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Cognition Before Curriculum: Rethinking the Integration of Basic Science and Clinical Learning

Kulasegaram, Kulamakan Mahan; Martimianakis, Maria Athina PhD; Mylopoulos, Maria PhD; Whitehead, Cynthia R. MD, PhD; Woods, Nicole N. PhD

doi: 10.1097/ACM.0b013e3182a45def

Purpose Integrating basic science and clinical concepts in the undergraduate medical curriculum is an important challenge for medical education. The health professions education literature includes a variety of educational strategies for integrating basic science and clinical concepts at multiple levels of the curriculum. To date, assessment of this literature has been limited.

Method In this critical narrative review, the authors analyzed literature published in the last 30 years (1982–2012) using a previously published integration framework. They included studies that documented approaches to integration at the level of programs, courses, or teaching sessions and that aimed to improve learning outcomes. The authors evaluated these studies for evidence of successful integration and to identify factors that contribute to integration.

Results Several strategies at the program and course level are well described but poorly evaluated. Multiple factors contribute to successful learning, so identifying how interventions at these levels result in successful integration is difficult. Evidence from session-level interventions and experimental studies suggests that integration can be achieved if learning interventions attempt to link basic and clinical science in a causal relationship. These interventions attend to how learners connect different domains of knowledge and suggest that successful integration requires learners to build cognitive associations between basic and clinical science.

Conclusions One way of understanding the integration of basic and clinical science is as a cognitive activity occurring within learners. This perspective suggests that learner-centered, content-focused, and session-level-oriented strategies can achieve cognitive integration.

Mr. Kulasegaram is a PhD candidate, Clinical Epidemiology and Biostatistics Program and Program for Education Research and Development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. He is also a Wilson Centre Fellow, University of Toronto, Toronto, Ontario, Canada.

Dr. Martimianakis is director of scholarship, assistant professor, Department of Paediatrics, and scientist, Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Dr. Mylopoulos is assistant professor of paediatrics, University of Toronto, scientist, Learning Institute, Sick Kids Hospital, and scientist, Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Dr. Whitehead is vice chair for education, associate professor, Department of Family and Community Medicine, scientist, Wilson Centre, and education scientist, Centre for Ambulatory Care Education, Women’s College Hospital, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Dr. Woods is assistant professor, Department of Surgery, and education scientist, Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Acknowledgments: The authors wish to thank Dr. Geoffrey R. Norman, Dr. Alan Neville, and Dr. Mariam Baghdady for their critical comments and suggestions for this paper as well as the Integration Research Group at the Wilson Centre for Health Professions Education for spurring the conversations that led to the exploration of this question.

Funding/Support: None.

Other disclosures: None.

Ethical approval: Not applicable.

Correspondence should be addressed to Mr. Kulasegaram, Wilson Centre for Health Professions Education, Toronto General Hospital, CRE (TGH) Eaton Wing, 1st Floor, 1 Eaton South 565, 200 Elizabeth St., Toronto, ON, Canada M5G 2C4; telephone: (647) 774-2731; e-mail:

© 2013 by the Association of American Medical Colleges