Explorative learning project has students work backwards from an assigned clinical diagnosis to construct a hypothetical patient case (oral case presentation and written supplement) . Students create an autopsy report with reflective component on donor’s last year of life
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Practice-based learning and improvement . Informal teaching occurs within dissection teams through daily peerto-peer interactions . Faculty assign learning points to each group for semiformal teamto-team teaching (at least once during course) . Third-year teaching assistants deliver briefing sessions, organize review lectures, perform prosections, prepare student feedback, and write examination items . Students maintain dynamic online list of ‘‘good findings’’ Professionalism . Faculty lead group discussion of professional behavior, then students write letter to daughter of donor whose confidentiality was breached . Self and peer-evaluations are completed weekly and feedback is provided . Students’ strengths and areas for improvement are reviewed at midpoint (formative evaluation) and end of course . All students serve three weeks as team leader in human structure or preceding block
diagnosis with clear anatomic correlation and assessed on their clinical presentation of the hypothetical case (Philip et al. 2008). Diagnoses range from hip fracture and portal hypertension to testicular torsion and Horner syndrome. Students work backwards, researching patient demographics, how their diagnosis typically presents, common features of the history of present illness, physical exam findings, and all other components of a clinical case presentation as it would be delivered on morning hospital rounds (Philip et al. 2008). In the process, students also develop an assessment, differential diagnosis, and plan of action for their hypothetical patient. In the second half of the course, teams present their patient to peers and faculty. Third-year teaching assistants listen to the presentations and offer feedback before the final cases are presented. In addition to oral presentations, teams must provide educational supplements to their classmates in a form that can be linked to the course website (e.g., patienteducation brochure, PowerPointÕ presentation, video). On the final day of the human structure block, every team submits an autopsy report for its donor. This report is broken down by organ system, and students are asked to include as many pathological findings as possible in each system. The report also requires students to hypothesize on the last year of their donor’s life. They are asked specifically to comment on overall health, estimated time spent in hospital, degree of independence, nature of death, and rate of decline. They are also encouraged to reflect on the clinical significance of observed pathological findings in terms of the quality of life. The reflective component of the autopsy report stresses compassion in patient care (Lachman & Pawlina 2006).
Medical knowledge . Full-body digital CT scans of donors available in dissection laboratory (one student serves as team radiologist; staff radiologists attend/deliver briefing sessions and are in lab) . Radiology-specific learning objectives are incorporated into didactic briefing sessions, which are team taught by anatomists and clinical radiologists . Embryology is introduced by organ system as corresponding body region is dissected . Electronic audience response system is used for daily formative feedback (individual and group questions) . Assessment is by clinical vignette multiple choice questions and laboratory practical examinations Interpersonal and communication skills . Students work with same dissection team through two blocks (12 weeks total) with rotating leadership . Audience response system questions are discussed in teams (and scores are reported by individual and team) . Medical and physical therapy students participate in the interdisciplinary dissection sessions . Students create and deliver weekly embryology lectures in combined groups (organizing information, delegating duties, speaking publicly) Systems-based practice . Students determine appropriate imaging for suspected pathology given various patient and system circumstances (timing, accessibility, radiation exposure, cost) . Patient relations are fostered by Convocation of Thanks ceremony for family and friends of donors (organized by medical and physical therapy students)
Competency 2: Medical knowledge Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and socialbehavioral sciences, as well as the application of this knowledge to patient care. (ACGME 1999) Gross anatomy is a basic science, and anatomical knowledge remains a cornerstone of medicine and related professions (Older 2004; Gillingwater 2008). In the past it included substantial fundamental knowledge but not much clinical application (Turney 2007). In the human structure block, serious efforts are made to tie every anatomical concept to a common clinical scenario. Much of this integration is achieved by demonstrating normal anatomy and its pathologic alterations in radiographic images. Whole-body computed tomography (CT) scans of every cadaver are obtained prior to the course and then made available for student review at portable workstations throughout the dissection laboratory (Bartholmai et al. 2006). At least one member of each dissection group is encouraged to adopt the role of ‘‘team radiologist’’ and lead the team daily through the images corresponding to the body region being dissected. Staff radiologists are also present during dissections to offer on-the-spot image interpretations and answer questions. In accordance with the team-teaching arrangement of the human structure block, 67 radiology-specific learning objectives have been incorporated into the didactic briefing sessions to alternate with gross and clinical anatomy objectives, facilitating real-time appreciation of the clinical relevance of basic anatomy.
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The third component of the human structure block, embryology, is taught by organ system in correlation with the body region being studied. The delivery of these topics is primarily the responsibility of the students, supervised by faculty. Three dissection teams work together to produce a unified, 45 min presentation that includes the normal developmental steps of a particular organ system and its most common congenital abnormalities. This teaching assignment involves summarizing a significant amount of information into a concise and coherent lecture, delegation of duties among a dozen or more peers, and public speaking. Rider et al. (2007) argue that assessment experiences should be designed intentionally because knowledge management and self-directed learning are elemental to professional development and delivery of high-quality care. The human structure block attempts to accomplish this in two ways: an electronic audience response system (ARS) is used for daily formative feedback (Alexander et al. 2009), and laboratory practical examinations evaluate students’ skills in structure identification three times during the course. ARS questions simulate items from national standardized examinations, with a multiple choice format that includes contextual stems, photographs, and radiographs. Every anatomy session ends with eight to 12 ARS questions, of which two or three may be discussed among teammates while the rest are answered individually. Explanations of the correct and incorrect responses are conducted immediately so that students affirm their knowledge or quickly identify areas requiring further study. Scores are tallied and reported to students daily. Cumulative ARS performance has been found to predict student performance on the National Board of Medical Examiners Gross Anatomy and Embryology Subject Examination that concludes the course (Alexander et al. 2009). Three laboratory practical examinations are offered during the course, with participation in the first two being optional. Items include a mix of ‘‘identify this structure’’ and second-order questions that require clinical knowledge of a tagged structure, its embryology, or its radiographic appearance. The purpose of all assessment techniques in the human structure block is to place the basic science of anatomy into a meaningful, memorable, and clinical context.
Competency 3: Practice-based learning and improvement Demonstrate the ability to investigate and evaluate care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. (ACGME 1999) The commonly heard phrase ‘‘See one. Do one. Teach one.’’ in medical training echoes the belief that knowledge is constructed from experience (Wilson et al. 1995). It is through teaching a subject or skill that one comes to master it. The value of teaching as a mechanism for self-improvement and life-long learning is woven throughout the human structure block. Informal teaching opportunities occur each day within dissection teams and between neighboring groups as students with prior anatomy experience or good understanding of 858
concepts share what they know. Each team is also asked to rotate around the laboratory at least once during the course with a specific set of teaching points to communicate to other members of the class. The philosophy of peer teaching is embedded in the human structure block by creating the opportunity for thirdyear teaching assistants to return to the dissection laboratory as mentors and instructors. Teaching assistants accept several responsibilities: the option of preparing and delivering a didactic briefing session, coordination of weekly review sessions, prosection before each day’s laboratory session, review of student presentations for content and delivery, creation of assessment items, and communication with students and course faculty. Many of these responsibilities extend beyond the anatomy laboratory and in fact enable students to become critically reflective and contributing members of the patient care team on subsequent clinical rotations. During the human structure block, students contribute to an online list of interesting pathology and well-dissected structures to be viewed on their cadaver. Students are also encouraged to review the CT scans of their cadavers for the radiographic correlates of these ‘‘interesting findings.’’ The online list is authored by and accessible to every member of the class, in keeping with the concept of collaborative learning. The list becomes a valuable resource for students to the highest-yield viewing opportunities in the dissection laboratory.
Competency 4: Interpersonal and communication skills Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. (ACGME 1999) The critical functional unit of the human structure block is the three- or four-person dissection team, and success in the course depends on effective communication within and between teams. In addition to assigned tables in the dissection laboratory, the classroom is designed to allow teams to sit together during didactic briefing sessions with the intention of encouraging discussion of more challenging concepts during didactic and ARS sessions. Reporting both individual and team scores to students allows them to assess their knowledge as well as their ability to negotiate a consensus answer. Students carry this association outside the scheduled class time for review, often including other dissection teams in combined sessions. There is little doubt that the dissection experience is by far one of the most influential in the development of medical students’ emotional disposition integral to their future role within the health care environment (Paff 2009; Wagoner & Romero-O’Connell 2009). Students facing their first day in the gross anatomy laboratory often harbor equal parts trepidation and excitement. They are worried that they might faint at the sight of a cadaver, and they know that they are in for several weeks of intense study, yet they cannot wait to get started. Before entering the laboratory, however, the class is asked to
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reflect on the generous gift each donor represents and the truly unique opportunity of learning human anatomy through cadaveric dissection. In order to foster interpersonal interaction and communication, dissection teams are maintained for the entire duration of the course. Leadership rotates among team members so that every student has the opportunity to assume this responsibility. The leadership role includes assigned duties as well as encouraged ones. At the start of each laboratory session, leaders are required to attend a brief orientation from the teaching assistants and then relay to their teams the dissection plan for the day. Leaders also must conduct the primary communication to and from faculty, coordinate with other team leaders on group projects, ensure that their area of the laboratory is kept tidy, and see that all members of their team are contributing to group learning. Leaders are further encouraged to organize study sessions for their team, mediate conflicts if they arise, and generally advocate for themselves and their teammates. Communication skills, responsibility, and accountability, like those developed among team members, have a significant impact on the quality of patient care (IOM 2001; Heisler et al. 2002; Gascon et al. 2004; Cabana et al. 2006).
Competency 5: Professionalism Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (ACGME 1999) Professional codes of conduct, which underpin patientprovider trust (Working Party of the Royal College of Physicians (WPRCP) 2005), are crucial for establishing excellence in health care. Practicing the set of values, behaviors, and relationships that comprise medical professionalism requires conscientious, explicit training in professional attitudes and actions (Cruess & Cruess 1997). When unprofessional behavior is observed during early medical training, it predicts disciplinary action later in one’s career (Papadakis et al. 2004, 2005). In contrast, internal medicine residents in the highest quintile of professionalism ratings have been found also to be above their peers in terms of medical knowledge, clinical skills, and conscientiousness (Reed et al. 2008). The human structure block is an early opportunity in the medical curriculum for serious discussions regarding patient confidentiality; self-reflection and peer evaluation; and professional interactions with colleagues, patients, and families (Escobar-Poni & Poni 2006; Lachman & Pawlina 2006; Pawlina 2006; Pawlina et al. 2006). As an example of a reflective exercise, students are presented with an actual incident where donor confidentiality was compromised by a medical student and subsequently reported as a complaint of unprofessional behavior to the anatomy department (Carmichael & Pawlina 2004; Graham 2006). After discussing issues related to patients’ or body donors’ confidentiality and watching a video-recorded interview between the anatomy professor and concerned family member, each student is required to write a letter of apology as if he or she had been the offending student (Kostas et al. 2007; Jethwa et al. 2009). The letter is not merely an apology but
is also meant to provoke self-reflection and a sense of professionalism. Self-reflection is further encouraged through peer evaluation and formative feedback on professional behavior (Bryan et al. 2005; Lachman & Pawlina 2006). For each of the 6 weeks of the human structure block, students complete anonymous peer- and self-evaluation surveys that target various aspects of professionalism (Bryan et al. 2005). These include (1) consideration of the needs of the group above self, (2) demonstration of compassion for others, (3) respect of group members and cadavers, (4) integrity and honesty, (5) accountability and responsibility, (6) commitment to excellence, and (7) being self-reflective of actions and decisions. Seven questions are scored on a Likert scale, and space is provided for additional written comments (e.g., strengths and areas for improvement). At the midpoint and conclusion of the course, average self and peer ratings are calculated for each student and distributed in a standardized form. The form also includes all written comments from peers regarding personal strengths and potential areas for improvement. Feedback is communicated by the course director and teaching assistants, who meet with students either individually or with their dissection teams to discuss professionalism scores and to develop personalized action plans for cultivating professional behavior. Working in a professional capacity requires being able to work effectively and respectfully within multidisciplinary teams that include nurses, technicians, residents, chaplains, social workers, and consulting peers. Failures in coordinating such multidisciplinary teams cause mistakes and endanger patient safety (Kohn et al. 2000). In the contemporary philosophy of medical education, interprofessional communication (Rider et al. 2007) and multidisciplinary teamwork (MedPAC 2009) are being increasingly emphasized. To initiate inter-professional interaction in the human structure block, physical therapy and basic science faculty arrange two laboratory sessions dedicated to combining the learning objectives and experiences of first-year medical and physical therapy students. During these sessions, dissection teams are completely reorganized and collaboration and the effective communication of detailed information between professional groups is emphasized. In pre- and postexperience scaled surveys, students from both programs have recognized the value of combined sessions in bringing together their respective areas of expertise (Hamilton et al. 2008).
Competency 6: Systems-based practice Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. (ACGME 1999) Systems-based practice is one of the most challenging competencies to teach and assess (Rider et al. 2007), especially in early medical education when students may have little to no awareness of the healthcare services they are meant to manage efficiently. In essence, the competency asks learners to use
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healthcare services for patient care and recognize how the costs of providing those services can affect its delivery (Rider et al. 2007). During the radiological anatomy portion of the human structure block, students are briefed on differences between various imaging modalities, including conventional X-ray, fluoroscopy, computed tomography, magnetic resonance imaging, positron emission tomography, and ultrasound. Not only are the technique, strengths, and weaknesses of each study delineated, but students are also educated on the risks, benefits, and associated costs of each test. Student participation is made active through discussions of several patient scenarios and what would be the imaging modality of choice in various circumstances. This requires that students determine the best technique to visualize the appropriate anatomy and pathology and that they factor timing, accessibility, radiation exposure, financial burden, and other patient characteristics into their decisions. Even early in their first-year of medical school, students in the human structure block begin to make hypothetical choices for individual patients while also considering the broader, systemic context. Recognizing that first-year students’ healthcare delivery experience is limited, the second piece of the human structure block that targets systems-based practice does so from a project management standpoint. The ‘‘Convocation of Thanks’’ is an annual ceremony hosted by all students who learn from cadavers in the gross anatomy laboratory ( primarily medical and physical therapy students). Families and friends of donors are invited to a reception of music, poetry, and commemoration. The event is organized by representatives of each dissection team, who work intimately with physical therapy students, anatomy department faculty, patient families, audiovisual technologists, and many others to create a program that attempts to relay our tremendous gratitude to donors and their families. Students must also fundraise so that all families in attendance receive a memorial DVD. Ultimately, the ‘‘Convocation of Thanks’’ is a patient relations endeavor that extends students’ learning beyond the anatomy laboratory.
Concluding remarks The contemporary model for medical training and professional development is increasingly based on outcomes and competencies. This trend is likely to continue as health care delivery systems evolve. Although mastery of the ACGME competencies develops over a lifetime of practice (Salam et al. 2008), targeted exposure to these clinical values early in medical training can initiate the process. Medical school curricula traditionally emphasize basic science in the first 2 years, yet exposure to clinical competencies can be achieved in this context. A competency-driven human structure block that integrates gross anatomy, radiology, and embryology can include educational interventions targeting all core competencies (Table 1). Among the basic sciences in the Mayo Medical School curriculum, gross anatomy was the logical starting point for implementing competency-based education because the ‘‘old’’ course already included experiential laboratory as well as didactic classroom time and because a team-based model was 860
already in place. It is possible that gross anatomy is unique among the basic sciences traditionally included in medical school curricula for its many opportunities to help students toward all six ACGME core competencies. Future work is needed to integrate all basic sciences across disciplines, to further connect them to clinical practice, and to make them outcomes-based so that a cadre of future physicians will be prepared to work in reformed health care delivery systems.
Acknowledgments The authors thank Sarah Jacobs and Cara Alexander for their allegiance as teaching assistants. We are also grateful to the Mayo Medical School Class of 2012 for participating in several novel educational interventions during the Human Structure block. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Notes on contributors JEREMY K. GREGORY, HBS, HBA; CHRISTOPHER L. CAMP, BS; and LAURA P. CHEN, BS, are a fourth-year medical students at Mayo Medical School, College of Medicine, Mayo Clinic, Rochester, MN, and served as Teaching Assistant for the human structure block for first-year medical students. NIRUSHA LACHMAN, PhD, is an assistant professor in the Department of Anatomy at Mayo Medical School, College of Medicine, Mayo Clinic, Rochester, MN. She teaches gross anatomy and histology to first-year medical students. WOJCIECH PAWLINA, MD, is a Professor and Chair of the Department of Anatomy and assistant dean for Curriculum Development and Innovation at Mayo Medical School, College of Medicine, Mayo Clinic, Rochester, MN. He teaches anatomy and histology and serves as director of the human structure block for first-year medical students.
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